Julia M. W. Hall and Sylvie Mrug

Department of Psychology

Abstract

In 2020, COVID-19 pandemic restrictions reduced social interactions and altered routines, increasing feelings of social isolation and instability. These restrictions increased adolescents’ psychosocial problems, likely due to COVID-19 related stressors. However, relatively few studies directly examined differences in psychosocial functioning before and during the pandemic. This study will examine psychosocial functioning before and during the COVID-19 pandemic in adolescents.

It is hypothesized that adolescents participating after the pandemic began will report more psychosocial problems (anxiety/depression, aggression, rule-breaking behaviors) than adolescents before restrictions were implemented. This study uses data from the Adolescent Diet Study, a longitudinal study of youth health. Wave 1 was completed in 2019 with 288 middle school students (M_age=12.1 years, 53.8% female). Wave 2 (N=196, M_age=13.2 years, 52.0% female) began in January 2020 and was interrupted by COVID-19 school closures in March. At both waves, adolescents self-reported anxiety/depression, aggression, and rule-breaking, whereas parents reported their level of educational attainment and household income. After controlling for demographics and Wave 1 psychosocial functioning, regression analyses showed that anxiety/depression, aggression and rule-breaking behaviors did not differ for children who participated before vs. during the COVID-19 pandemic. Anxiety/depression, aggression, and rule-breaking were stable over time and higher aggression at Wave 1 predicted more rule-breaking behaviors at Wave 2. Finally, females and white students reported more anxiety/depression at Wave 2. Findings highlight adolescent resilience and the importance of emotional support during adolescence, especially for females and non-Hispanic White students, for internalizing problems.

Psychosocial Development and Functioning

Adolescence is a critical period of social, emotional, and physical development marked by heightened hormones, stress, and impulsiveness (Casey et al., 2019; National Academies of Sciences, Engineering, and Medicine [NASEM], 2019). Typical psychosocial development for adolescents demonstrates a decrease in self-regulation behaviors, self-efficacy, and social awareness and an increase in impulsivity to emotional cues in the brain (Casey et al., 2019; Soland et al., 2022). Therefore, adolescents become more at risk for developing psychological disorders and behavior problems, both internalizing and externalizing problems (NASEM, 2019). In 2016-2019, depression, anxiety, and behavior disorders were most common among adolescents aged 12-17 years (Centers for Disease Control and Prevention [CDC], 2019).

Two other characteristics of this transitional period from childhood to adolescence are identity formation and relational patterns, especially with friends and parents (Livesey & Rostain, 2017). Identity formation is shaped by a sense of self, relationships, and quality of life, and stressors during this time may contribute to the onset of psychological disorders and behavior problems (Rapee et al., 2019). As adolescents navigate relationship dynamics, they face high friendship-related distress and experience conflict in parent-child relationships for greater self-autonomy (Palmeroni et al., 2020; Sznitman et al., 2022).

Internalizing Problems

Internalizing behavior is a set of maladaptive behaviors that are self-directed, which could lead to and stem from psychological distress (Eisenstadt et al., 2020). During adolescence, youth often struggle with heightened emotional responses and report experiencing increases in anger, low self-esteem, worry, anxiety, and sadness (Eisenstadt et al., 2020). Negative emotionality appears to remain stable from childhood into adolescence as stressful events reinforce feelings of hopelessness and lack of control (Olino et al., 2022). The most common internalizing problems reported by adolescents are depression and anxiety (Rapee et al., 2019).

Worries mostly revolve around physical appearances, academic performance, and interpersonal relationships (Arbel et al., 2018). Poor education behaviors and academic performance relate to anxiety and depressive symptoms, respectively (Duncan et al., 2021). Moreover, adolescents place a great importance on peer relationships in school, where unreciprocated friendships are linked to depressive symptoms and social anxiety (Walsh et al., 2023). Previous research underscores the bidirectional effects between depression and anxiety symptoms in adolescents with maternal depression (Thompson & Henrich, 2022). Adolescent internalizing behavior is more apparent when they have depressed mothers and anxious fathers, suggesting that parental psychopathology is heritable and modeled (Olino et al., 2022). The combination of puberty-related stressors like school and chronic stressors like parental psychopathology could exacerbate internalizing problems during this stressful developmental period (Duncan et al., 2021; Thompson & Henrich, 2022).

