“The sharp increase in depression risk [due to COVID-19] among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures.” — NCANDA paper, November 2, 2021
The COVID-19 pandemic has been a profoundly difficult and stressful time, putting many people at risk for depression. A recent study, led by experts at the Center for Health Sciences at SRI International and the Department of Psychiatry and Behavioral Sciences at Stanford University, has highlighted the vulnerability of emerging adults, who are transitioning from adolescence to young adulthood, in the midst of their education or starting new jobs, with aspirations for the future.
This work took advantage of a longitudinal, NIH-funded study, NCANDA, the National Consortium on Alcohol and Neurodevelopment in Adolescence, which is following adolescents and emerging adults in the US. When the pandemic hit, participants had already been tracked for 7–8 years, and additional data collection in 2020 enabled an investigation of how the COVID-19 pandemic is affecting our young people.
NCANDA: A collaboration across the USA
NCANDA is a collaboration of five institutions for data collection: SRI International, University of California San Diego (UCSD), Oregon University Health Sciences, Duke University and the University of Pittsburgh. SRI International, together with the Department of Psychiatry and Behavioral Sciences at Stanford University, is responsible for data releases and analysis, focusing on developmental and alcohol-use effects on brain function.
Fiona Baker, Director, Center for Health Studies, is a Principal Investigator of the NCANDA data collection site at SRI International. As part of this project, investigators use tools such as MRI brain imaging to explore longitudinal changes in brain development as adolescents progress into young adulthood and how behaviors such as heavy alcohol use impact that development. They also explore changes in sleep and mood and how all these behaviors intersect within the context of adolescent development. The study continued throughout the pandemic, capturing how this unprecedented event impacted depression in emerging adults.
NCANDA-SRI is based at the Center for Health Sciences, Biosciences Division at SRI International, in Menlo Park, California. Its work is enhanced by access to the GE-ASL West Brain Imaging Center on campus. NCANDA-SRI collaborates with NCANDA-Pittsburgh in a laboratory sleep study to examine the effects of development and alcohol use on adolescent sleep architecture.
How longitudinal data during a pandemic gave insights into depression
“We have had to use a leap of logic to try to understand what’s going on in the pandemic, and from every perspective. This is not just about an infectious disease, it is about understanding the social and the psychological impacts so that we could better understand what to do in any future pandemics or other crises.” — Fiona Baker, Director, Center for Health Studies, SRI International
When the pandemic began, Baker and other NCANDA investigators had already tracked the sample of more than 500 adolescents and young adults, known as “emerging adults,” for up to seven years. The ongoing longitudinal study allowed the team to swiftly develop tailored surveys on the impact of the pandemic on participants’ behavior and health. The current analysis, led by Elisabet Alzueta, Simon Podhajsky, Qingyu Zhao, Kilian Pohl, and Fiona Baker, gives insights into how the pandemic has impacted mood and allowed for a comparison of depressive symptoms pre-and post-pandemic.
One of the further objectives of the study was to work out predictors of depression and why people may diverge in certain factors leading to depression, such as female sex, heavy drinking or getting insufficient sleep.
Baker explained why longitudinal data, which is gathered through sampling the same participants repeatedly over time, is important in understanding the impact of crises on the human mental state: “We know that as humans are hit by some traumatic event, whether it’s a pandemic or a natural disaster, different people respond in different ways. There are long-term effects for some but not for others; longitudinal data is the best way to understand why this is.”
Studying human behavior is a long-term commitment
The NCANDA consortium’s project is looking at brain development and behaviors in adolescents and young adults. The project includes several elements such as sleep, alcohol and other substance use. The study started with recruiting a group of people aged between 12 and 21 years old. When the pandemic hit, this cohort had reached 17–29 years of age. By then, the participants had been involved in the study for up to seven years. The study uses several methodologies to capture results, but one important part is the use of self-reporting measures, including a depressive symptom scale.
The same depressive symptom scale was used before and during the pandemic. Self-reported observations on depressive symptoms were recorded during the pandemic at two time points, June and December 2020.
During the years leading up to the pandemic, depressive symptoms stayed, on average, fairly consistent (considering individual variability changes). With the first pandemic assessment, the researchers noted a large increase in depressive symptoms. This uptick persisted into the December reporting, with around one-third of the cohort meeting the cutoff criteria for a high risk of depression.
Factors of depression outside of the pandemic
One of the outcomes of the study was that younger adolescents, and younger women in particular, were more likely to show an increase in depressive symptoms during the pandemic. Fiona Baker said, “…this is of particular interest to me; I am seeing that women are more vulnerable to the negative effects of the pandemic on mood. Women are more likely to suffer from depressive disorders, in general, with this sex difference emerging in adolescence, and now our data suggest that the pandemic is adding to this vulnerability of women.”
As the study involved younger people, the majority did not yet have children. Therefore, the effects of working at home while managing children and a family were not considered. It is thought that women respond differently to stress compared to men, although the underlying causes of this are still to be determined. Likely, a mix of biology, social roles, society, and individual factors are at play in increasing females’ risk of depression, including in the context of the pandemic.
The project looked at predictors of depressive symptoms, such as alcohol use, pre-pandemic. The research found that people who had more days of drinking in the year before the pandemic were at greater risk of an increase in depressive symptoms, pointing to a relationship between alcohol use and mood.
It is known that poor sleep patterns can also be a risk factor for depression and this study showed that those with a shorter sleep duration pre-pandemic were at a higher risk for an increase in depressive symptoms during the pandemic. These are modifiable behaviors and, therefore, can offer a way to protect against depression.
The research into depression could be useful to develop the tools needed to help emerging adults cope with negative feelings.
Protecting against depression
While the finding that emerging adult depression risk tripled during the pandemic was shocking, the study also identified protective factors. For example, maintaining a healthy sleep pattern, or improving sleep behavior, can be protective against future stressful life events and the development of depression, whether at the personal level or during a pandemic. The NCANDA study continues and can be used to provide valuable information in the future not just about the long-term effects of the pandemic on mood but also about the recovery and resilience of young people.