Exposure to disasters and the life stress that can result in the aftermath has been associated with subsequent mental health (MH) problems in up to about 30% of affected individuals (Bonanno et al. 2010). Young adults, ages 18-30 may be more vulnerable to the impact of disaster than older adults (Acierno et al., 2006; Bonanno et al., 2007). Increased levels of MH symptom severity have been observed among young adults over the past two decades (Twenge et al., 2019; Twenge et al., 2020), as well during the COVID-19 pandemic (National Center for Health Statistics, 2021). Additional research investigating risk and resilience factors associated with long-term patterns of MH is needed (Chen & Bonanno, 2020), particularly among disaster-exposed young adults during the COVID-19 pandemic.Originally intended to understand young adult psychosocial adjustment after exposure to natural disasters in 2017 and 2018, the current longitudinal study also examined impacts of the COVID-19 pandemic on MH across four waves (two pre-pandemic and two during-pandemic). This presented a unique opportunity to evaluate the associations among prospective data collected prior to the pandemic, and pandemic functioning among disaster-exposed young adults in the mainland U.S. and Puerto Rico. The current study had the following aims: 1) identify pre-pandemic, and pandemic risk and protective factors predicting pandemic-MH; 2) examine the shape of MH symptom trajectories over time, from pre to during-pandemic; and 3) examine whether pre-pandemic factors were associated with differences in MH trajectory starting points, or with increases or decreases in MH growth rates over time.
Data were collected at universities in California, Florida, Texas, and Puerto Rico through online Qualtrics questionnaires in English and Spanish. The Wave (W) 1 surveys were distributed in the mainland U.S. in 2018, about three to six months after several natural disasters; the Spanish survey was distributed in Puerto Rico also in 2018, a little over one year after several hurricanes occurred. W1 participants indicated whether they agreed to be contacted for subsequent follow-up surveys as part of a longitudinal study. A subset of participants (n = 466) agreed and were contacted via personal email to participate in Ws 2-4. W2 data collection occurred in October through December 2019, W3 data collection occurred in summer of 2020 during the COVID-19 pandemic, and W4 data collection took place between late February and early April 2021. Compensation differed slightly across waves; at W1, participants chose to either receive research credit or to enter a raffle to win one of many e-gift cards ($25.00), while at Ws 2-4, each participant received an e-gift card.
Pre-pandemic factors were measured at W1 and included prior trauma history, disaster exposure (e.g., specific to hurricanes, wildfires, mudslide), life stressors since disaster, and MH. Pandemic risk factors were measured at W3 and included COVID-19 fear, COVID-19-related experiences, and life stressors during the pandemic. Also measured at W3, pandemic protective factors included perceived social support, self-compassion, and coping self-efficacy. MH outcomes were measured across Ws 1-4 and included anxiety, depression, and post-traumatic stress symptoms (PTSS).
To evaluate aim one, a subsample of 120 young adults who experienced a natural disaster during college and who had complete Ws 1 and 3 data were selected. Participants were mostly female (88%), and half identified as Latinx and from Puerto Rico. The majority (69.2%) had reported been exposed to a hurricane, and the remainder experienced wildfires. At W1, participants were on average 20.3 years of age.
Three separate multiple linear regression analyses for each W3 pandemic-MH outcome (anxiety, depression, and PTSS) were conducted using Mplus Version 8. In summary, W1 MH or prior MH functioning was the only pre-pandemic factor significantly associated with pandemic MH. Pandemic risk factors (W3 COVID-19 fear, W3 COVID-19 experiences, and W3 life stressors) were significantly associated with anxiety and PTSS during the pandemic, but not depressive symptoms. W3 coping self-efficacy was associated with decreased risk for depression and PTSS during the pandemic. Lastly, W3 self-compassion and W3 social support were not significantly associated with any pandemic MH outcomes, and no pandemic protective factors were associated with anxiety during the pandemic.
To evaluate aims two and three, a subsample of 205 young adults who completed W1 and one or more of the subsequent three waves of data collection were selected. Participants were again mostly female and about half identified as Latinx and from Puerto Rico. Three separate MH trajectories (anxiety, depression, and PTSS) were plotted using hierarchical linear modeling analyses (HLM) and HLM8 statistical software. Associations among pre-pandemic factors and young adults’ MH starting points and trajectories were examined. MH symptom trajectories of young adults with higher levels of prior trauma history, disaster exposure, and life stressors since disaster were hypothesized to be more severe at W1 and decelerate more slowly across subsequent waves than those without.
The anxiety trajectory did not differ among individuals and changes in anxiety symptom levels across Ws 1-4 were non-significant. The only significant pre-pandemic factors associated with W1 anxiety (trajectory starting point) were past trauma history (p = .042) and W1 life stressors since the disaster (p = .027). Similarly, the depression trajectory did not differ among individuals and changes in depression symptom levels across Ws 1-4 were non-significant. The only significant pre-pandemic factors associated with W1 depression (trajectory starting point) were also past life trauma (p = .01), and W1 life stressors since the disaster (p = .005).
Significant differences among PTSS were found across Ws 1-4. The PTSS trajectory followed an S-shaped cubic trend. From Ws 1-2 (post-disaster to pre-pandemic), the PTSS trajectory was observed to be linear and slightly decreasing, from Ws 2-3 (pre-pandemic to during-pandemic), the trajectory significantly increased and from Ws 3-4 (during-pandemic to one-year-during-pandemic) it gradually declined. The PTSS trajectory model statistics with all time-level predictors included were significant and showed improvements in fit. Significant pre-pandemic factors associated with W1 PTSS (trajectory starting point) were prior trauma history (p = .042), W1 life stressors since the disaster (p = .003), and region (p = .03). Young adults from Puerto Rico and those with higher levels of prior trauma history or W1 life stressors since the disaster on average endorsed higher levels of PTSS post-disaster and at the start of the PTSS trajectory (W1), than those who did not. No other person-level factors significantly predicted changes among PTSS over time.
In summary, a close examination of both environmental and individual risk and protective factors can help to predict subsequent MH outcomes after collectively experienced disasters. The current study results suggest that prior-MH functioning, COVID-19 fear, pandemic life stressors, COVID-19 related experiences, and coping self-efficacy may predict pandemic-MH outcomes among disaster-exposed young adults. Additionally, young adults who have experienced greater levels of prior trauma history or W1 life stressors following a disaster are more likely to experience higher levels of initial MH outcomes after a collectively experienced trauma, like the pandemic, as well as young adults from Puerto Rico, in comparison to young adults from the mainland U.S. Increases in PTSS may also occur after the experience of another collective trauma. These findings can help to identify young adults that may benefit from MH support. Increased support and protections can be provided accordingly to those at greater risk of developing more severe MH symptoms, particularly at the university level.
