Adolescent Psychopathology: The Role of Brain-based Diatheses, Sensitivities, and Susceptibilities

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

Manifold learning uncovers nonlinear interactions between the adolescent brain and environment that predict emotional and behavioral problems

BACKGROUND

To progress adolescent mental health research beyond our present achievements - a complex account of brain and environmental risk factors without understanding neurobiological embedding in the environment - we need methods to unveil relationships between the developing brain and real-world environmental experiences.

METHODS

We investigated associations among brain function, environments, and emotional and behavioral problems using participants from the Adolescent Brain and Cognitive Development Study (N=2,401 female). We applied manifold learning, a promising technique for uncovering latent structure from high-dimensional biomedical data like functional magnetic resonance imaging (fMRI). Specifically, we developed exogenous PHATE (E-PHATE) to model brain-environment interactions. We used E-PHATE embeddings of participants' brain activation during emotional and cognitive processing to predict individual differences in cognition and emotional and behavioral problems, both cross-sectionally and longitudinally.

RESULTS

E-PHATE embeddings of participants' brain activation and environments at baseline show moderate-to-large associations with total, externalizing, and internalizing problems at baseline, across several subcortical regions and large-scale cortical networks, relative to the zero-to-small effects achieved by voxel or PHATE methods. E-PHATE embeddings of the brain and environment at baseline also relate to emotional and behavioral problems two years later. These longitudinal predictions show a consistent, moderate effect in the frontoparietal and attention networks.

CONCLUSIONS

Adolescent brain's embedding in the environment yields enriched insight into emotional and behavioral problems. Using E-PHATE, we demonstrate how the harmonization of cutting-edge computational methods with longstanding developmental theories advances detection and prediction of adolescent emotional and behavioral problems.

Manifold learning uncovers nonlinear interactions between the adolescent brain and environment that predict emotional and behavioral problems

Background

To progress adolescent mental health research beyond our present achievements - a complex account of brain and environmental risk factors without understanding neurobiological embedding in the environment - we need methods to unveil relationships between the developing brain and real-world environmental experiences.

Methods

We investigated associations among brain function, environments, and emotional and behavioral problems using participants from the Adolescent Brain and Cognitive Development Study (N=2,401 female). We applied manifold learning, a promising technique for uncovering latent structure from high-dimensional biomedical data like functional magnetic resonance imaging (fMRI). Specifically, we developed exogenous PHATE (E-PHATE) to model brain-environment interactions. We used E-PHATE embeddings of participants' brain activation during emotional and cognitive processing to predict individual differences in cognition and emotional and behavioral problems, both cross-sectionally and longitudinally.

Results

E-PHATE embeddings of participants' brain activation and environments at baseline show moderate-to-large associations with total, externalizing, and internalizing problems at baseline, across several subcortical regions and large-scale cortical networks, relative to the zero-to-small effects achieved by voxel or PHATE methods. E-PHATE embeddings of the brain and environment at baseline also relate to emotional and behavioral problems two years later. These longitudinal predictions show a consistent, moderate effect in the frontoparietal and attention networks.

Conclusions

Adolescent brain's embedding in the environment yields enriched insight into emotional and behavioral problems. Using E-PHATE, we demonstrate how the harmonization of cutting-edge computational methods with longstanding developmental theories advances detection and prediction of adolescent emotional and behavioral problems.

Longitudinal associations between neighborhood safety and adolescent adjustment: The moderating role of affective neural sensitivity

Research on social determinants of health has highlighted the influence of neighborhood characteristics (e.g., neighborhood safety) on adolescents' health. However, it is less clear how changes in neighborhood environments play a role in adolescent development, and who are more sensitive to such changes. Utilizing the first three waves of data from the Adolescent Brain Cognitive Development (ABCD) project (N = 7932, M (SD) age = 9.93 (.63) years at T1; 51% boys), the present study found that increases in neighborhood safety were associated with decreased adolescent externalizing symptoms, internalizing symptoms, but not sleep disturbance over time, controlling for baseline neighborhood safety. Further, adolescents' insula and anterior cingulate cortex (ACC) reactivity to positive emotional stimuli moderated the association between changes in neighborhood safety and adolescent adjustment. Among youth who showed higher, but not lower, insula and ACC reactivity to positive emotion, increases in neighborhood safety were linked with better adjustment. The current study contributes to the differential susceptibility literature by identifying affective neural sensitivity as a marker of youth's susceptibility to changes in neighborhood environment. The findings highlight the importance of neighborhood safety for youth during the transition to adolescence, particularly for those with heightened affective neural sensitivity.

