Direct and indirect effects of dorsolateral prefrontal cortex and emotion regulation strategy use on mental health during Covid-19

Abstract

Background. Covid-19 and associated restrictions have been linked to negative mental health outcomes across the globe. Cognitive emotion regulation strategies constitute means to mitigating negative affect resulting from stressful life events, possibly offering an opportunity to change negative consequences associated with pandemics. Neuronally, emotion regulation is supported by prefrontal and limbic brain regions, but a direct investigation of brain structural characteristics in association with contextual emotion regulation during prolonged stressful events is yet missing. Methods. Variations in cognitive emotion regulation strategy use, anxiety and depression scores were assessed in 43 adults (31♀/12♂, age=35.14±9.20y) during the first months following Covid-19 onset and again at the end of 2020 (seven repeated measures assessments). Pre-pandemic behavioral and neuroimaging measures were available for all participants, allowing the investigation of mediating effects of pre-pandemic emotion regulatory brain structures and use of cognitive emotion regulation strategies during the pandemic on mental well-being at the beginning and end of the first pandemic year. Results. Heightened, but varying levels of anxiety and depression were observed across 2020. While adaptive emotion regulation strategies were most frequently employed, maladaptive strategies explained the highest variation in negative mental health outcomes (i.e., anxiety and depression scores). Adaptive strategies had a positive, maladaptive strategies a negative effect, however, this direction varied when considering long-term mental health effects. Emotion regulation strategy use mediated the association between pre-pandemic emotion regulatory brain structure (i.e., cortical thickness) in right dorsolateral prefrontal cortex and mental health, with prefrontal-amygdala coupling as a possible driving factor. Additionally, early mental health measures impacted later mental well-being. Conclusion. Maladaptive emotion regulation strategies have a negative effect on mental health during prolonged stress as induced by pandemics. Interventions targeting the reduction of maladaptive emotion regulation strategies may provide a way to counteract negative effects, thus offering a window of opportunity for action.