Externalizing Problems

Externalizing behavior is a set of maladaptive behaviors that are acted out by the individual and directed toward the environment (Eisenstadt et al., 2020). During adolescence, immature reward systems and executive functions promote impulsive actions with little insight into consequences to gauge personal limits (NASEM, 2019). Conduct problems, hyperactivity, and peer problems in early childhood have been shown to persist and escalate into further externalizing problems in adolescence (Ehrenreich et al., 2016; Givens & Reid, 2019; Lewis et al., 2017). Rule-breaking, aggression, and disruptive behavior encompass common adolescent externalizing problems (Eisenstadt et al., 2020).

Within a school context, adolescents exhibit these externalizing problems by engaging in school behavior problems and delinquency (Arbel et al., 2018). Disruptive behavior, such as conduct problems and hyperactivity, negatively impacts academics and creates an achievement gap with their peers without externalizing problems (Lewis et al., 2017; Wallin et al., 2019). While teachers could address these learning challenges, teacher support does not buffer against delinquent behavior (Darvishi et al., 2022). Again, adolescents follow their peers to influence their behaviors, where poor friend support encourages school behavior problems, delinquency, and aggression through peer pressure, and strong friend support buffers the relationship between stressors and delinquency (Darvishi et al., 2022; Sullivan et al., 2022). Additionally, parent-child conflict, such as harsh parenting, less parental monitoring, and poor relationship quality, is positively related to externalizing problems (Eisenstadt et al., 2020; Olson et al., 2023). Experiencing numerous stressful life events contributes to emotion-driven impulsive behavior, and these negative mental states make it difficult for adolescents to control their emotions and thought processes (Do et al., 2021).

Psychosocial Functioning During the COVID-19 Pandemic

The COVID-19 pandemic and the stay-at-home mandate impacted adolescent development and psychosocial functioning by disrupting milestones and socialization (Velez et al., 2022). Once adolescents were forced to leave school, they felt increasingly disconnected from their daily routines, such as sports, hobbies, and peers, and the inconsistent routines and worries about friends indirectly related to behavioral problems (Magson et al., 2021; Penner et al., 2022). Previous research highlights the importance of consistency and stability during the COVID-19 pandemic, especially in adolescents’ lives, as they face increased emotions and stressors compared to young children (Casey et al., 2019; Rosen et al., 2021). Based on the adolescents’ thoughts in the study by Velez et al. (2022), many noted that they missed developmental milestones of adolescents that help form their identities, like opportunities to socialize with friends, a stable academic environment, summer jobs, and coming-of-age activities (e.g., prom and high school graduation). As a result, they felt insecure and unprepared to progress to the next stage of development — adulthood.

Pandemic-related stressors, such as difficulty in relationships and uncertainty in the school environment transition, were strongly associated with both internalizing and externalizing problems (Rosen et al., 2021). While adolescents still met with friends and family online, the absence of in-person interactions led to a sense of loneliness, and without the necessary social support, adolescents with pre-existing internalizing problems reported more depressive and anxiety symptoms during the COVID-19 pandemic (Danneel et al., 2019; Magson et al., 2021; Velez et al., 2022). Similarly, adolescents who previously engaged in rule-breaking behaviors displayed higher rates of externalizing problems, and peer conflict and comorbid internalizing problems further exacerbated rule-breaking and aggressive behavior (Grazzani et al., 2022; Melegari et al., 2022). With the extended time at home around family, parents experienced worsened mental health and more inconsistent daily routines and discipline; as a result, adolescents faced challenges of stability inside and outside the home, contributing to increased behavioral problems (Penner et al., 2022). However, a few studies observed no significant differences before and during the COVID-19 pandemic in internalizing and externalizing problems among adolescents (Jolliff et al., 2021; Kerekes et al., 2021).

Sex Differences in COVID-19 Influences

The literature has shown sex differences in psychosocial functioning among adolescents. Internalizing problems are relatively stable across sex until about age 14, when girls report significantly lower mental well-being, more anxiety, and more depressive symptoms than boys (Gutman & McMaster, 2020; Olino et al., 2022). Sex differences in externalizing problems occur at the beginning of adolescence, where boys are more likely to engage in conduct problems, peer problems, and hyperactivity than girls (Eisenstadt et al., 2020; Gutman & McMaster, 2020). While physical aggression decreases with age, nonaggressive rule-breaking increases with age, and females are more likely to engage in covert aggression (Givens & Reid, 2019).

