Coping Behaviors Lowered Stress for Adolescents With ACEs During COVID-19

Among adolescents with adverse childhood experiences (ACEs), in-person schooling and coping behaviors were associated with significantly higher mental well-being during the COVID-19 pandemic, according to study results published in JAMA Network Open.

Adolescent mental health has significantly deteriorated globally. With the onset of the COVID-19 pandemic, adolescents experienced disruptions to school and social routines, contributing to heightened anxiety, depression, and suicidal ideation. Mental health was particularly affected among adolescents with ACEs. However, relatively little is known about the factors which improve well-being of adversity-exposed adolescents.

To this aim, researchers conducted a cross-sectional study of survey data from the Adolescent Brain Cognitive Development (ABCD) study during the COVID-19 pandemic. Adolescents 11 to 15 years of age who completed the COVID Rapid Response Research surveys of the ABCD study were included for analysis. The primary exposures were in-person schooling and 8 coping behaviors, including taking care of one’s body, exercising, engaging in healthy behaviors, neighborhood social distance activity, taking breaks from news, connecting with others online or by phone, and engaging in hobbies.

Overall, 4515 adolescents were included in the analysis. On average, participants were 13.3 (SD, 0.88) years of age, 51% were girls, and 61% were White. Of the total sample, 1159 participants did not have ACEs, 3124 had 1 to 3 ACEs, and 232 experienced 4 or more ACEs.

The investigators found adolescents with high ACEs had a significantly great improvement in positive affect (PA) scores with in-person schooling (B=5.55; 95% CI, 2.08-9.01) relative to adolescents with low-to-intermediate ACEs (B=1.27; 95% CI, 0.27-2.27). Additionally, in-person schooling was associated with lower perceived stress (PS) among adolescents with higher ACEs (B= -1.48; 95% CI, -2.69 to -0.28).

For coping behaviors, adolescents with high ACEs benefitted from taking care of one’s body (PA: B=4.02; 95% CI, 1.39-6.66 and PS: B= -0.92; 95% CI, -1.84 to 0.00), exercising (PA: B=3.19; 95% CI, 0.46-5.92 and PS: B= -1.41; 95% CI, -2.40 to -0.43), and engaging in healthy behaviors (PA: B=4.07; 95% CI, 1.28-6.84 and PS: B= -1.01; 95% CI, -1.98 to -0.05).

The researchers stated, “Among adolescents who had experienced high ACEs, in-person schooling, taking care of the body (stretching, meditating, and deep breathing), exercise, and engaging in healthy behaviors (eating healthy and sleeping well) were all associated with higher PA and lower PS scores.” Study authors concluded, “[W]e recommend that future studies build on these findings so that clinic and policy guidelines, as well as parents and educators, may identify protective factors to promote health equity and improved mental health among these adolescents at high risk of poor outcomes.”

Limitations of the study include the variable timing of exploratory and outcome measures, lack of validated clinical associations for PA and PS scores, potential bias in ACE score reporting, limited generalizability due to the sample composition, insufficient power for analyzing high ACE exposure groups, and inability to investigate causal inferences due to the cross-sectional, observational design.