Neural Reward Anticipation Moderates Longitudinal Relation between Parents' Familism Values and Latinx American Youth's School Disengagement

Parents' familism values predict a variety of Latinx American youth's academic adjustment. However, it is unclear how cultural values such as familism interact with youth's brain development, which is sensitive to sociocultural input, to shape their academic adjustment. Using a sample of 1916 Latinx American youth (mean age = 9.90 years, SD = .63 years; 50% girls) and their primary caregivers (mean age = 38.43 years, SD = 6.81 years; 90% mothers) from the Adolescent Brain Cognitive Development Study, this study examined the longitudinal relation between parents' familism values and youth's school disengagement, as well as the moderating role of youth's neural sensitivity to personal reward. Parents' familism values predicted youth's decreased school disengagement 1 year later, adjusting for their baseline school disengagement and demographic covariates. Notably, this association was more salient among youth who showed lower (vs. higher) neural activation in the ventral striatum and the lateral OFC during the anticipation of a personal reward. These findings underscore the protective role of familism for Latinx American youth, highlighting the necessity of developing culturally informed interventions that take into consideration a youth's brain development.

The role of neural reward sensitivity in the longitudinal relations between parents' familism values and Latinx American youth's prosocial behaviors

Past research suggests that parents' familism values play a positive role in Latinx American youth's prosocial tendencies. However, little is known about how individual differences in youth's neural development may contribute to this developmental process. Therefore, using two-wave longitudinal data of 1916 early adolescents (mean age = 9.90 years; 50% girls) and their parents (mean age = 38.43 years; 90% mothers) from the Adolescent Brain Cognitive Development study, this pre-registered study took a biopsychosocial approach to examine the moderating role of youth's neural reward sensitivity in the link between parents' familism values and youth's prosocial behaviors. Results showed that parents' familism values were associated with increased prosocial behaviors among youth two years later, controlling for baseline prosocial behaviors and demographic covariates. Notably, parents' familism values played a larger role in promoting youth's prosocial behaviors among youth who showed lower ventral striatum activation during reward anticipation. Moreover, such association between parents' familism values and youth's later prosocial behaviors was stronger among youth who showed lower levels of prosocial behaviors initially. Taken together, the findings highlight individual differences in neurobiological development and baseline prosocial behaviors as markers of sensitivity to cultural environments with regard to Latinx American youth's prosocial development.

The future of neuroscience in developmental psychopathology

Developmental psychopathology started as an intersection of fields and is now a field itself. As we contemplate the future of this field, we consider the ways in which a newer, interdisciplinary field - human developmental neuroscience - can inform, and be informed by, developmental psychopathology. To do so, we outline principles of developmental psychopathology and how they are and/or can be implemented in developmental neuroscience. In turn, we highlight how the collaboration between these fields can lead to richer models and more impactful translation. In doing so, we describe the ways in which models from developmental psychopathology can enrich developmental neuroscience and future directions for developmental psychopathology.

The longitudinal role of family conflict and neural reward sensitivity in youth's internalizing symptoms

Adolescence is often associated with an increase in psychopathology. Although previous studies have examined how family environments and neural reward sensitivity separately play a role in youth's emotional development, it remains unknown how they interact with each other in predicting youth's internalizing symptoms. Therefore, the current research took a biopsychosocial approach to examine this question using two-wave longitudinal data of 9353 preadolescents (mean age = 9.93 years at T1; 51% boys) from the Adolescent Brain Cognitive Development study. Using mixed-effects models, results showed that higher family conflict predicted youth's increased internalizing symptoms 1 year later, whereas greater ventral striatum (VS) activity during reward receipt predicted reduced internalizing symptoms over time. Importantly, there was an interaction effect between family conflict and VS activity. For youth who showed greater VS activation during reward receipt, high family conflict was more likely to predict increased internalizing symptoms. In contrast, youth with low VS activation during reward receipt showed high levels of internalizing symptoms regardless of family conflict. The findings suggest that youth's neural reward sensitivity is a marker of susceptibility to adverse family environments and highlight the importance of cultivating supportive family environments where youth experience less general conflict within the family.