Although the literature on adolescent psychosocial functioning before and during the COVID-19 pandemic is mixed, most studies suggest girls were impacted more than boys (Craig et al., 2022; Jolliff et al., 2021; Kerekes et al., 2021). Compared to boys, girls were more likely to report less control but more family control, depressive symptoms, anxiety, stress, and psychological trauma related to the COVID-19 pandemic (Craig et al., 2022; Kerekes et al., 2021; Lewis et al., 2022). An unexpected development from the study by Grazzani et al. (2022) identified higher levels of externalizing problems in girls instead of boys from pandemic-related stressors, implying that the increased negative emotions experienced by girls may lead to aggression and other co-occurring externalizing problems. Other research follows expected gendered behavioral trends, but a small proportion of adolescents, particularly boys, reported norm-breaking behaviors during the COVID-19 pandemic (Kerekes et al., 2021).

The Current Study

The COVID-19 pandemic proves to be a global stressor due to drastic transitions from schools into homes and moving away from a sense of social support from friends to a more isolated and uncertain mental state (Velez et al., 2022). The chronic stress from the COVID-19 pandemic, in addition to puberty-related stress, could have increased the risk of adolescents developing internalizing and externalizing problems (NASEM, 2019; Thompson & Henrich, 2022). However, it is still unclear whether the increased stress from the COVID-19 pandemic worsened behavioral problems beyond puberty-related stress. Previous studies have shown mixed results in adolescent psychosocial functioning before and during the COVID-19 pandemic (Jolliff et al., 2021; Kerekes et al., 2021). Ample evidence demonstrates gendered behavioral trends, with boys having higher externalizing and girls with higher internalizing (Eisenstadt et al., 2020; Olino et al., 2022), but increased internalizing during the COVID-19 pandemic has unexpectedly prompted higher externalizing behaviors in girls (Grazzani et al., 2022). Exposure to a global stressor could reveal changes in behavioral trends. While considering the COVID-19 pandemic restrictions on psychosocial contexts, the current study will contribute to the growing literature on the effects of the COVID-19 pandemic on adolescents’ psychosocial functioning and sex. The current study aims to investigate the differences in internalizing and externalizing problems between adolescents who participated before the COVID-19 pandemic and those who participated during the pandemic. The current study hypothesizes:

1. Adolescents who participated during the COVID-19 pandemic will report significantly more anxiety/depression, aggression, and rule-breaking behaviors than adolescents who participated before the pandemic restrictions.
2. Males will significantly report more aggression and rule-breaking behaviors, while females will significantly report more anxiety/depression before and during the pandemic.
3. Pandemic participation will predict increased psychosocial problems at Wave 2 after controlling for Wave 1 psychosocial functioning and demographic characteristics.

Method

Participants

The current study was a part of a longitudinal study of adolescent health called the Adolescent Diet Study. In 2019, researchers recruited adolescents in middle school through random sampling method of 15 middle schools in the greater Birmingham Metropolitan Area in Alabama. Students had to speak English and be able to cognitively and physically complete study activities to participate. After the child and one primary caregiver provided consent, 288 students in 6th and 7th grade participated at Wave 1 in 2019 (M_age = 12.1 years; 53.8% female; 36.6% White; 47.9% Black; 10.2% Hispanic/Latinx, 4.9% Other). 196 students in 7th and 8th grade participated at Wave 2 in 2020 (M_age = 13.2 years; 52.0% female; 29.6% White; 53.6% Black; 11.7% Hispanic/Latinx, 5.1% Other). Students at Wave 2 were used to determine the groups for pandemic participation. Of the 196 students at Wave 2, 114 participated before the COVID-19 pandemic and before school closures in March 2020, and 82 participated during the COVID-19 pandemic after September 2020, when restrictions were lessened. At each wave, adolescents were compensated $50, and parents were compensated $60 for their participation. The University of Birmingham at Alabama Institutional Review Board approved the study.

