Verlenden Jorge V, Fodeman Ari, Kaczkowski Wojciech, Li Jingjing, Wilkins Natalie, Hertz Marci, Anderson Kayla N, Bacon Sarah, Dittus Patricia
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, Atlanta, Georgia.
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, Atlanta, Georgia.
J Adolesc Health. 2025 Aug;77(2):284-291. doi: 10.1016/j.jadohealth.2025.04.017. Epub 2025 Jun 21.
This study sought to determine the influence of pandemic-related stress and adverse childhood experiences (ACEs) on adolescent mental health during the COVID-19 pandemic and examine the protective role of school connectedness (SC).
Cohort data from the two-wave COVID Experiences (CovEx) surveys of US adolescents were analyzed. CovEx surveys were administered online in English to US adolescents aged 13-19 years using the NORC AmeriSpeak and NORC AmeriSpeak Teen panels, probability-based panels designed to be representative of the US household population. Data from Wave 1 (W1, October to November 2020 [N = 727]) and Wave 2 (W2, April to May 2021, N = 569) were analyzed. Pairwise deletion was used for missing data. Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ W2), and symptoms of trauma-related disorders were assessed using the six-item Trauma Symptom Checklist for Children (TSCC W2). SC was assessed at W1 and W2 using three items measuring: closeness to people at school; perception of teachers caring; and feeling like a part of school. ACEs since birth were assessed using eight items at W1. Items align with the core ACE constructs included in the Behavioral Risk Factor Surveillance System ACE module and the Youth Risk Behavior Survey. Pandemic-related stress exposure at W1 was measured using the seven-item Pandemic-Related Stress Index (PRSI). Structural equation modeling was used to examine direct and indirect associations.
In each model, ACEs W1 and PRSI W1 were significantly associated with higher depressive symptoms and symptoms of trauma-related disorders. PRSI W1 partially mediated the association between ACEs W1 and symptoms of poor mental health, with higher exposure to ACEs W1 associated with higher PRSI W1 scores and higher PRSI W1 scores associated with more symptoms of poor mental health at W2. SC at W1 and W2 each were negatively associated with ACEs W1 and PRSI W1. SC W1 and SC W2 significantly attenuated depressive symptoms and symptoms of trauma-related disorders at W2 and therein partially mediated the relationships between ACEs, PRSI, and symptoms of poor mental health.
Findings illustrate the interplay between ACE and pandemic-related stress and their association with adolescent mental health and highlight the strength of SC as a protective factor. The results emphasize the importance of incorporating multisystem, trauma-informed approaches and prioritizing connectedness in efforts to address the adolescent mental health crisis.
本研究旨在确定在新冠疫情期间，与疫情相关的压力和童年不良经历（ACEs）对青少年心理健康的影响，并检验学校联结感（SC）的保护作用。
对美国青少年两波新冠疫情经历（CovEx）调查的队列数据进行分析。CovEx调查通过在线方式用英语对13 - 19岁的美国青少年进行，使用的是NORC AmeriSpeak和NORC AmeriSpeak Teen小组，这两个基于概率的小组旨在代表美国家庭人口。分析了第一波（W1，2020年10月至11月 [N = 727]）和第二波（W2，2021年4月至5月，N = 569）的数据。对缺失数据采用成对删除法。使用九项患者健康问卷（PHQ W2）测量抑郁症状，使用六项儿童创伤症状清单（TSCC W2）评估创伤相关障碍的症状。在W1和W2使用三个项目评估SC：与学校人员的亲近程度；对教师关怀的感知；以及感觉自己是学校的一部分。在W1使用八个项目评估自出生以来的ACEs。这些项目与行为危险因素监测系统ACE模块和青少年风险行为调查中包含的核心ACE结构一致。在W1使用七项与疫情相关的压力指数（PRSI）测量与疫情相关的压力暴露。采用结构方程模型来检验直接和间接关联。
在每个模型中，W1的ACEs和W1的PRSI与更高的抑郁症状和创伤相关障碍症状显著相关。W1的PRSI部分介导了W1的ACEs与心理健康不良症状之间的关联，W1的ACEs暴露越高，W1的PRSI得分越高，而W1的PRSI得分越高与W2更多的心理健康不良症状相关。W1和W2的SC分别与W1的ACEs和PRSI呈负相关。W1的SC和W2的SC显著减轻了W2的抑郁症状和创伤相关障碍症状，并在其中部分介导了ACEs、PRSI与心理健康不良症状之间的关系。
研究结果说明了ACEs与疫情相关压力之间的相互作用及其与青少年心理健康的关联，并突出了SC作为保护因素的作用。结果强调了在应对青少年心理健康危机的努力中纳入多系统、创伤知情方法并优先考虑联结感的重要性。
