Preventing Adult Mental Health Problems from Early Childhood in the Contexts of Genetic Susceptibility, Poverty, Racism, and the COVID-19 Pandemic

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ABSTRACT As Americans enter the third year of the COVID-19 pandemic, we are also in a mental health crisis. Emerging adults in particular are experiencing a high prevalence of anxiety, depression, suicidality, and psychosis compared to pre-pandemic levels. A slowed economy, increased social isolation, loss of typical support systems, and financial instability abruptly hit just as emerging adults were transitioning from adolescence to adulthood, potentially disrupting typical milestones such as leaving home, pursuing higher education, starting vocations, and becoming financially independent. The pandemic has also underscored persistent health inequalities that exist between White Americans and racial/ethnic minorities, due at least in part to experiences of discrimination. Living in poverty is an additional risk factor for mental health problems, and is a vastly different experience for White and minoritized individuals due to environmental and social factors afforded to different racial/ethnic groups. In addition, neighborhood characteristics and community type (i.e., rural, urban) can intersect with racial/ethnic identity to increase risk or offer protection from mental health problems. The genetically-informative Early Steps Multisite (ESM) study of 731 racially/ethnically diverse low-income families presents a unique opportunity to examine how a sample of at-risk emerging adults, prospectively followed since age two and now in their early twenties, are coping within the context of the pandemic. The ESM sample was recruited at Women, Infant, and Children centers in three geographically, socioeconomically, and racially/ethnically diverse communities: Eugene, OR; Pittsburgh, PA; and Charlottesville, VA. Participating families were randomly assigned to receive the Family Check-Up (FCU) intervention annually from child age 2 to 10.5, or to participate in study assessments without intervention. Assessments continued at child ages 14, 16, and 19, including two pandemic-related surveys focused on mental health, and participant genotyping. Recruited from diverse sites, the ESM can examine community- and neighborhood-level effects on mental health risk and resilience. Continuing this longitudinal study, we will assess participants at ages 22 and 24, including a clinical diagnostic interview of depression, anxiety, and psychosis. With a wealth of prospective data on neighborhood risk, experiences of discrimination, and mental health, we propose to examine direct, interactive, and cascading effects on mental health outcomes. Our first aim is to investigate whether race/ethnicity and discriminatory experiences shift the developmental trajectories of mental health, and whether protective ecological factors mitigate these risks. Our second aim is to test genetic moderation of risk and resilience on emerging adult mental health. Our third aim is to examine the long-term preventive effects of the FCU on mental health, in the context of growing up in poverty, and, more recently, the pandemic, while focusing on who is able to glean the largest benefit from this intervention. Following this emerging adult sample would provide unique data on the persistence of intervention effects on mental health during the transition to adulthood in the context of a pandemic.