Procedure

Before the COVID-19 pandemic, behavior surveys were administered in schools and completed by adolescents on an electronic tablet. Researchers emailed the parents a confidential link to provide demographic information about their family. When the COVID-19 pandemic shut down the schools due to the stay-at-home mandates, adolescents and their parents completed the behavior and demographic surveys on electronic tablets in the Youth Development Lab located on the University of Alabama at Birmingham campus. Researchers and families complied with campus safety protocols such as screenings, mask-wearing, and social distancing guidelines.

Measures

Demographic Characteristics

Demographic information, such as the sex and race/ethnicity of the adolescent, household income, and highest education level of the parent, was collected by the parent at Wave 1 and Wave 2. Minority status was dichotomized 0 (White and non-Hispanic/Latinx) and 1 (non-White, Hispanic/Latinx, or other). Pandemic participation represented the period before or during the COVID-19 pandemic when participants at Wave 2 completed the study, and this measure was dichotomized 0 (prior to March 2020) and 1 (after September 2020).

Adolescent’s Internalizing Problems

Youth Self Report (YSR; Achenbach & Rescorla, 2001) is a self-report measure of behavioral problems for children of 11-18 years within the past 6 months. Adolescents self-reported internalizing behavior at Wave 1 and Wave 2. The 10-item subscale for anxiety (“I am too fearful or anxious”) and depression (“I cry a lot”) was measured on a 3-point Likert scale from 0 (Not true) to 2 (Very true or often true). Items were averaged with higher scores indicating more anxiety/depression. The scale exhibits an acceptable internal consistency with a Cronbach’s alpha of 0.83.

Adolescent’s Externalizing Problems

Youth Self Report (YSR; Achenbach & Rescorla, 2001) is a self-report measure of child behavioral problems for children of 11-18 years within the past 6 months. Adolescents self-reported externalizing behavior at Wave 1 and Wave 2. The 16-item subscale for aggression (“I physically attack people”) and the 8-item subscale for rule-breaking behavior (“I run away from home”) were measured on a 3-point Likert scale from 0 (Not true) to 2 (Very true or often true). Items were averaged within each subscale, with higher scores indicating more aggression or rule-breaking behavior. These scales exhibit an acceptable internal consistency with a Cronbach’s alpha of 0.83 and 0.83 for aggression and rule breaking, respectively.

Data Analyses

The current longitudinal study, part of the Adolescent Diet Study, utilized secondary data analysis. Descriptive statistics were performed on demographic characteristics and adolescents’ psychosocial functioning at both waves. Independent sample t-tests were calculated to examine psychosocial functioning differences by adolescent’s sex and Wave 2 pandemic participation. Bivariate Pearson correlations and Spearman Rank Correlation Coefficients analyzed the associations between Wave 1 and Wave 2 psychosocial functioning and Wave 1 demographic characteristics. Multiple regression analyses tested whether pandemic participation predicted more anxiety/depression, aggression, and rule-breaking behaviors at Wave 2, controlling for Wave 1 covariates. Covariates included Wave 1 psychosocial functioning, adolescent’s sex and minority status, household income, and parent’s highest level of education.

Results

Sample characteristics of Wave 1, Wave 2, and before and during the pandemic are shown in Table 1. Overall, the study utilized a diverse sample of adolescents that represented the population of the Birmingham Metropolitan Area. Adolescents typically came from middle-class socioeconomic backgrounds with at least one parent with some college or a college degree. Descriptives of psychosocial functioning are shown in Table 2. Adolescents reported low levels of anxiety/depression, aggression, and rule-breaking behaviors at both waves.

Table 1. Sample Characteristics of Wave 1, Wave 2, and Pandemic Participation.

Independent samples t-tests observed males and females did not differ in any externalizing or internalizing problems in Wave 1 (Table 2). At Wave 2, as a whole, females reported more anxiety/depression than males (Table 2). Accounting for pandemic participation within Wave 2, females reported more anxiety/depression symptoms during but not before the pandemic (Table 3). Adolescents reported less rule-breaking during the pandemic (Table 2), but there were no gender differences in externalizing problems before or during the pandemic (Table 3). There were only sex differences for internalizing problems among female adolescents in Wave 2 overall and for pandemic participation (Table 2 and Table 3).

