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by Sophia Garbarino, Clare Beatty & Brady Nelson, May 25, 2021

See Sophia’s poster for the URECA 2021 Symposium here.

Abstract

In adolescence, females are more likely than males to experience an episode of depression (Hyde et al., 2008). Having a strong social network has been shown to protect against the development of depression and anxiety symptoms (Santini et al., 2015). In the U.S., adolescent social circles were largely disrupted during the initial phases of the COVID-19 pandemic. Although it has been suggested that higher perceived social support protects against poorer mental health (Magson et al., 2021), few studies have examined the potential association between relationship quality and mental health during the COVID-19 pandemic. In a sample of 104 12 to 18 year-old girls, the present study examined peer relationship quality prior to the COVID-19 pandemic and changes in depression and anxiety symptoms during March to April 2020. Relationship quality was measured with the self-report Network of Relationships Inventory – Relationship Qualities Version (NRI-RQV). Depression was measured with the Child’s Depression Inventory (CDI), and anxiety was measured with the Screener for Child Anxiety Related Disorders (SCARED). Across the entire sample, there was an increase in both depression (t = -4.88, p < 0.001) and anxiety (t = -3.07, p = 0.003) symptoms during the COVID-19 pandemic. In addition, pre-COVID-19 perceived closeness of friendships predicted changes in depression and anxiety symptoms during the COVID-19 pandemic. Specifically, greater same-sex (r = -0.29, p = 0.003) and opposite-sex (r = -0.21, p = 0.04) friendship closeness were inversely correlated with generalized anxiety symptoms. Opposite-sex friendship closeness was inversely correlated with depression symptoms (r = -0.26, p = 0.008). Parent-child relationships were also examined but were not associated with changes in mental health. Findings suggest that healthier peer friendships may serve as protective factors against depression and anxiety in adolescents. As vaccine distribution increases and social distancing policies become more relaxed, adolescents may be able to strengthen relationships that were impacted by the COVID-19 pandemic, contributing to improved mental health.

Keywords: COVID-19, adolescents, relationships, friendships, depression, anxiety

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Introduction

Background

Adolescence is a critical developmental period for the emergence of sex differences in depression. By ages 13 to 15 girls are approximately twice as likely as boys to experience an episode of depression (Hyde et al., 2008). Prior research has taken a particular interest in the psychological mechanisms responsible for this shift, focusing specifically on girls.

For both sexes, strong social support networks have been shown to protect against the development of depressive and anxiety symptoms (Santini et al., 2015). In early 2020, when the initial phases of the COVID-19 pandemic began, these social networks were largely disrupted, especially for children and teenagers. The daily routine of interacting with classmates and peers at school was abruptly interrupted due to the shift to remote learning. During this time, research suggests that females in particular experienced a notable increase in depressive and anxiety symptoms (Hawes et al., 2021).

While some studies suggest that higher perceived social support protects against poorer mental health (Magson et al., 2021), few studies have examined the potential association between relationship quality and mental health during COVID-19. The present study examined pre-pandemic peer relationship quality and its potential for predicting depressive and anxiety symptoms during the early COVID-19 pandemic.

Hypotheses

The present study tested two hypotheses: 1) Individuals would display an increase in depressive and anxiety symptoms during the initial stages of the COVID-19 pandemic as compared to pre-pandemic symptoms, and 2) Both parent and peer relationships would inversely correlate with depressive and anxiety symptoms during the COVID-19 pandemic. In other words, healthier and closer relationships would be associated with fewer depressive and anxiety symptoms during COVID-19.

Methods

Participants

The sample consisted of 104 girls from an ongoing longitudinal study at Stony Brook University, the Impact of Puberty on Affect and Neural Development across Adolescence (iPANDA) project. This project is currently investigating the relationship between neural reward sensitivity and the development of depression. Eligibility included being assigned female at birth, aged 8 to 14, being literate in English, having no known medical or developmental disabilities, and living within 30 miles of Stony Brook University in Long Island, NY. One of the child’s biological parents also had to be willing to participate. The baseline sample consisted of 317 girls along with one of their biological parents. Baseline data collection was followed by two additional waves, each spaced approximately two years apart. The third wave was still in progress when the COVID-19 pandemic began in late March 2020, therefore not all of the participants had completed the data collection.

