Coping with COVID-19: Testing the stress sensitization hypothesis among adults with and without a history of adverse childhood experiences

BACKGROUND: Substantial research suggests that adverse childhood experiences (ACEs) disrupt neurobiology, impacting regulatory processes (i.e., emotion regulation) that may sensitize individuals to psychopathology in response to later life stressors. Given the known increase in mental health distress related to the current ongoing global pandemic, this study investigated the extent to which COVID-related stress moderates the association between emotion regulation difficulties and psychological symptom ratings among individuals with and without exposure to ACEs. METHODS: Participants (N = 315, aged 18-48) provided self-ratings of ACEs, emotion regulation difficulties, COVID-related stress, and symptoms of depression, anxiety, and PTSD. The interaction between emotion regulation difficulties and COVID-related stress on psychological symptoms was examined using path analysis. Multigroup analysis was used to examine the moderating effects of ACEs. RESULTS: For individuals with ACEs, COVID-stress was associated positively with depression and anxiety symptoms when emotion regulation difficulties were low. Higher emotion regulation difficulties were associated with higher symptom ratings and COVID-related stress did not add a significant effect. Goal-setting difficulties, a subscale of emotion regulation difficulties, accounted for the most variance in these associations. LIMITATIONS: Cross-sectional design precludes determining causality, retrospective reports may be subject to recall bias, and participant demographics may limit generalizability. CONCLUSIONS: The current study provides support for stress sensitization theory and highlights the protective role of emotion regulation in enduring moderate stressors. Significant stressors (e.g., COVID-19), however, may warrant additional skills and supports to mitigate internalizing symptoms, particularly for individuals with a history of ACEs.