120. Cascading Further into a Crisis: Joint Effects of COVID-19 Pandemic-related Stress and Adverse Childhood Experiences on Adolescent Mental Health

Widescale stress amidst the COVID-19 pandemic including disruption to youth serving systems (e.g., schools, health care) has been hypothesized to exacerbate the impact of risk factors, such as adverse childhood experiences (ACEs), on mental health for many adolescents. However, research is needed to understand individual and contextual risk factors associated with negative mental health outcomes and to guide prevention and intervention strategies. This study seeks to examine direct and synergistic relationships among adolescent-reported exposure to ACEs prior to the pandemic, exposure to pandemic-related stress, and adolescent mental health. This study uses adolescent self-report data to model relationships between stress exposures and indicators of poor mental health from the longitudinal COVID Experiences (CovEx) Surveys. These surveys were administered online in English to U.S. adolescents ages 13-19 using the NORC AmeriSpeak® and NORC AmeriSpeak® Teen panels, probability-based panels designed to be representative of the U.S. household population. Two waves of data were analyzed (Wave 1: October-November 2020, n=727; Wave 2: March-May 2021, n=569). Principal component analysis and multiple regression analysis were used to develop a pandemic-related stress index (PRSI, 7 items). Other measures included demographics, adverse childhood experiences (ACEs, 8-items), depression symptoms (Patient Health Questionnaire for Adolescents [PHQ-A], 9 items), and risk for trauma-related disorder (Trauma Symptoms Checklist, [TSC] 6-items). Path analyses were conducted to examine pathways between Wave 1 ACEs, Wave 1 PRSI, and Wave 2 mental health outcomes (PHQ-A and TSC, modeled separately), controlling for sex, race/ethnicity, and mode of school instruction. PRSI scores were positively associated with PHQ-A (b=0.29, SE=0.14, p<0.001) and positively related to TSC scores (b=0.20, SE=0.14, p<0.001). ACEs were positively associated with PRSI (b=0.31, SE=0.03, p<0.001) and PHQ-A (b=0.32, SE=0.12, p<0.001); the association with depressive symptoms remained significant after accounting for the indirect effect of pandemic-related stress (b=0.09, SE=0.05, p<0.001). Likewise, ACEs were positively associated with TSC scores (b=0.38, SE=0.12, p<0.001), and the direct association remained significant (b=0.32, SE=0.12, p<0.001) after accounting for the indirect effect of pandemic stress (b=0.06, SE=0.04, p<0.001). Pandemic-related stress had an adverse impact on adolescent depressive and trauma-related disorder symptoms. Results demonstrate a compounding effect of childhood adversity and pandemic-related stress on adolescent mental health. Support for health services and programming that foster safe and supportive environments in child-serving spaces is needed to address the widescale negative impact of pandemic stress while also benefiting those who have experienced ACEs. Findings can aid the design of primary, secondary, and tertiary prevention approaches including bolstering trauma-informed care and intervention services that promote mental health and support adolescent coping and recovery.