Interactions Between Early-Life Adversity, Pandemic Stress, and Social Support on Psychiatric Disorders in a Nationally Representative Sample of Canadian Adults

Abstract PURPOSE Mental health problems increased during the COVID-19 pandemic, but the interaction between pandemic stress, early-life adversity, and social support in predicting mental health is not well understood. This study examined independent and interactive associations between pandemic stress, early-life adversity, and social support on psychiatric disorders in a nationally-representative sample of Canadian adults. METHODS Participants (n = 9,409) were from the Mental Health and Access to Care Survey, a cross-sectional survey of Canadian adults during the pandemic. Measures included pandemic stressors (Statistics Canada), early-life adversity (Childhood Experiences of Violence Questionnaire), social support (Social Provisions Scale), and past 12-month psychiatric problems (World Mental Health-Composite International Diagnostic Interview). Statistical analyses included two-step logistic regression models adjusted for covariates and weighted for complex survey design. RESULTS Early-life adversity (aOR = 1.24 [1.15–1.35]-aOR = 1.53 [1.39–1.69]) and pandemic stress (aOR = 1.18 [1.12–1.25]-aOR = 1.32 [1.26–1.39]) were associated with higher odds of psychiatric problems. Significant interactions between early-life adversity and pandemic stress for depression (aOR = 0.96 [0.93–0.98]) suggested an attenuated effect of pandemic stress at higher levels of early-life adversity. Social support was negatively associated with psychiatric problems (aOR = 0.88 [0.86–0.91]-aOR = 0.97 [0.94–0.99]), while pandemic stress was positively associated (aOR = 1.20 [1.15–1.26]-aOR = 1.33 [1.27–1.40]). An interaction between social support and pandemic stress for suicidality (aOR = 1.02 [1.01–1.03]) suggested higher odds of pandemic stress at higher levels of social support. CONCLUSION Early-life adversity and pandemic stress increased psychiatric disorder likelihood, while social support was protective. However, complex interactions indicate nuanced relationships in mental health risk during the pandemic.