Table 2. Descriptives and Differences by Sex and Wave 2 Pandemic Participation

*p<.05, **p<.01

Table 3. Sex Differences for Wave 2 Before and During the Pandemic

*p<.05, **p<.01

Correlations are shown in Table 4 and determined that anxiety/depression, aggression, and rule-breaking behaviors were significantly related during and across waves. However, Wave 1 rule-breaking behaviors were not correlated with Wave 2 anxiety/depression. In Wave 2, females and non-minority adolescents correlated with increased anxiety/depression, while lower parent’s education was correlated with more aggression and rule-breaking behaviors. Household income was not significantly related to psychosocial problems in Wave 2. Pandemic participation was not significantly related to Wave 2 psychosocial problems, except for rule-breaking behaviors. Adolescents were less likely to engage in rule-breaking behaviors during the pandemic. Higher household incomes, higher parent’s education, and non-minority status were correlated with participation during the pandemic.

Table 4. Correlations between W1 and W2 Psychosocial Functioning, Income, Education, Sex, Minority Status, and Pandemic Participation

*p<.05, **p<.01. †Spearman Rank Correlation Coefficient

Three regression analyses are shown in Table 5 and investigated whether Wave 1 psychosocial functioning and covariates predicted Wave 2 anxiety/depression, aggression, and rule-breaking behaviors. Psychosocial functioning was stable over time. Wave 1 aggression predicted more rule-breaking at Wave 2. Pandemic participation did not uniquely predict changes in psychosocial functioning from Wave 1 to Wave 2. Females and non-minority adolescents reported greater increase in internalizing symptoms at Wave 2. After controlling for Wave 1 demographic characteristics, the relationship between parent’s education and Wave 2 rule-breaking behaviors was no longer significant.

Table 5. Regressions Predicting Wave 2 Psychosocial Functioning

*p<.05, **p<.01

Discussion

The current study examined psychosocial functioning before and during the COVID-19 pandemic in adolescents. Hypothesis 1 was not supported, whereas adolescents who participated during the pandemic reported significantly less rule-breaking behavior than those who participated before the pandemic restrictions, based on independent samples t-test results. This pattern was also reflected in a significant negative correlation between rule-breaking behaviors and pandemic participation. No other significant differences in psychosocial problems on pandemic participation were observed. Although the findings contradict the hypothesis and most studies reported increased psychosocial problems during the pandemic, the impact of the COVID-19 pandemic and social restrictions is still unclear in the literature (Jolliff et al., 2021; Kerekes et al., 2021; Magson et al., 2020). Previous research underscores that adolescents with existing internalizing and externalizing problems experienced increased psychosocial problems during the pandemic (Danneel et al., 2019; Magson et al., 2022; Melegari et al., 2022), and family instability predicted increased psychosocial problems (Penner et al., 2022). Since the current sample displayed relatively healthy levels of psychosocial functioning and available socioeconomic resources, the pandemic may not have negatively impact these adolescents because White adolescents with higher household incomes and educated parents were more likely to participate after the pandemic began.

Hypothesis 2 was partially supported. Females reported more anxiety/depression symptoms in Wave 2, and females reported more internalizing problems during (but not before) the pandemic compared to males. This finding is consistent with previous research that females were more susceptible to the impact of the pandemic on internalizing problems (Kerekes et al., 2021). Nevertheless, pandemic participation was not related to the adolescent’s sex or Wave 2 psychosocial functioning after controlling for demographic characteristics. Regression analyses demonstrated males and females differed in psychosocial problems over time, specifically for anxiety/depression symptoms, which aligns with expected gendered behavior (Gutman & McMaster, 2020; Olino et al., 2022). The results suggest the COVID-19 pandemic may have contributed to some differences in internalizing problems in female adolescents; however, the extent to which these differences go beyond puberty-related stressors or other individual differences remains unclear.

Contrary to hypotheses, there were no overall differences in adolescents’ psychosocial functioning before and during the pandemic, perhaps because of low levels of psychosocial problems and moderately more socioeconomic resources in this general sample of youth. Pandemic participation did not have a unique effect on Wave 2 anxiety/depression, aggression, or rule-breaking behaviors. However, Wave 1 aggression predicted increased rule-breaking behaviors at Wave 2, suggesting escalating externalizing problems over time. Previous research has detected that childhood social and physical aggression predicted increased rule-breaking behaviors in adolescence, and environmental reinforcers could account for progressively more externalizing problems (Ehrenreich et al., 2016). It is not clear whether the COVID-19 pandemic impacted this relationship.

