Prospective predictors of risk and resilience trajectories of mental health in US youth during COVID-19

The COVID-19 pandemic has had substantial effects on youth in multiple aspects of life, raising concern about its impact on youth mental health. Indeed, mounting data suggest that youth depression and anxiety rates have increased compared to the pre-pandemic era. A key challenge is to recognize prospective predictors that can help identify youth at risk for serious mental health sequelae following COVID-19 and to disentangle the factors that contribute to resilient trajectories. Resilience, often defined as an adaptive outcome (i.e., low symptoms levels) following adversity, is driven by multiple systems including individual- and structural-level environmental factors, neurocognitive traits, and genetic factors. One approach to study resilience is to identify inter-individual variation in mental health trajectories following the pandemic, and use data collected prospectively before and early in the pandemic to better understands what determines variability in mental health trajectories under stress. The Adolescent Brain Cognitive Development (ABCD) Study (N~12,000, 52% male, recruited at age 9-10 years, 20% Black) follows diverse US youth longitudinally since 2017. The study collected multidimensional (i.e., environment, clinical, neurocognitive, genetic) data before the pandemic, and participants were ~12-13 years old when the pandemic hit. Between May 2020 to June 2021, the study team collected data on mental health and on COVID-19 related exposures at multiple time points from ~9,500 participants and will continue following participants into late adolescence. Therefore, ABCD Study creates a unique opportunity to disentangle risk and resilience factors collected prospectively in youth who were in early-mid adolescence when the pandemic hit, a critical developmental window when stress related disorders become more prevalent. In the current project, we propose to leverage the multi-dimensional ABCD Study data to identify factors that contribute to variability in mental health trajectories in US youth during the COVID-19 pandemic. We will first use latent growth mixture modeling to identify trajectories of internalizing symptoms over time. Thereafter, we will characterize the individual stressors and the structural (based on geocoded address) environmental exposures- before and early in the pandemic- that contribute to trajectories of risk and resilience (Aim 1). In addition, we will leverage the deep phenotyping that was conducted pre-COVID-19 to identify clinical and neurocognitive risk and resilience factors (Aim 2). Lastly, we will explore whether participants' genetic information (i.e., polygenic risk for psychiatric disorders) can help explain variability in mental health trajectories during the pandemic (Aim 3). The proposed research will identify what factors contribute to resilience (i.e., resilience factors); and who will show risk or resilience trajectory in response to chronic (pandemic-imposed) stress. The study addresses key gaps that are critical considering the expected chronic stress that is (and will likely keep being) imposed on youth due to the pandemic and other future adversities. Findings will improve risk stratification in youth exposed to chronic adversity and will identify targets for interventions aimed at enhancing resilience.