Perceived stress during the COVID-19 pandemic: Effects of childhood trauma and associations with pandemic alcohol use

Background: The negative impact of the COVID-19 pandemic on stress and mental health both locally and globally has been well publicized in the media, while more scientific data on the specific effects of pandemic-related stressors (e.g., social isolation, economic insecurity, health concerns) are still emerging. Perceived stress, or the degree to which life events are appraised as stressful by an individual, is an important measure to consider in the context of the pandemic as it encompasses emotional and coping responses to life's challenges. Individual differences in stress perception and coping are well documented in the literature and are influenced by a variety of factors, including childhood trauma, personality, and history of AUD. The current study had three objectives: 1) to investigate changes in perceived stress levels due to the pandemic, assessing the role of pandemic wave and alcohol use disorder (AUD) status; 2) to evaluate whether childhood trauma exposure is associated with increased perceived stress during the pandemic; 3) to investigate the association of perceived stress with alcohol use during the pandemic, and the moderating of role of AUD status on this association. Method(s): From June 2020 to March 2021, a sample of participants previously enrolled in NIAAA clinical research studies were contacted by phone and invited to participate in a longitudinal survey study to assess the effect of the pandemic on alcohol use and related outcomes. Following consent, participants completed a survey to obtain pre-pandemic baseline ("In the month before the pandemic [February 2020].") and initial impact data ("In the last month."). Due to rolling enrollment, initial impact data were collected during different "waves" of the pandemic across participants: Wave 1: 3/11/2020-7/ 31/2020; Wave 2: 8/1/2020-11/22/2020; Wave 3: 11/23/2020 onward. The survey included, among other assessments, the Perceived Stress Scale (PSS) and the Alcohol Use Disorder Identification Test (AUDIT). Screening data from when participants initially enrolled in NIAAA clinical research studies, including the PSS, the Childhood Trauma Questionnaire (CTQ) and the NEO Five Factor Personality Inventory, were also included in the current analysis. Participants in the current study (n = 390; 183 females, 207 males) represented a wide spectrum of alcohol use, from nondrinkers to those with severe AUD (219 non-AUD, 171 AUD). Perceived stress scores were compared between pre-pandemic and pandemic timepoints using linear mixed models. Associations between childhood trauma (measured by the five CTQ subscales of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect), pre-pandemic and pandemic perceived stress levels, and alcohol use during the pandemic were analyzed using path analysis. A multigroup path model was utilized to evaluate the moderating effects of AUD status on these associations. Result(s): Overall, perceived stress levels were significantly elevated during the pandemic compared to pre-pandemic (p < 0.0001). There was no interaction effect with pandemic wave, indicating that perceived stress levels were comparable across the three waves. There was a significant interaction between pandemic timepoint and AUD status (p = 0.03), such that perceived stress levels significantly increased in non-AUD participants but not in AUD participants; however, stress levels were higher in the AUD vs. non-AUD participants at both timepoints. These effects remained significant when controlling for perceived stress level, CTQ score, and the NEO neuroticism factor measured at initial screening. Path analysis indicated that emotional abuse, sexual abuse, and emotional neglect were all positively associated with perceived stress levels during the pandemic. Sexual abuse had both a direct effect on perceived stress, and an indirect effect that was mediated by neuroticism and pre-pandemic stress levels; effects of emotional abuse and neglect were all indirect. Alcohol use during the pandemic (AUDITC score) was associated with bo h pandemic perceived stress and pre-pandemic alcohol use, with the latter exhibiting a stronger effect. Analysis of a multigroup path model showed that the direct effect of sexual abuse on pandemic perceived stress was only observed in AUD participants, and that there was a stronger association between pandemic stress and alcohol use in AUD participants. Conclusion(s): Perceived stress levels were elevated during the pandemic among participants across all wave timepoints in which they were initially evaluated, although our results suggest this increase was only true for individuals without AUD. Exposure to childhood trauma was both directly and indirectly associated with increased perceived stress during the pandemic through neuroticism and pre-pandemic stress levels. These findings add to existing evidence that early life stress exposure may sensitize individuals to heightened stress responses later in life. Lastly, alcohol use during the pandemic, while primarily influenced by pre-pandemic consumption levels, was also associated with pandemic perceived stress, particularly in those with AUD. A better understanding of the trajectory and impact of the COVID-19 pandemic on alcohol and related outcomes may help develop interventions that benefit individuals vulnerable to pandemicrelated negative outcomes.