The Psychological Impact of the Coronavirus Pandemic and the Importance of Resilience

The coronavirus pandemic, caused by the December 2019 outbreak of the novel coronavirus SARS-CoV-2, brought abrupt and pervasive changes in our lives that go beyond the infection itself. For many, the pandemic period has comprised an ongoing set of stressful experiences such as fear of contracting the virus, social isolation, inadequate information, witnessing death or suffering, financial difficulties, stigma, and inadequate supplies (1). A massive amount of research is being done to investigate the impact of these stresses and the long-term effects on mental health that many fear will linger long after the pandemic has subsided (2). One important factor determining a person’s perceived level of stress is resilience, which represents a person’s ability to return to equilibrium when difficulties occur. Resilience can be thought of as comprising both a psychological and a biological component, with the former being defined as a psychological process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress, or bouncing back from difficult experiences (3), and the latter pointing to the role of distinct neurobiological substrates associated with response adaptation to adverse life events [e.g., (4)]. As such, resilience (both psychological and biological) may act as a buffer and may protect individuals against the deleterious effects of stress that may have been triggered by traumatic life events. Investigating the association between pandemic-related perceived stress and mental health changes in the context of resilience may provide critical information to understand changes in people’s well-being and may inform the management of future pandemics.

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In the current issue of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, Cabello-Toscano et al. (5) investigate the psychological and biological factors associated with interindividual differences in mental health resilience related to the pandemic. The study includes a large sample of healthy individuals (mean age about 54 years) from the Barcelona Brain Health Initiative—a cohort in which all participants had mental health symptoms, including anxiety and depression, collected before and during the pandemic. These data were used to investigate whether the pandemic might have exacerbated individuals’ mental health challenges as well as to investigate the influence of sociodemographic factors (age, sex, and education) on these potential changes. Moreover, additional questionnaires were administered during the pandemic to assess the participants’ perceived level of stress and psychological resilience, the latter measured with the Brief Resilient Coping Scale. Cabello-Toscano et al. used these data to determine whether pandemic-related perceived stress could explain the change in anxiety and depressive symptoms as well as whether coping strategies (psychological resilience) attenuated the effect of these associations. Moreover, a smaller subsample also had resting-state functional magnetic resonance imaging data acquired before the pandemic. Cabello-Toscano et al. used these data to assess functional brain network strength through a metric called system segregation (SyS). Specifically, resting-state functional correlation networks measured using functional magnetic resonance imaging are thought to emerge from neural dynamics and may represent large-scale brain networks consisting of multiple segregated subnetworks of interacting brain areas (6). SyS summarizes the balance between integration within and between networks using a single value and has been implicated in vulnerability to brain damage as well as resilience [e.g., (7)]. As such, Cabello-Toscano et al. aimed to investigate whether SyS values from 7 brain networks, originally defined by Yeo et al. (8), could modulate the impact of perceived stress on mental health.

Cabello-Toscano et al. (5) found that participants had been experiencing low to moderate levels of stress—a finding that is in line with other studies examining perceived stress related to the pandemic [e.g., (9)]. The participants also reported overall decreased mental health compared with pre-pandemic levels, a finding that adds to the reports of a measurable impact of the pandemic on mental health in healthy middle-aged individuals. In-depth analyses revealed that stress predicted the change in mental health, such that higher perceived stress levels were associated with greater mental health changes. Importantly, Cabello-Toscano et al. also found that the association between perceived stress and mental health was attenuated by resilience—both psychological and biological—revealing a critical piece of information for intervention studies focused on supporting individuals who are navigating stressful situations. Specifically, using a graph theory approach, the authors found that 2 networks, the frontoparietal control network and the default mode network, operated in opposite manners to moderate the effects of perceived stress on changes in depression and anxiety. Both networks have been associated with resilience processes, but whereas the effect was attenuated by lower SyS values in the frontoparietal control network, the same effect was attenuated by higher SyS values in the default mode network. Although the biological mechanism of these findings is yet to be unraveled, it nonetheless supports the idea of a neurobiological substrate of resilience that seems to have an impact on mental health outcome.

Cabello-Toscano et al. (5) noted that these findings provide support for the diathesis-stress (or vulnerability-stress) model of psychopathology (10). Diathesis comes from the Greek term (διάθεσις) for a predisposition, and the model attempts to explain an (abnormal) state or condition as the result of an interaction between a predispositional vulnerability, the diathesis, and stress caused by life experiences (10). According to Ingram and Luxton (10), the diathesis can take the form of genetic, psychological, situational, or biological traits or factors. In this context, one could interpret the strength of the brain networks as a neurobiological marker or trait, suggesting that some individuals (indicated by altered connectivity measures) may be particularly vulnerable to developing mental health disorders because of the stresses experienced during the pandemic. However, given the small numbers of individuals (10%) that scored above the clinical cutoff scores for clinical depression or anxiety assessments collected by the authors during the pandemic, longer follow-up times may be needed to fully confirm this statement. In contrast, the results also support the notion that resilience can act as a protective factor against mental health decline, a finding that may have implications for a wide range of interventions and clinical trials focused on extending health lifespan in adults. For instance, the status of functional brain networks may not only provide valuable predictors of the probability of response to an intervention but also reveal neural mechanistic effects of successful treatments. Subsequently, this technique could potentially be used in combination with methods using noninvasive brain stimulation (e.g., transcranial magnetic stimulation) to treat depression and/or anxiety.

In summary, the work by Cabello-Toscano et al. (5) provides an important piece of the puzzle as we continue to understand the long-term impact of the coronavirus pandemic, particularly the non–virally mediated psychological effect it has had on the individual. The findings of this work suggest that resilience—both psychological and biological—is critical for coping with stress during the coronavirus pandemic and may provide protection against worsening mental health. As such, these results add to the discussion about the need to augment resilience to mitigate the impact on mental health in this or in a future pandemic. Beyond this work, there are still questions about the extensibility of these findings to other negative psychological effects induced by the pandemic (e.g., feelings of distress, mood disorders, or behavioral disorders). In addition, more research is needed to investigate these associations in vulnerable groups, such as minority ethnic groups, as they may have been disproportionally impacted by the pandemic, resulting in a greater health disparity gap in both physical and mental well-being. As we advance with research in this field, the answers will provide valuable future directions for developing strategies to enhance individual resilience as well as intervention studies focused on successful aging.