Childhood Adversity, Reward Processing, and Health During the COVID-19 Outbreak: The Mediating Role of Reward Learning

Objective: Childhood adversity (CA) is associated with various health problems, and recent data suggest reward processing may be an important mechanism linking the 2. However, different reward processing dimensions may have distinct roles in these associations that may be sensible to the psychological impact of more recent stressful events. We examined these associations in the COVID-19 pandemic context. Method: A community sample of 419 respondents (M age = 27.32 years, SD = 8.98, 88.1% females) completed an online survey. Participants filled in self-report measures of CA, reward processing dimensions, depressive and anxiety symptoms, physical status, and psychological impact of COVID-19. Results: CA was significantly associated (p < .05) with depressive (r = .20) and anxiety symptoms (r = .19), physical health (r= -.16), reward learning (r = -.11) and responsiveness (r = -.16), but not reward valuation. Reward learning mediated the association between CA and all health status indicators (i.e., higher CA predicted decreased reward learning which in turn predicted increased depressive and anxiety symptoms and poorer physical health). Psychological impact of COVID-19 did not moderate the mediating role of reward processing in the associations between CA and health outcomes. Conclusions: Reward learning appears to be the only reward processing dimension which cuts across depressive and anxiety symptoms, and physical health problems, providing information about their onset and maintenance. Given that these findings suggest that it is a potential transdiagnostic mechanism for these various health problems, reward learning should be targeted through specific interventions. Clinical Impact Statement The present study suggests that individuals reporting a history of childhood adversity tend to experience higher levels of depressive and anxiety symptoms, and physical health issues. Additionally, it suggests that reward learning impairments (i.e., a reward processing dimension linking information about stimuli, actions, and contexts with reward) partially explain the associations between childhood adversity and health outcomes. Reward learning may be a transdiagnostic mechanism that could be targeted in interventions, especially among individuals with high levels of childhood adversity.