Measures

The iPANDA participants (N = 104) were included in the present study if they completed the included measures within the appropriate timeframes. One measure was completed prior to the pandemic (before March 18, 2020), and two measures were completed before and during (March 18, 2020 and after) the pandemic. The average time between the pre-COVID and during-COVID assessments was 55 weeks.

Network of Relationships Inventory – Relationship Quality Version (NRI-RQV)

The NRI-RQV questionnaire is a self-report measure that assesses participants’ relationships with their 1) mother or mother figure, 2) father or father figure, 3) boyfriend or girlfriend, 4) sibling, 5) best same-sex friend, and 6) best opposite-sex friend. The questions had Likert-style responses (1 to 6: 1 = low occurrence, 5 = high occurrence, 6 = not applicable) and were presented in matrix format with each relationship type. Questions were classified into one of ten scales; the five positive scales measured companionship, intimate disclosure, emotional support, approval, and satisfaction, while the five negative scales measured conflict, criticism, pressure, dominance, and exclusion. Each scale contained three items and was scored by averaging the item responses (Furman & Buhrmester, 2010). The present study focused on the Closeness score, which is the mean of the five positive scale scores, for the mother, father, best same-sex friend, and best opposite-sex friend relationships. Participants completed the NRI-RQV assessment pre-COVID.

Children’s Depression Inventory (CDI)

The CDI questionnaire is a self-report measure that assesses participants’ depressive symptoms (Kovacs, 1992). Scores were calculated by summing the item responses, which were Likert style (not often/doesn’t apply to me, sometimes/somewhat applies to me, very often/strongly applies to me). Participants completed the CDI assessment pre-COVID and during COVID.

Screen for Child Related Anxiety Disorders (SCARED)

The SCARED questionnaire is a self-report measure that assesses participants’ anxiety symptoms. Each item had Likert-style responses (0 to 2: 0 = not true, 2 = very true) and was categorized into one of five subscales: panic disorder or significant somatic symptoms, generalized anxiety disorder (GAD), separation anxiety disorder, social anxiety disorder, and significant school avoidance. A total sum score of 25 or above (out of 82) indicated the possible presence of an anxiety disorder (Birmaher et al., 1997). The present study focused only on the GAD subscale, where a sum score over 9 indicated the possible presence of GAD. Participants completed the SCARED assessment pre-COVID and during COVID.

Data Analysis

Using IBM®️ SPSS®️ Statistics (v.27) software, we conducted two paired samples t-tests to examine whether depressive and anxiety symptoms increased during the pandemic as compared to pre-pandemic. Further, we conducted follow-up partial correlations (controlling for pre-pandemic symptoms) to investigate the relationship between relationship quality and depressive/anxiety symptoms during the pandemic.

Results & Discussion

Figure 1. Pre-COVID-19 vs. COVID-19 SCARED GAD Subscale t-test

Figure 2. Pre-COVID-19 vs. COVID-19 CDI Total t-test

Table 1. Correlations between SCARED GAD (COVID-19), CDI (COVID-19), and peer relationships

	COVID-19 SCARED GAD Subscale	COVID-19 CDI Total
NRI-RQV Best Same-Sex Friend Closeness (pre-COVID)	-0.287**	-0.080
NRI-RQV Best Opposite-Sex Friend Closeness (pre-COVID)	-0.205*	-0.259**

Table 2. Friendship closeness vs. COVID-19 symptoms regressions

	COVID-19 SCARED GAD Subscale (β)	COVID-19 CDI Total (β)
NRI-RQV Best Same-Sex Friend Closeness (pre-COVID)	-.168**	.074
NRI-RQV Best Opposite-Sex Friend Closeness (pre-COVID)	-.018	-.124****

Results indicated support for the first hypothesis. Across the sample, participants had greater depressive (t = -4.88, p <.001) and anxiety (t = -3.07, p < .01)symptoms during the COVID-19 pandemic, as compared to pre-pandemic. However, results indicated only partial support for the second hypothesis. Pre-pandemic friendship closeness was associated with changes in anxiety and depressive symptoms; specifically, stronger pre-COVID same-sex friendship closeness uniquely correlated with smaller increases in anxiety symptoms during COVID (r = -.29, p < .01), while stronger pre-COVID opposite-sex friendship closeness uniquely correlated with smaller increases in depressive symptoms during COVID (r = -.26, p < .01). When controlling for pre-pandemic symptoms, pre-COVID same-sex friendship closeness still predicted changes in COVID anxiety symptoms (r = -.17, p < .01). Mother and father relationships were not found to be significantly predictive of changes in mental health during COVID.