Genetic and Environmental Contributions to Subcortical Gray Matter Microstructure and Volume in the Developing Brain

Using baseline (ages 9-10) and two-year follow-up (ages 11-12) data from monozygotic and dizygotic twins enrolled in the longitudinal Adolescent Brain Cognitive Development^SM Study, we investigated the genetic and environmental contributions to microstructure and volume of nine subcortical gray matter regions. Microstructure was assessed using diffusion MRI data analyzed using restriction spectrum imaging (RSI) and diffusion tensor imaging (DTI) models. The highest heritability estimates (estimate [95% confidence interval]) for microstructure were found using the RSI model in the pallidum (baseline: 0.859 [0.818, 0.889], follow-up: 0.835 [0.787, 0.871]), putamen (baseline: 0.859 [0.819, 0.889], follow-up: 0.874 [0.838, 0.902]), and thalamus (baseline: 0.855 [0.814, 0.887], follow-up: 0.819 [0.769, 0.857]). For volumes the corresponding regions were the caudate (baseline: 0.831 [0.688, 0.992], follow-up: 0.848 [0.701, 1.011]) and putamen (baseline: 0.906 [0.875, 0.914], follow-up: 0.906 [0.885, 0.923]). The subcortical regions displayed high genetic stability (rA = 0.743-1.000) across time and exhibited unique environmental correlations (rE = 0.194-0.610). Individual differences in both gray matter microstructure and volumes can be largely explained by additive genetic effects in this sample.

The role of stress phenotypes in understanding childhood adversity as a transdiagnostic risk factor for psychopathology

Childhood adversity is a leading transdiagnostic risk factor for psychopathology, being associated with an estimated 31-62% of childhood-onset disorders and 23-42% of adult-onset disorders (Kessler et al., 2010). Major unresolved theoretical challenges stem from the nonspecific and probabilistic nature of the links between childhood adversity and psychopathology. The links are nonspecific because childhood adversity increases risk, through a range of mechanisms, for diverse forms of psychopathology and are probabilistic because not all individuals exposed to childhood adversity develop psychopathology. In this article, we propose a path forward by focusing on stress phenotypes, defined as biobehavioral patterns activated in response to stressors that can disrupt future functioning when persistent (e.g., reward seeking, social withdrawal, aggression). This review centers on the accumulating evidence that psychopathology appears to be more strongly predicted by behavior and biology during states of stress. Building on this observation, our theoretical framework proposes that we can model pathways from childhood adversity to psychopathology with greater specificity and certainty by understanding stress phenotypes, defined as patterns of behavior and their corresponding biological substrates that are elicited by stressors. This approach aims to advance our conceptualization of mediating pathways from childhood adversity to psychopathology. Understanding stress phenotypes will bring us closer to "precision mental health," a person-centered approach to identifying, preventing, and treating psychopathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Executive Network Activation Moderates the Association between Neighborhood Threats and Externalizing Behavior in Youth

Neighborhood threats can increase risk for externalizing problems, including aggressive, oppositional, and delinquent behavior. Yet, there is substantial variability in how youth respond to neighborhood threats. Difficulty with cognitive functioning, particularly in the face of emotional information, may increase risk for externalizing in youth who live in neighborhoods with higher threats. However, little research has examined: 1) associations between neighborhood threats and executive networks involved in cognitive functioning or 2) whether executive networks may amplify risk for externalizing in the context of neighborhood threats. Further, most research on neighborhood threats does not account for youth's experiences in other social contexts. Utilizing the large, sociodemographically diverse cohort of youth (ages 9-10) included in the Adolescent Brain Cognitive Development^SM Study, we identified four latent profiles of youth based on threats in their neighborhoods, families, and schools: low threat in all contexts, elevated family threat, elevated neighborhood threat, and elevated threat in all contexts. The elevated neighborhood threat and elevated all threat profiles showed lower behavioral performance on an emotional n-back task relative to low threat and elevated family threat profiles. Lower behavioral performance in the elevated neighborhood threat profile specifically was paralleled by lower executive network activity during a cognitive challenge. Moreover, among youth with lower executive network activity, higher probability of membership in the elevated neighborhood threat profile was associated with higher externalizing. Together, these results provide evidence that interactions between threats that are concentrated in youth's neighborhoods and attenuated executive network function may contribute to risk for externalizing problems.

Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity

Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners, and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual, and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally informed research, because structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice, and policy that connect biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from classrooms through laboratories, hospitals, and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.

Continuity versus change in latent profiles of emotion regulation and working memory during adolescence

Significant structural and functional brain development occurs during early adolescence. These changes underlie developments in central neurocognitive processes such as working memory (WM) and emotion regulation (ER). The preponderance of studies modeling trajectories of adolescent brain development use variable-centered approaches, omitting attention to individual differences that may undergird neurobiological embedding of early life stress and attendant psychopathology. This preregistered, data-driven study used latent transition analysis (LTA) to identify (1) latent profiles of neural function during a WM and implicit ER task, (2) transitions in profiles across 24 months, and 3) associations between transitions, parental support, and subsequent psychopathology. Using two waves of data from the ABCD Study (Mage T1 = 10; Mage T2 = 12), we found three unique profiles of neural function at both T1 and T2. The Typical, Emotion Hypo-response, and Emotion-Hyper response profiles were characterized by, respectively: moderate amygdala activation and fusiform deactivation; high ACC, fusiform, and insula deactivation; and high amygdala, ACC, and insula response to ER. While 69.5 % remained in the Typical profile from T1 to T2, 27.8 % of the sample moved from one profile at T1 to another at T2. However, neither latent profiles nor transitions exhibited associations between parental support or psychopathology symptoms.

Hippocampal volume indexes neurobiological sensitivity to the effect of pollution burden on telomere length in adolescents

Exposure to environmental pollutants has been associated with cellular aging in children and adolescents. Individuals may vary, however, in their sensitivity or vulnerability to the effects of environmental pollutants. Larger hippocampal volume has emerged as a potential index of increased sensitivity to social contexts. In exploratory analyses (N = 214), we extend work in this area by providing evidence that larger hippocampal volume in early adolescence reflects increased sensitivity to the effect of neighborhood pollution burden on telomere length (standardized β = -0.40, 95% CI[-0.65, -0.15]). In contrast, smaller hippocampal volume appears to buffer this association (standardized β = 0.02). In youth with larger hippocampal volume, pollution burden was indirectly associated with shorter telomere length approximately 2 years later through shorter telomere length at baseline (indirect standardized β = -0.25, 95% CI[-0.40, 0.10]). For these youth, living in high or low pollution-burdened neighborhoods may predispose them to develop shorter or longer telomeres, respectively, later in adolescence.

Neural Response to Social Exclusion Moderates the Link Between Adolescent Anxiety Symptoms and Substance Use

BACKGROUND

Substance use (SU) typically increases from middle to late adolescence. Anxiety is one factor associated with greater SU, although variability in who uses substances remains. Some models suggest that brain-based susceptibility markers could reveal which adolescents are at a higher risk for psychopathology, but it is unknown whether these individual differences attenuate or accentuate the association between anxiety and elevated SU even if normative. This study addressed this gap by testing whether neural response to social exclusion moderates the association between anxiety symptoms and increased SU from middle to late adolescence.

METHODS

Participants were 181 Mexican-origin adolescents (48% female; 16-17 years old) who completed a social exclusion task during a functional magnetic resonance imaging scan and filled out questionnaires about their SU and anxiety symptoms. Analyses focused on neural response to social exclusion versus inclusion within 3 regions of interest and change in SU across 2 years.

RESULTS

Dorsal anterior cingulate cortex response to social exclusion, but not subgenual anterior cingulate cortex or anterior insula, moderated the relation between anxiety symptoms and SU, such that higher anxiety symptoms predicted a greater relative increase in SU only for those youth with a lower dorsal anterior cingulate cortex response to exclusion.

CONCLUSIONS

Blunted dorsal anterior cingulate cortex response to social exclusion may serve as a neural susceptibility marker of altered conflict monitoring or emotion regulation in middle adolescence that, in combination with high levels of anxious feelings, elevates the risk for onset of and/or increased SU by late adolescence. These findings have implications for designing targeted interventions to mitigate SU among adolescents.

Early Life Stress and Neurodevelopment in Adolescence: Implications for Risk and Adaptation

An alarming high proportion of youth experience at least one kind of stressor in childhood and/or adolescence. Exposure to early life stress is associated with increased risk for psychopathology, accelerated biological aging, and poor physical health; however, it is important to recognize that not all youth who experience such stress go on to develop difficulties. In fact, resilience, or positive adaptation in the face of adversity, is relatively common. Individual differences in vulnerability or resilience to the effects of early stress may be represented in the brain as specific patterns, profiles, or signatures of neural activation, structure, and connectivity (i.e., neurophenotypes). Whereas neurophenotypes of risk that reflect the deleterious effects of early stress on the developing brain are likely to exacerbate negative outcomes in youth, neurophenotypes of resilience may reduce the risk of experiencing these negative outcomes and instead promote positive functioning. In this chapter we describe our perspective concerning the neurobiological mechanisms and moderators of risk and resilience in adolescence following early life stress and integrate our own work into this framework. We present findings suggesting that exposure to stress in childhood and adolescence is associated with functional and structural alterations in neurobiological systems that are important for social-affective processing and for cognitive control. While some of these neurobiological alterations increase risk for psychopathology, they may also help to limit adolescents' sensitivity to subsequent negative experiences. We also discuss person-centered strategies that we believe can advance our understanding of risk and resilience to early stress in adolescents. Finally, we describe ways in which the field can broaden its focus to include a consideration of other types of environmental factors, such as environmental pollutants, in affecting both risk and resilience to stress-related health difficulties in youth.

Amygdalar Activation as a Neurobiological Marker of Differential Sensitivity in the Effects of Family Rearing Experiences on Socioemotional Adjustment in Youths

BACKGROUND

Substantial heterogeneity exists in how rearing environments influence youths' socioemotional outcomes. This heterogeneity, as suggested by the biological sensitivity to context theory and the differential susceptibility theory, is associated with emotional reactivity patterns and underlying neural functions. The present study investigated amygdalar reactivity to emotional stimuli as a neural signature that amplified the influence of rearing environments on youths' socioemotional outcomes.

METHODS

To increase replicability and generalizability, this investigation included two independent studies that methodologically complemented each other. Study 1 employed a large, national, longitudinal dataset (the Adolescent Brain Cognitive Development study; N = 11,875). Study 2 used a community sample of youths (N = 123) with multimethod and multireporter assessments.

RESULTS

In study 1, high left amygdalar reactivity to positive stimuli significantly amplified the impact of parental warmth on youths' prosocial behaviors. In study 2, left and right amygdalar reactivity to positive stimuli significantly intensified the associations between family functioning and youths' internalizing problems. These findings were consistent with the biological sensitivity to context theory/differential susceptibility theory hypothesis because significant socioemotional differences were observed at both negative and positive extremes of rearing environments. Additionally, study 2 partially supported the diathesis-stress hypothesis by showing significant differences in youths' vulnerability to negative family environments. Specifically, left amygdalar response to negative stimuli exacerbated the associations between unbalanced family functioning and heightened internalizing/externalizing symptoms. Left amygdalar reactivity to positive stimuli intensified the link between unbalanced family functioning and elevated externalizing problems.

CONCLUSIONS

Among youths and adolescents, amygdalar emotional reactivity may serve as a biomarker of differential sensitivity to rearing environments.

Social neural sensitivity as a susceptibility marker to family context in predicting adolescent externalizing behavior

Adolescence represents a period of risk for developing patterns of risk-taking and conduct problems, and the quality of the family environment is one robust predictor of such externalizing behavior. However, family factors may not affect all youth uniformly, and individual differences in neurobiological susceptibility to the family context may moderate its influence. The current study investigated brain-based individual differences in social motivational processing as a susceptibility marker to family conflict in predicting externalizing behavior in early adolescent youth. 163 adolescents (M_age = 12.87 years) completed an fMRI scan during which they anticipated social rewards and social punishments. For adolescents with heightened ventral striatum and amygdala blood oxygen-level dependent (BOLD) response during the anticipation of social rewards and heightened ventral striatum BOLD response during the anticipation of social punishments, higher levels of family conflict were associated with greater externalizing behavior. BOLD response when anticipating both social rewards and punishments suggested increased susceptibility to maladaptive family contexts, highlighting the importance of considering adolescent social motivation in positive and negatively valenced contexts.

