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Since the novel coronavirus disease 2019 (COVID-19) has been declared a pandemic in March 2020 (World Health Organization, 2020), extensive public health actions to slow down the spread of the virus (e.g., social distancing, self-isolation) have been implemented worldwide. While these actions were implemented “to flatten the curve”, they also come along with an enormous impact on public mental health. Investigating mental health effects of the COVID-19 pandemic in the general population and vulnerable groups has thus been proposed as an immediate research priority (Holmes et al., 2020).
Emerging evidence suggests that individuals who have been exposed to childhood traumatic experiences (CTEs) might be particularly vulnerable to the negative psychological effects of the COVID-19 pandemic and its associated countermeasures. While exposure to CTEs has been associated with elevated levels of psychopathology, including posttraumatic stress disorder (PTSD) symptomatology, during the COVID-19 pandemic (e.g., Chi et al., 2020), social support has been reported to mitigate the adverse mental health effects of the pandemic (Marroquín et al., 2020). Additionally, fear of COVID-19 should also be considered when investigating mental health effects of the COVID-19 pandemic in childhood trauma-exposed individuals, given that CTEs have been associated with higher levels of health anxiety in clinical and general population samples (Thorgaard et al., 2018). Together, these findings suggest that childhood trauma-exposed individuals, both with and without a history of mental illness, might be exceptionally burdened by the COVID-19 pandemic and its associated social restrictions. However, thus far, most studies on mental health effects of the COVID-19 pandemic have relied on cross-sectional data, and pre-post analyses with prepandemic data have been scarce.
The aim of this prospective study was to investigate whether general psychopathology and PTSD symptom severity increase in individuals with varying levels of CTEs during the COVID-19 pandemic compared to prepandemic baseline data. Furthermore, we investigated whether an increase in symptomatology is linked to CTEs and mediated by lack of perceived social support and fear of COVID-19. We collected pre-pandemic baseline data (i.e., interview and self-report data on CTEs, clinical characteristics, and psychiatric disorders) between September 2018 and November 2019 (i.e., 2-16 months before the COVID-19 outbreak in Germany) within the scope of a larger study. We assessed peri-pandemic data (i.e., self-report data on clinical characteristics) during the first most severe shut-down in Germany (i.e., April to May 2020) via an online survey. A total of 85 individuals with varying levels of CTEs completed our online survey, including participants with PTSD (n = 17), major depression (n = 20), or somatic symptom disorder (n = 26), and healthy volunteers (n = 22).
As we expected, we found a significant increase in general psychopathology and PTSD symptom severity during as compared to before the COVID-19 pandemic in the whole sample. CTEs predicted the increase in PTSD symptom severity, but not the increase in general psychopathology. The effect of CTEs on the increase in PTSD symptom severity was mediated by a lack of perceived social support, but not fear of COVID-19. 
In these challenging times, one global priority is to develop interventions targeting the potentially detrimental mental health effects of the COVID-19 pandemic in the general population and vulnerable groups. Our results may inform these efforts by emphasizing the importance of promoting social inclusion particularly in individuals with CTEs.

Reference Article

Seitz, K. I., Bertsch, K., & Herpertz, S. C. (in press). A prospective study of mental health during the COVID-19 pandemic in childhood trauma-exposed individuals: Social support mattersJournal of Traumatic Stress.

Discussion Questions

1. Do childhood traumatic experiences or a history of mental illness render individuals more vulnerable to the adverse mental health effects of the COVID-19 pandemic?
2. How may social support be promoted while adhering to strict lockdown measures, including social distancing and self-isolation?
3. After the end of the COVID-19 pandemic, how can we provide psychological support to childhood trauma-exposed individuals to help them recover from the sequelae of the pandemic?

About the Authors

Katja I. Seitz
, MSc, is a psychotherapist, and a PhD student at the Department of General Psychiatry of Heidelberg University, Germany. She focuses on investigating transdiagnostic and diagnosis-specific effects of adverse childhood experiences on social cognition and is a member of the German Research Foundation’s Research Training Group 2350 (“Impact of adverse childhood experiences on psychosocial and somatic conditions across the lifespan”). Katja Seitz can be contacted at katja.seitz@med.uni-heidelberg.de
Prof. Dr. Sabine C. Herpertz,
 MD, is Full Professor of Psychiatry and Director of the Department of General Psychiatry at the University of Heidelberg, Germany. Her key aspects of research activities are early stress related mental disorders, e.g. borderline personality disorder, focusing on impairments of emotion regulation and social cognition using fMRI and psychoendocrinology in addition to neuropsychology and experimental psychopathology. By identifying biobehavioral mechanisms underlying psychological dysfunction, her research group develops mechanism-based treatment options.
Prof. Dr. Katja Bertsch,
 PhD, is a Professor of Clinical Psychology and Psychotherapy at the Department of Psychology, Ludwig-Maximilians-University Munich, Germany. She is interested in investigating interpersonal dysfunctioning, including aggression and social anxiety as well as their neural and endocrine correlates as well as their relation to deficient self-functioning, including interoception and self-control.


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