Background The COVID-19 pandemic had profound effects on developing adolescents that, to date, remain incompletely understood. Youth with preexisting mental health problems and associated brain alterations were at increased risk for higher stress and poor mental health. This study investigated impacts of adolescent pre-pandemic mental health problems and their neural correlates on stress, negative emotions and poor mental health during the first ∼15 months of the COVID-19 pandemic.

Methods N=2,641 adolescents (median age=12.0 years) from the Adolescent Brain Cognitive Development (ABCD) cohort, with pre-pandemic data on anxiety, depression, and behavioral (attention, aggression, social withdrawal, internalizing, externalizing) problems, longitudinal survey data on mental health, stress and emotions during the first ∼15 months following the outbreak, structural MRI, and resting-state fMRI. Data were analyzed using mixed effects mediation and moderation models.

Results Preexisting mental health and behavioral problems predicted higher stress, negative affect and negative emotions (β=0.09-0.21, CI=[0.03,0.32]), and lower positive affect (β=-0.21 to -0.09, CI=[-0.31,-0.01]) during the first ∼6 months of the outbreak. Pre-pandemic structural characteristics of brain regions supporting social function and emotional processing (insula, superior temporal gyrus, orbitofrontal cortex, and the cerebellum) mediated some of these relationships (β=0.10-0.15, CI=[0.01,0.24]). Pre-pandemic brain circuit organization moderated (attenuated) relationships between preexisting mental health and pandemic stress and negative emotions (β=-0.17 to -0.06, CI=[-0.27,-0.01]).

Conclusions Preexisting mental health problems and their structural brain correlates were risk factors for youth stress and emotions during the early months of the outbreak. In addition, the organization of some brain circuits was protective and attenuated the effects of preexisting mental health issues on youth responses to the pandemic’s stressors.

The authors have declared no competing interest.

The study was funded by the National Science Foundation, grant #2116707

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The National Institute of Mental Health Data Archive (NDA)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes