Changes in Internalizing Symptoms During the COVID-19 Pandemic in a Transdiagnostic Sample of Youth: Exploring Mediators and Predictors

Abstract

The COVID-19 pandemic is a chronically stressful event, particularly for youth. Here, we examine (i) changes in mood and anxiety symtpoms, (ii) pandemic-related stress as a mediator of change in symptoms, and (ii) threat processing biases as a predictor of increased anxiety during the pandemic. A clinically well-characterized sample of 81 youth ages 8–18 years (M = 13.8 years, SD = 2.65; 40.7% female) including youth with affective and/or behavioral psychiatric diagnoses and youth without psychopathology completed pre- and during pandemic assessments of anxiety and depression and COVID-related stress. Forty-six youth also completed a threat processing fMRI task pre-pandemic. Anxiety and depression significantly increased during the pandemic (all ps < 0.05). Significant symptom change was partially mediated by pandemic stress and worries. Increased prefrontal activity in response to neutral faces pre-pandemic was associated with more intense parent-reported anxiety during the pandemic (all Fs(1.95,81.86) > 14.44, ps < 0.001). The present work extends existing knowledge on the mediating role of psychological stress on symptoms of anxiety and depression in youth.

Associations between pre-pandemic authoritative parenting, pandemic stressors, and children’s depression and anxiety at the initial stage of the COVID-19 pandemic

“…We found that children’s depression symptom severity increased at the beginning of the pandemic, but this change was not related to the early, acute impact of COVID-19 family stressors. This finding differs from previous research showing significant associations between youth’s depression symptoms and COVID-19 stressors 8 , 34 – 38 . It is important to note, however, that a significant association was found between child depression symptom severity and acute COVID-19 family impacts in a sensitivity analysis in which statistical outliers were retained (see Supplementary Materials).…”

“…As predicted, the current study found that children’s anxiety symptom severity increased in the early stage of the pandemic. This finding reflects previous literature showing the prevalence of, and increases in, youth anxiety at the beginning of COVID-19 6 , 8 , 9 , 37 . Furthermore, we found that increased impact of COVID-19 family stressors heightened young children’s anxiety symptom severity at the onset of the pandemic, extending previous research in older children by showing an association between COVID-19 family stressors and anxiety symptoms during early-middle childhood 34 .…”

“…In light of prior research 1 , 6 , 7 , 33 , the impact of COVID-19 on child mental health likely also varied as a function of familial stress and disruptions in day-to-day family routines 8 , 34 – 38 at the onset of the pandemic. More specifically, large disruptions in family routines and resultant household chaos due to public health measures in response to COVID-19 have been found to be associated with parental stress and emotional and behavioral difficulties in children 39 – 41 .…”