Contributions of emotion regulation and brain structure and function to adolescent internalizing problems and stress vulnerability during the COVID-19 pandemic: A longitudinal study

Background: Adolescence is a period of increased vulnerability for internalizing problems, particularly following exposure to stressful life events. We examine how patterns of emotion regulation and brain structure and function predict internalizing problems during the COVID-19 pandemic, as well as moderate the association between pandemic-related stressors and internalizing problems. Methods: Data are from a longitudinal sample (N=145, aged 10-15) strategically assessed at three crucial timepoints: prior to the pandemic, early during the stay-at-home order period, and again six months later. We examined associations of neural structure and function during an emotional processing task prior to the pandemic, use of emotion regulation strategies prior to and during the pandemic, and pandemic-related stressors with internalizing problems. Results: Greater exposure to pandemic-related stressors was associated with higher levels of internalizing symptoms both early (ß=.437, p<.001) and later (ß=.225, p=.004) in the pandemic. Youth who reported more frequent use of maladaptive emotion regulation strategies, including rumination (ß=.204, p=.026) and expressive suppression (ß=.177, p=.023), also had higher internalizing problems. Higher left amygdala activation to neutral relative to fearful faces prior to the pandemic was associated with greater internalizing symptoms (ß=-.229, p=.007), and a stronger relation between pandemic-related stressors and internalizing problems (ß=-.186, p=.014). Conclusion: Pandemic-related stressors are strongly associated with internalizing problems in adolescents, and individual differences in emotional reactivity and regulation and their underlying neural mechanisms contribute to stress-related vulnerability. Interventions that reduce pandemic-related stressors and foster adaptive emotion regulation skills may protect against adolescent psychopathology during this period of heightened exposure to stress.