Unexpectedly, adolescents from racial/ethnic minority groups reported fewer internalizing problems at Wave 2, suggesting greater resilience compared to White adolescents. In the literature, minority status is typically not associated with internalizing problems (Alvis et al., 2022; Jolliff et al., 2021), though, there are differences in psychosocial functioning based on available of socioeconomic resources (Kerekes et al., 2021). Racial/ethnic minority groups are significantly related to fewer socioeconomic resources, such as lower household income and parent’s education, and in turn, adolescents may be more resilient to environmental stressors because they regularly encounter negative experiences and hardships. While the study’s findings identified unexpected resiliency among minority students, it also highlights the racial/ethnic disparities in socioeconomic resources that impact adolescent psychosocial development.

Despite the unexpected circumstances in the middle of a study about youth health, the longitudinal study turned into an opportunity to compare psychosocial functioning before and during the pandemic among middle school students. The current study contributed to the literature related to the COVID-19 pandemic and supported research about the pandemic having no impact, in general, on psychosocial functioning (Jolliff et al., 2021). There was some evidence of females becoming more susceptible of anxiety/depression symptoms during Wave 2, which aligns with expected gendered behavior and impact related to the pandemic (Kerekes et al., 2021). Additionally, the diverse and representative sample provided insight into racial/ethnic disparities in adolescent psychosocial development since most studies have had predominantly White samples (Grazzani et al., 2022; Magson et al., 2020; Melegari et al., 2022).

While the study added to the understanding of the impact of the pandemic on adolescents’ psychosocial functioning, there were several limitations. As the larger study did not foresee interruption by the COVID-19 pandemic in March 2020, the current study halted data collection and had to continue when pandemic restrictions lessened after September 2020. As a result, the reasons behind adolescents’ behaviors and their respective contexts were not evaluated during the pandemic, and there was small number of students at Wave 2 who did participate after the pandemic began; namely, a higher number of White children with more socioeconomic resources. During the shutdown with stringent pandemic restrictions, students remained at home and did not attend school for the majority of Wave 2, and being out of school could have contributed to the lower levels of psychosocial problems due to reduced school obligations and social interactions. However, it is unclear psychosocial problems experienced during the shutdown were related to the COVID-19 pandemic and social restrictions. Future research should examine these relations in large, diverse samples of adolescents with heterogeneous psychosocial problems and incorporate various measures of psychosocial functioning, like social relationships and perceived support, to better understand the buffering effects of protective factors. Also, the current study was limited to using only self-reported measures completed by adolescents to assess psychosocial functioning, and factors such as social desirability bias and limited self-awareness of psychosocial problems due to developmental maturity could have influenced results. Parent and teacher perceptions should be included in future studies to create a broader perspective on adolescent psychosocial functioning before and during the pandemic.

Though pandemic participation did not have a unique effect on psychosocial functioning, there were significant relations between pandemic participation and demographic characteristics, suggesting a potential moderating role of demographics between pandemic participation and psychosocial problems. The current study investigated differences in psychosocial functioning, but whether the effects of the pandemic have been resolved or will persist into later adolescence and early adulthood are still unknown. Thus, follow-up studies 1-2 years after the stay-at-home mandates are necessary to understand the potential lasting effect of the COVID-19 pandemic restrictions on psychosocial development.

Overall, the study’s findings highlight adolescent resilience, where COVID-19 pandemic restrictions did not influence psychosocial functioning before and during the pandemic. Even though the pandemic could have fostered feelings of hopelessness and lack of control as a global and national stressor (Eisenstadt et al., 2020; Olino et al., 2022), psychosocial problems remained relatively low across Wave 1 and Wave 2. However, adolescents, particularly females and White non-Hispanic/Latinx, still reported increased anxiety/depression symptoms in Wave 2. The current study demonstrates the importance of social support during adolescence for emotional processing to promote resilience against life stressors. Social networks serve as a protective factor, and as adolescents are experiencing physical, emotional, and social changes, it is crucial to have stable and strong connections to buffer against negative life experiences, such as the COVID-19 pandemic (Livesey & Rostain, 2017).

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