Adolescent Depressive Symptom Trajectories From Before to After the COVID-19 Pandemic

Adolescent depression rates increased during the COVID-19 pandemic globally. Data on risk and resilience factors can inform prevention and intervention strategies during a major adversity.

To characterize depression symptom trajectories from before, during, and after the lockdown stages of the pandemic and to identify prospective risk and resilience factors.

This cohort study followed participants from the Adolescent Brain Cognitive Development Study ascertained through 21 sites across the US from before March 2020 to February 2022. The design and hypotheses were preregistered in March 2024. Analyses were conducted from April to November 2024.

Prepandemic risk and resilience factors spanning developmental stage, household environment, peer relationships, and depression polygenic risk.

The primary outcome was depression-susceptible symptom trajectory of low prepandemic and high postpandemic symptoms. Trajectories of depression symptom score (6 symptoms: depressed mood, anhedonia, guilt or worthlessness, fatigue, sleep, and concentration impairments) were modeled using logistic regression models with prepandemic factors (independent variables) explaining trajectory class (dependent variable; resilient, 0; depression susceptible, 1), adjusting for sex and age at the pandemic onset.

In the sample of 3512 participants included in the analyses (mean [SD] age in March 2020, 12.05 [0.85] years; 1672 [47.6%] female), a 3-class trajectory model identified resilient (low symptoms throughout follow-up, 3027 participants [86.2%]), depression-susceptible (low symptoms before the pandemic and high symptoms after the pandemic, 326 participants [9.3%]), and chronically high (159 participants [4.5%]) symptom trajectory classes. Girls were overrepresented in the depression-susceptible vs the resilient group (240 girls [73.6%] vs 1327 girls [43.8%]). The depression-susceptible trajectory, compared with the resilient trajectory, was associated with late pubertal or postpubertal stage before the pandemic (odds ratio [OR], 1.46; 95% CI, 1.08-1.96; P = .01), prepandemic family conflict (OR, 1.23; 95% CI, 1.10-1.38; P < .001), peer bullying (OR, 1.71; 95% CI, 1.11-2.65; P = .02), cyberbullying (OR, 2.28; 95% CI, 1.45-3.59; P < .001), maternal history of depression (OR, 1.52; 95% CI, 1.16-1.99; P = .002), polyenvironmental adversity exposure (OR, 1.28; 95% CI, 1.13-1.45; P < .001), and polygenic risk of depression (OR, 1.28; 95% CI, 1.03-1.59; P = .02 among those of European-like genetic ancestry, but not those of African-like ancestry). Greater prepandemic parental monitoring (OR, 0.81; 95% CI, 0.73-0.91; P < .001) and problem-solving skills (OR, 0.80; 95% CI, 0.66-0.97; P = .02) were associated with lower depression susceptibility.

In this cohort study of adolescent depression trajectories throughout COVID-19, girls, teens in later puberty, and those with experiences of peer bullying, cyberbullying, and greater family conflict before the pandemic were more susceptible to developing depressive symptoms that persisted after the pandemic, whereas prepandemic parental monitoring and problem-solving skills were identified as prospective modifiable resilience factors.