Ecological stress, amygdala reactivity, and internalizing symptoms in preadolescence: Is parenting a buffer?

Ecological stress during adolescent development may increase the sensitivity to negative emotional processes that can contribute to the onset and progression of internalizing behaviors during preadolescence. Although a small number of studies have considered the link among the relations between ecological stress, amygdala reactivity, and internalizing symptoms in childhood and adolescence, these studies have largely been small, cross-sectional, and often do not consider unique roles of parenting or sex. In the current study, we evaluated the interrelations between ecological stress, amygdala reactivity, subsequent internalizing symptoms, and the moderating roles of parenting and sex among 9- and 10-year-old preadolescents from the Adolescent Brain Cognitive Development (ABCD) Study ®. A subset of participants who met a priori quality control criteria for bilateral amygdala activation during the EN-back faces versus places contrast (N = 7,385; Mean Age = 120 months, SD = 7.52; 49.5% Female) were included in the study. A confirmatory factor analysis was performed to create a latent variable of ecological stress, and multiple structural equation models were tested to evaluate the association among baseline ecological stress and internalizing symptoms one year later, the mediating role of amygdala reactivity, and moderating effects of parental acceptance and sex. The results revealed a significant association between ecological stress and subsequent internalizing symptoms, which was greater in males than females. There was no association between amygdala reactivity during the Faces versus Places contrast and ecological stress or subsequent internalizing symptoms, and no mediating role of amygdala or moderating effect of parental acceptance on the association between ecological stress and internalizing symptoms. An alternative mediation model was tested which revealed that there was a small mediating effect of parental acceptance on the association between ecological stress and internalizing symptoms, demonstrating lower internalizing symptoms among preadolescents one year later. Given the lack of association in brain function, ecological stress and internalizing symptoms in preadolescents in this registered report, effects from comparable small studies should be reconsidered in larger samples.

Heart rate variability moderates the effects of COVID-19-related stress and family adversity on emotional problems in adolescents: Testing models of differential susceptibility and diathesis stress

The COVID-19 pandemic is a unique period of stress, uncertainty, and adversity that will have significant implications for adolescent mental health. Nevertheless, stress and adversity related to COVID-19 may be more consequential for some adolescents' mental health than for others. We examined whether heart rate variability (HRV) indicated differential susceptibility to mental health difficulties associated with COVID-19 stress and COVID-19 family adversity. Approximately 4 years prior to the pandemic, we assessed resting HRV and HRV reactivity to a well-validated stress paradigm in 87 adolescents. During the pandemic, these adolescents (ages 13-19) reported on their health-related stress and concerns about COVID-19, family adversity related to COVID-19, and their recent emotional problems. The association between COVID-19 stress and emotional problems was significantly stronger for adolescents who previously exhibited higher resting HRV or higher HRV reactivity. For adolescents who exhibited lower resting HRV or HRV augmentation, COVID-19 stress was not associated with emotional problems. Conversely, lower resting HRV indicated vulnerability to the effect of COVID-19 family adversity on emotional problems. Different patterns of parasympathetic functioning may reflect differential susceptibility to the effects of COVID-19 stress versus vulnerability to the effects of COVID-19 family adversity on mental health during the pandemic.

Mapping future directions to test biopsychosocial pathways to health and well-being

The original biopsychosocial (BPS) model by Engel, although important for challenging the biomedical model and adding psychological and social factors to the study of health, has long been criticized for being too vague and untestable. The BPS-Pathways model introduced by Karunamuni et al. (2020) builds on the original model by making the model more specific and testable. The authors cite research that provides support for individual pathways between biological, psychological, and social variables that influence subjective well-being and physical health. The current commentary discusses three considerations for scientists and practitioners using the model, including: 1) expanding the range of outcomes that should be considered within the model to include mental health and societal well-being, 2) considering how certain factors may fall into more than one category (biological, psychological, and/or social), and 3) considering ways that social factors may directly affect biology independent of psychological mediation. Future directions are discussed, which include considering biopsychosocial pathways across development, studying individual differences in susceptibility to specific biological, psychological, or social factors, and using rigorous methods such as randomized controlled trials and advanced statistical tools at the biological, psychological, and societal levels to test these pathways and create more effective interventions.