Trait Emotion Regulation as a Predictor of Mental Health and Substance Use During a Period of Chronic Stress: A Longitudinal Analysis of US Veterans

Emotion regulation, or the ways in which individuals respond to or modulate their emotional experience, is critical when responding to distressing life circumstances. However, less is known about response to prolonged stressful situations. The present study seeks to understand how trait emotion regulation contributes to poorer mental health and more substance use during a prolonged chronic stress event, the coronavirus 19 (COVID-19) pandemic. A sample of 188 post-9/11 veterans who were part of an ongoing longitudinal study of post-deployment functioning participated in the present observational prospective cohort study. Veterans (29.25% women) completed online assessments of substance use and mental health at four time points over an 8-month period. Measures of trait emotion regulation and flexibility were taken approximately 2 years before and pre-pandemic mood was rated at baseline of the COVID-19 specific study. We also considered current, COVID-related distress, social media, and sleep as mediators. There was little uniform change in mental health or substance use over the course of the study; however, considerable variability was observed, with some individuals experiencing worsening mental health or increased substance use. Greater COVID-related distress, but not sleep quantity or media use, contributed to poorer mental health and more substance use. There were indirect effects of trait emotion regulation and distress on alcohol, mental health, and sedative use through COVID-related distress. No effects were observed for emotional flexibility as a predictor or cigarette use as an outcome. Overall, results point to no uniform change in mental health or substance use as a consequence of the COVID-19 pandemic and subsequent mitigation measures. Instead, this highlights the contribution of multiple individual factors for mental health and substance use. Considerations for future research and implications for care during chronically stressful times are discussed.