Youth COVID-19 Pandemic-Related Traumatic Stress and Familial Hardships, Behavior Change, and Coping Mechanisms

• In Event: Social Inequities in COVID-19 experiences and Child Mental Health: Insights from the NIH ECHO Program

Abstract

Introduction. Quarantine after infectious disease exposure quadruples children’s risk for post-traumatic stress disorder (Brooks et al., 2020). We examined youth pandemic-related traumatic stress (PTS) symptoms (Margolis, 2021) associated with parent and youth experiences of COVID-19-related mitigation strategies, family hardships, and changes in behavior or coping strategies from April 2020 to August 2021.

Hypotheses. We sought to identify clusters of co-occurring pandemic-related hardships (e.g., loss of job, ability to work remotely, contracting the SARS-COV-2 virus), changes in parent/caregiver and child/adolescent behavior practices and parent (or adolescent) adoption of adaptive (e.g. social support, meditation/mindfulness practices) or maladaptive (e.g. escaping problems through substances, binge eating) coping strategies based on their responses to the ECHO COVID-19 survey. We then evaluated associations between clustering parameters and youth PTS symptoms. We hypothesized the clustering approach would identify families living in different contexts, and that different patterns of hardships, behavior changes, and coping strategies would be associated with varied degrees of youth PTS symptoms.

Study Population and Methods. Beginning in April 2020 we measured PTS symptoms in youth in the ECHO Program (Blaisdell et al., 2021) - a large, epidemiologic sample of socioeconomically, racially, and ethnically diverse families across the United States. Participants in the current study are 7,786 children (n=1,293 with PTS scores, 2-12 years old) and 1,354 adolescents (n=1335 with PTS scores, 13-21 years old) from across the country (Figure 1) who completed questionnaires between April 2020 and August 2021. Using data from the ECHO COVID-19 survey, K-means clustering identified patterns of family hardships, behavior change, and coping strategies in 7,786 parent/caregivers. Sparse partial least squares (SPLS) regression in two samples (parent/caregiver report n = 1,293 of children <13 years; adolescent self-report n = 1,335) evaluated associations between clustering parameters and PTS symptoms, a 10-item survey based on DSM-5 acute stress symptoms.

Results. We identified two clusters of families, with one reporting more (HiChange) versus fewer (LoChange) pandemic-related changes, in both samples. The LoChange versus HiChange cluster included more Black individuals and had lower income and education. Youth showed similar patterns of behavior change (e.g., increased media engagement) but to a lesser degree in the LoChange cluster. The LoChange versus HiChange cluster showed lower PTS symptoms. Risk factors for PTS symptoms include more quarantine experiences, contact with healthcare providers, and media use, and less ability to isolate and contact with friends. More youth PTS symptoms associated with more parent/caregiver change in work status, smoking, screentime, meditation, and utilization of healthcare, and in parent/caregiver or youth health behaviors (eating, sleeping, exercising, and time spent outside).

In conclusion, risk factors for youth PTS symptoms suggest that public health agencies should educate families and provide resources to facilitate 1) youth remote (versus in person) contact with friends, 2) stability in health behaviors (sleeping, eating, exercising), and 3) increased parent/caregiver ability to work remotely. Targeting these modifiable factors may improve youth mental health outcomes.

Group Authors

The ECHO Consortium

Authors

• Amy Margolis, Columbia University
  Presenting Author

• Andrew Law, Johns Hopkins Bloomberg School of Public Health

• Paige Greenwood, SRCD/AAAS Fellow

• Margaret R. Karagas, Dartmouth College Geisel School of Medicine,

• Rebecca Schmidt, University of California, Davis

• Darby E. Saxbe, University of Southern California

• Xiaodan Tang, Northwestern University

• Carrie Breton, Keck School of Medicine of the University of Southern California

• Julie A. Hofheimer, University of North Carolina School of Medicine

• Courtney King Blackwell, Northwestern University

• Emily Knapp, Johns Hopkins Bloomberg School of Public Health

• Ghassan Hamra, Johns Hopkins Bloomberg School of Public Health

• Tracy Bastain, Keck School of Medicine of the University of Southern California