Participants
Participants in the current study were part of a larger, longitudinal study, conducted in a large metropolitan city in the Mid-Atlantic region of the United States, designed to examine links between temperament and psychopathology. Participants were 291 children (135 male, 156 female) selected at 4 months of age based on temperamental reactivity and their parents. For additional details on the recruitment and screening for the longitudinal sample see (Hane et al. 2008). Based on parent report at recruitment, maternal demographics included 69.1% White, 16.5% Black, 7.2% Hispanic, 3.1% Asian, 3.4% other, and 0.7% missing; paternal demographics included 68.7% White, 18.6% Black, 5.5% Hispanic, 2.7% Asian, 3.1% other, and 1.4% missing. At recruitment, most of the mothers in the sample had a college degree or higher (77.6%), some had a high school degree (16.2%), and a few reported other education (5.5%). At recruitment, most of the fathers in the sample had a college degree or higher (71.9%), some had a high school degree (19.6%), and a few reported other education (6.9%). Based on clinical diagnostic interviews conducted when adolescents were 15 and 18 years old, 21 (13%) met criteria for generalized anxiety disorder and 10 (6%) met criteria for depression.
For purposes of the current study, adolescents (M = 18.27, SD = 0.665), and their parents completed questionnaires online via REDCap (i.e., online survey application) between April 20th and May 15th of 2020, approximately one month (M = 29.67 days, SD = 6.01 days) after a stay-at-home order was implemented in Maryland on March 30 (Time 1). Approximately one month later (M = 26.48 days, SD = 7.31 days), participants completed a second assessment (Time 2) after the mandatory stay-at-home order was lifted and restrictions were slowly reduced, in the state of Maryland. Specifically, 156 adolescent participants and 173 parent participants (90% mothers) completed the first assessment during the pandemic. Of the participants who completed the assessments for the current study compared to the original sample, more adolescent participants were female (n = 91, 58.7%); maternal demographics included 76% White, 11% Black, 5% Hispanic, 3% Asian, 3% other, and 0.6% missing; paternal demographics included 80% White and 20% Hispanic. The Institutional Review Board at the University of Maryland approved all study protocols as meeting ethical guidelines and all participants were compensated for their time.
Measures
Avoidant coping
Avoidant coping was measured using the avoidant coping scale of the Brief COPE Inventory at two assessments during the COVID-19 pandemic, self-reported by parents and adolescents. The Brief COPE is a 28-item self-report questionnaire designed to assess use of coping strategies during stressful life events (Carver 1997). The avoidant coping scale (10 items) is the average of the denial, substance use, behavioral disengagement, self-distraction, and self-blame subscales, each of which included two items. Items ranged from a scale of 1, “I haven’t been doing this at all,” to 4, “I’ve been doing this a lot,” (Baumstarck et al. 2017). Higher scores indicated a higher tendency to engage in avoidant coping in response to stressful life events. The Brief COPE has been shown to have good internal reliability (Yusoff, 2011), and good convergent and discriminant validity (Carver 1997). The avoidant scale showed questionable internal reliability in the current study for parent reports, α = 0.63, with limited variability (SD = 0.029), and good internal reliability for adolescent participants, α = 0.75.
Anxiety symptoms
Adolescents and parents completed the Generalized Anxiety Disorder-7 (GAD-7; Spitzer et al. 2006) and the Patient Health Questionnaire-8 (PHQ-8; Kroenke et al. 2009) at two assessments during the COVID-19 pandemic. GAD-7 items consisted of various anxiety symptoms, rated on a four-point scale (i.e., 0-not at all to 3-nearly every day), and were summed to create an overall score. Higher scores indicated greater anxiety and a score ≥10 is considered to be in the clinical range. This scale has been shown to have high test-retest reliability and good convergent validity (Spitzer et al. 2006). The scale showed excellent internal consistency for adolescent participants at both time points, α’s > 0.92 and good test re-test reliability, r = 0.81, as well as for parent participants; good internal consistency, α’s > 0.85, and test re-test reliability, r = 0.72. Higher scores indicated greater anxiety symptoms.
