Early Life Stress Predicts Depressive Symptoms in Adolescents During the COVID-19 Pandemic: The Mediating Role of Perceived Stress

Importance: The ongoing COVID-19 pandemic, and related quarantine (“shelter-in-place”) and isolation (“social distancing”) policies, is posing a significant challenge to mental health. Stress experienced during childhood may cause sustained neurobiological changes that increase sensitivity to future stressors, thereby increasing risk for developing depression during the pandemic. Objective: We tested whether perceived stress significantly mediated the association between severity of early life stress (ELS) and depression symptoms in adolescents during the early weeks of quarantine and social distancing policies. Design & Setting & Participants: From 2013–2016 we recruited over 200 adolescents from the San Francisco Bay Area to participate in a longitudinal study examining the psychobiological effects of ELS. At enrollment, we carefully characterized stress history and depression symptoms. From April 3, 2020–April 25, 2020, 100 (43 males, ages 13–20 years) of these adolescents completed online questionnaires assessing depression symptoms, perceived stress, and exposure to and impact of COVID-19. Main Outcomes and Measures: Our primary study outcome, predictor, and mediator were depression symptom severity, ELS severity, and perceived levels of stress, respectively. Covariates included age at baseline, depression at baseline, sex, race, parental income, and age at the COVID-19 assessment. Results: Greater severity of ELS predicted higher depression symptoms (r=.25, p=.012) and perceived stress during COVID-19 (r=.37, p .45, ps<.001). Conclusions and Relevance: Perceived stress is a modifiable target for accessible interventions that may prevent the development of depressive symptoms in high-risk adolescents during a time when access to standard care and social support is dramatically reduced. Our results highlight the importance of social connectedness in adolescent well-being and may guide public health policies seeking to reduce viral transmission while considering the mental health implications of such directives for high-risk youth. Funding Statement: This research was supported by the National Institutes of Health (NIH; R37MH101495 to IHG, F32MH120975 to RC, K01MH117442 to TCH), the Stanford University Precision Health and Integrated Diagnostics Center (PHIND to IHG and TCH), and the Fonds de Recherche du Quebec – Sante (FRQS/MSSS Resident Physician Health Research Career Training Program to AJG). Declaration of Interests: All authors report no biomedical conflicts of interest. Ethics Approval Statement: The Stanford University Institutional Review Board approved the protocols for this study and all participants were compensated for their time.