Conclusion

Interpretations

It is possible that participants were more comfortable expressing worry to same-sex friends (girls), buffering against increased anxiety symptoms. Perhaps they shared feelings about missing friends or romantic interests at school. Findings also suggest that opposite-sex friends (boys) may have helped improve participants’ moods, buffering against increased depressive symptoms. The girls may have had a crush or two and were happier interacting with them, even if only virtually, while following stay-at-home orders.

Limitations

The sample was predominantly Caucasian and middle class, and from the Long Island, New York area. As such, the sample is certainly not representative of the entire United States, as the U.S. is much more racially and socioeconomically diverse. It is unclear whether or not these results would be similar for individuals of different backgrounds, since a variety of factors, including race, ethnicity, sex, and economic class, impact the degree to which people have been affected, either positively or negatively, by the pandemic (Center for Disease Control and Prevention). For example, Black and Indigenous Americans had the highest COVID-related death rates, while Asians and Whites had much lower rates (APM Research Lab Staff). According to the Pew Research Center, lower-income individuals were also more likely to report lost income and jobs due to the pandemic (Parker et al., 2020). As such, the present study’s sample may not have been affected by COVID-19 as much as other groups.

Further, all measures were self-reported, so participants may have been reluctant to share the full extent of their relationships and COVID-19 experiences. Another important consideration is that there was over a year, on average, between the pre-COVID and during-COVID assessments, meaning we could not account for potential significant life changes, such the death of a parent, losing touch with a friend, moving to a new place, and changes in relationship nature itself. Therefore, the present study’s results regarding pre-pandemic relationship quality may not be fully applicable to pandemic-era relationship health.

Future Directions

Overall, the results were largely what we hypothesized. Increased anxiety and depressive symptoms during the COVID-19 pandemic were evident across the sample and peer relationships predicted changes in mental health. Future studies should investigate these findings further and consider potential gender, race, and socioeconomic class differences that were not found in the present sample. Social factors like gender norms, double sex standards, race/ethnicity, and wealth may further influence the nature of adolescents’ social support networks and how they experienced the COVID-19 pandemic.

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References

APM Research Lab Staff. (2021, March 5). The color of coronavirus: COVID-19 deaths by race and ethnicity in the U.S. APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race

Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., & Kaufman, J. (1997, April). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36: 545–553. https://doi.org/10.1097/00004583-199704000-00018

Center for Disease Control and Prevention. (2021, April 19). Health equity considerations and racial and ethnic minority groups. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

Furman, W., & Buhrmester, D. (2010). Network of relationships questionnaire manual. Unpublished manuscript, University of Denver, Denver, CO, and the University of Texas at Dallas.

Hawes, M.T., Szenczy, A.K., Klein, D.N., Hajcak, G., & Nelson, B.D. (2021, January 13). Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychological Medicine, 1–9. https://doi.org/10.1017/s0033291720005358

Hyde, J.H., Mezuklis, A.H., & Abramson, L.Y. (2008). The ABCs of depression: Integrating affective, biological and cognitive models to explain the emergence of the gender difference in depression. Psychological Review, 115, 291-313. https://doi.org/10.1037/0033-295x.115.2.291

Magson, N.R., Freeman, J.Y., Rapee, R.M, Richardson, C.E., Oar, E.L., & Fardouly, J. (2021). Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. Journal of Youth and Adolescence, 50, 44-57. https://doi.org/10.1007/s10964-020-01332-9

Kovacs, M. (1992). Children’s depression inventory. Multi-Health Systems, Inc.

Parker, K., Horowitz, J.M., & Brown, A. (2020, April 21). About half of lower-income Americans report household job or wage loss due to COVID-19. Pew Research Center. https://www.pewresearch.org/social-trends/2020/04/21/about-half-of-lower-income-americans-report-household-job-or-wage-loss-due-to-covid-19/

Santini, Z.I., Koyanagi, A., Tyrovolas, S., Mason, C., & Haro, J.M. (2015, April 1). The association between social relationships and depression: A systematic review. Journal of Affective Disorders, 175, 53–65. https://doi.org/10.1016/j.jad.2014.12.049