Depressive symptoms
The PHQ-8 is a short form version of the Patient Health Questionnaire created to assess symptoms of depression (Kroenke et al. 2009). It consists of 8 items that are scored using a 4-point Likert Scale from 0 (not at all) to 3 (nearly every day). Both internal and test-retest reliability of the PHQ-8 are strong (Kroenke et al. 2009). Higher scores on the PHQ-8 indicate increased risk for a diagnosis of various depressive disorders, with scores ≥10 considered in the clinical range. The scale showed good internal consistency for adolescent participants at both time points, α’s > 0.88, and good test re-test reliability, r = 0.71, as well as parent participants: α’s > 0.82, and test re-test reliability, r = 0.78. Anxiety (GAD-7) and depressive (PHQ-8) symptom scores were summed to create an internalizing problem score, as in previous studies (Kroenke et al. 2016). Higher scores indicated greater internalizing problems.
Data Analysis
To examine the aims of the present study, a cross-lagged moderation path model was conducted using Mplus 8.0 (Muthén and Muthén 1998–2017). See Fig. 1 for the path model. Given the high correlation between anxiety and depressive symptoms at Time 1 for adolescent, r = 0.704, p < 0.001, and parent, r = 0.700, p < 0.001, participants, as well as support for combining the two constructs in the literature (Kroenke et al. 2019), internalizing composites were created for adolescent and parent participants by summing GAD and PHQ scores (Kroenke et al. 2016). To test the moderating effect of adolescent avoidant coping on the relation between parent internalizing symptoms and adolescent internalizing symptoms, parent internalizing symptoms and adolescent avoidant coping were mean-centered, and a product interaction term was created. Additionally, to test the moderating effect of parent avoidant coping in the relation between adolescent internalizing symptoms and parent internalizing symptoms, adolescent internalizing symptoms and parent avoidant coping were mean-centered, and a product term was created.
Sensitivity Analyses
Given the potential clinical and intervention implications that may be different for anxiety and depressive symptoms, two additional cross-lagged models were tested as exploratory analyses: one for anxiety symptoms and one for depressive symptoms. Mean centering was used before creating interaction terms between parent anxiety symptoms and adolescent avoidant coping, adolescent anxiety symptoms and parent avoidant coping, parent depressive symptoms and adolescent avoidant coping, and adolescent depressive symptoms and parent avoidant coping. Although avoidant coping was the expected coping moderator, for sensitivity analyses the other coping scales (i.e., positive thinking, social support, problem solving) were explored. The results for all other scales demonstrated non-significant moderation effects (p = 0.29–0.95) and therefore are not presented.
Missing Data and Attrition
In order to test whether participants who provided data during the COVID-19 assessments differed from the participants in the original sample of infants, chi-square analyses comparing these two samples in relation to child gender, and mothers’ ethnicity and education were conducted. Mother’s ethnicity (non-Hispanic, White vs. other) was associated with missing data at Time 2, χ2 (1) = 5.58, p = 0.018, such that participants with available data were more likely to have non-Hispanic, White mothers. Therefore, maternal ethnicity was included as a covariate in the analyses, Non-Hispanic, White = 1 and Other = 0. Missing data on all other variables was not significantly associated with any demographic variables or variables included in the model, p’s > 0.05. In addition, adolescent sex, adolescent mean age across both assessments, the time between assessments during the pandemic for both parents and adolescents, and the days between the assessment and the stay-at-home order for both parents and adolescents, were included as covariates (See Table 1 for more descriptive information).
Table 1 Means, standard deviations, and correlations Attrition between Time 1 and Time 2 was minimal. Specifically, for adolescent participants, nine participants did not complete Time 2, and for parents, only seven participants. Additionally, seven adolescent participants and nine parent participants completed Time 2, but not Time 1. In order to correct for any departures from multivariate normality, the model was estimated using maximum likelihood with robust standard errors (MLR). Missing data was handled using full information maximum likelihood estimation (FIML), which has been shown to reduce bias in parameter estimates while maintaining the full sample of participants (N = 291; Enders and Bandalos 2001). Of note, an additional model using only participants who completed the assessments for the current study yielded the same pattern of results.