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. 2023 Feb;8(2):200-209.
doi: 10.1016/j.bpsc.2022.08.005. Epub 2022 Aug 20.

Functional Brain Connectivity Prior to the COVID-19 Outbreak Moderates the Effects of Coping and Perceived Stress on Mental Health Changes: A First Year of COVID-19 Pandemic Follow-up Study

María Cabello-Toscano  1 , Lídia Vaqué-Alcázar  2 , Gabriele Cattaneo  3 , Javier Solana-Sánchez  3 , Ivet Bayes-Marin  4 , Kilian Abellaneda-Pérez  2 , Dídac Macià-Bros  5 , Lídia Mulet-Pons  2 , Cristina Portellano-Ortiz  6 , Miquel Angel Fullana  7 , Laura Oleaga  8 , Sofía González  8 , Nuria Bargalló  9 , Jose M Tormos  3 , Alvaro Pascual-Leone  10 , David Bartrés-Faz  11
Affiliations

Functional Brain Connectivity Prior to the COVID-19 Outbreak Moderates the Effects of Coping and Perceived Stress on Mental Health Changes: A First Year of COVID-19 Pandemic Follow-up Study

María Cabello-Toscano et al. Biol Psychiatry Cogn Neurosci Neuroimaging. 2023 Feb.

Abstract

Background: The COVID-19 pandemic provides a unique opportunity to investigate the psychological impact of a global major adverse situation. Our aim was to examine, in a longitudinal prospective study, the demographic, psychological, and neurobiological factors associated with interindividual differences in resilience to the mental health impact of the pandemic.

Methods: We included 2023 healthy participants (age: 54.32 ± 7.18 years, 65.69% female) from the Barcelona Brain Health Initiative cohort. A linear mixed model was used to characterize the change in anxiety and depression symptoms based on data collected both pre-pandemic and during the pandemic. During the pandemic, psychological variables assessing individual differences in perceived stress and coping strategies were obtained. In addition, in a subsample (n = 433, age 53.02 ± 7.04 years, 46.88% female) with pre-pandemic resting-state functional magnetic resonance imaging available, the system segregation of networks was calculated. Multivariate linear models were fitted to test associations between COVID-19-related changes in mental health and demographics, psychological features, and brain network status.

Results: The whole sample showed a general increase in anxiety and depressive symptoms after the pandemic onset, and both age and sex were independent predictors. Coping strategies attenuated the impact of perceived stress on mental health. The system segregation of the frontoparietal control and default mode networks were found to modulate the impact of perceived stress on mental health.

Conclusions: Preventive strategies targeting the promotion of mental health at the individual level during similar adverse events in the future should consider intervening on sociodemographic and psychological factors as well as their interplay with neurobiological substrates.

Keywords: Brain networks; COVID-19 pandemic; Coping strategies; Mental health; Perceived stress.

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Figures

Figure 1
Figure 1
Timeline study design showing baseline (i.e., pre-pandemic) and during-pandemic points of acquisition for the main outcome (i.e., Patient Health Questionnaire-4 [PHQ-4]), magnetic resonance imaging (MRI), and psychological factors (perceived stress measured by the Perceived Stress Scale [PSS] and coping strategies measured by the Brief Resilient Coping Scale [BRCS]). On the left and colored in purple are pre-pandemic data including 1 MRI acquisition and 2 online PHQ-4 measures obtained between 2018 and 2020 (average follow-up: 12.73 ± 2.18 months). The beginning of the pandemic outbreak was defined according to the Spanish Government’s State of Emergency declaration on March 14, 2020. On the right and colored in green, 6 online questionnaires were administered during the first year of the COVID-19 pandemic (until March–April 2021). Each questionnaire was available for answering during the specified data periods shown.
Figure 2
Figure 2
Average values of the Patient Health Questionnaire-4 (PHQ-4) along time point measurements for the whole sample (N = 2023) showing ratings increases. Shadow areas above and below the average PHQ-4 line (i.e., thick line) represent standard errors. Abscissa axes indicate the timeline of observations in the study, which are grouped within pre-pandemic (i.e., from 2018 to early 2020) and during-pandemic observations (i.e., those from March 2020 to March–April 2021). The green line indicates the beginning of the lock-down (March 14, 2020 in Spain) and separates pre-pandemic and during-pandemic observations. Black vertical dashed lines delimit 2020 and 2021. Finally, in the upper part of the figure, the increase in PHQ-4 values at points during the pandemic compared with pre-pandemic is indicated.
Figure 3
Figure 3
Plots illustrating the associations found between the studied psychological factors (i.e., coping strategies and perceived stress) and psychological distress worsening (i.e., Patient Health Questionnaire-4 [PHQ-4] change). (A) Scatter and lines plot showing the association between PHQ-4 change (vertical axis) and perceived stress (horizontal axis) as modulated by coping strategies. Dots show individual observations of PHQ-4 change and perceived stress for 2 groups with low (in brown; i.e., below median) and high (in green; i.e., above median) coping strategies. Thick lines illustrate estimated slopes for the association between PHQ-4 change and perceived stress for extreme minimum and maximum levels of low (in brown) and high (in green) coping strategies. This difference between slopes was found to be significant as an interaction between coping strategies and perceived stress to predict PHQ-4 change. Shadow areas above and below the slope lines represent standard errors. (B) Schema of the associations between variables of psychological factors and psychological distress worsening.
Figure 4
Figure 4
Representation of the modulatory effect of frontoparietal control network (FPCN) and default mode network (DMN) system segregation (SyS) values on the association between perceived stress and Patient Health Questionnaire-4 (PHQ-4) change. (A, B) Graphs representing within- and between-network connectivity taking part in the computation of FPCN and DMN-SyS values, respectively. Nodes in the graph represent studied regions of interest (ROIs) as defined by the Schaefer-Yeo atlas of 100 nodes and 7 networks. The nodes and edges in light orange illustrate ROIs and within-network connectivity of the studied network (i.e., FPCN or DMN), while those in gray refer to outside network ROIs and the connectivity between them and the studied network. These graphs were created with the BrainNet Viewer (http://www.nitrc.org/projects/bnv/). (C, D) Scatter and lines plot showing the association between PHQ-4 change (vertical axis) and perceived stress (horizontal axis), as modulated by values of SyS, from the FPCN in panel (C) and the DMN in panel (D). Dots show individual observations of PHQ-4 change and perceived stress for 2 groups with low (in brown; i.e., below median) and high (in green; i.e., over median) SyS values. Thick lines illustrate estimated slopes for the association between PHQ-4 change and perceived stress for extreme minimum and maximum levels of low (in brown) and high (in green) SyS. This difference between slopes was found significant as an interaction between each particular SyS variable and perceived stress to predict PHQ-4 change. Shadow areas above and below the slope lines represent standard errors. (E) Schema of the associations between perceived stress and psychological distress worsening, as regulated by FPCN-SyS, DMN-SyS, and coping strategies.
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