How Pre-Pandemic Emotion Regulation Shielded Mental Health During COVID-19

When the COVID-19 pandemic swept across the globe in early 2020, it did more than disrupt daily routines; it launched one of the largest unplanned stress experiments in modern history. Millions of young people suddenly faced school closures, social isolation, family strain, and an unrelenting sense of uncertainty. Yet while population-level surveys documented rising rates of depression, anxiety, and sleep disturbance, something equally striking became clear: individuals responded very differently to the same crisis. Some deteriorated sharply, while others remained remarkably stable. Understanding why has become one of the central questions in developmental psychopathology, and a new study now offers a rare, prospective answer.

Researchers at the Lifespan Brain Institute of the Children’s Hospital of Philadelphia and the University of Pennsylvania took advantage of a fortuitous scientific circumstance. Years before the pandemic began, between May 2017 and August 2019, they had administered in-person clinical assessments and resilience questionnaires to a cohort of youth and young adults as part of work developing the Lifespan Risk and Resilience Battery. When the pandemic struck, the team recontacted participants and assessed their mental health remotely between May and August 2020, roughly 21 months after the baseline visits. Because resilience factors were measured before anyone knew a global crisis was coming, the design sidesteps the recall and reverse-causation problems that plague most pandemic-era research.

The analytic sample included 96 participants with a mean baseline age of 19.34 years, ranging from 8 to 29 years old. Fifty-one percent were female and 59 percent identified as People of Color. Critically, the cohort was psychiatrically enriched: 70 percent met criteria for a lifetime or current psychiatric disorder, including schizophrenia spectrum disorders in 15 percent and subthreshold psychosis-spectrum syndromes such as attenuated psychosis syndrome in 36 percent. Thirty percent had no diagnosis. This deliberate clinical heterogeneity meant the researchers could ask whether pre-existing resilience operated across a broad spectrum of psychiatric vulnerability, not merely in healthy community samples where the stakes are lower.

The study focused on two theoretically grounded resilience processes drawn from the 47-item Risk and Resilience Battery. The first was emotion regulation, assessed with five items from the Difficulties in Emotion Regulation Scale Short Form that capture difficulties modulating emotional responses, such as trouble concentrating or controlling behavior when upset. Scores were reverse coded so higher values reflected greater regulatory capacity. The second was supportive close relationships, measured with four items from the Network of Relationships Inventory assessing the perceived quality of close family bonds, including feelings of care, admiration, and stability with parental figures and siblings. These factors were chosen because developmental resilience frameworks, notably Ann Masten’s account of resilience as ordinary magic arising from interacting intrapersonal and interpersonal systems, position them as distinct yet interconnected regulatory resources.

At follow-up, participants completed brief self-report measures of depression, anxiety, psychosis-spectrum symptoms, and sleep disturbance, including the Patient Health Questionnaire-2, the Generalized Anxiety Disorder-7, a five-item PRIME short form, and the Insomnia Severity Index. The analytical strategy was rigorous. Multivariate regression models controlled for age, sex, race, baseline psychotropic medication use, time between visits, and, crucially, corresponding baseline symptom levels, so the findings reflect protection against new or worsening symptoms rather than simple symptom stability. Given the moderate sample size, the team used nonparametric bootstrapping with 5,000 resamples to generate bias-corrected and accelerated 95 percent confidence intervals, treating coefficients as significant only when those intervals excluded zero.

The results were clear and, in places, striking. Higher pre-pandemic emotion regulation predicted lower anxiety during the pandemic (p = .007), fewer psychosis-spectrum symptoms (p = .034), and fewer sleep problems (p = .002). Notably, resilience factors added 6.7 percent of explained variance to the anxiety model beyond covariates and baseline anxiety, a substantial incremental contribution. Supportive close relationships independently predicted fewer sleep problems (p = .022), although they were not associated with depression, anxiety, or psychotic-like experiences. Neither resilience factor related to depressive symptoms, and neither significantly changed the odds of crossing the screening threshold for elevated depression in supplemental logistic analyses. Baseline psychotropic medication use was not a significant predictor in any model.

The transdiagnostic breadth of the emotion regulation finding carries particular weight. Emotion regulation difficulties have long been implicated across depression, anxiety, and psychosis-spectrum conditions, and stress-diathesis models of schizophrenia posit that stress sensitivity and poor coping fuel psychotic-like experiences such as unusual thoughts, suspiciousness, and perceptual disturbances. The new data extend this literature by showing that regulatory capacity measured nearly two years before a chronic stressor predicted symptom levels across affective and psychosis-spectrum domains while that stressor was still unfolding. Mechanistically, the authors argue, emotion regulation likely functions as an upstream regulator of stress reactivity: individuals with stronger regulatory skills can modulate cognitive, affective, and physiological responses to adversity, reducing vulnerability that would otherwise cascade into multiple symptom domains.

The protective link between supportive family relationships and sleep points to a complementary, downstream mechanism. Theoretical accounts of interpersonal co-regulation propose that close relationships stabilize physiological arousal, dampen hypervigilance, and help restore daily rhythms, processes that are especially important for sleep onset and maintenance. The social buffering literature similarly suggests that supportive ties attenuate hypothalamic-pituitary-adrenal axis reactivity and autonomic arousal, both of which disrupt sleep. During lockdowns, when families became the primary source of co-regulatory support, relationships characterized by emotional reassurance and felt security may have helped preserve healthy sleep routines. Because sleep disturbance is itself a transdiagnostic risk factor for mood, anxiety, and psychosis-spectrum conditions, protecting sleep during chronic stress may prevent broader psychiatric cascades.

The authors are careful to note that these two resilience processes probably do not operate in isolation. Supportive relationships may scaffold emotion regulation capacities through co-regulatory exchange, while individual regulatory skills in turn shape relationship quality and stability over time, creating reciprocal feedback between intrapersonal and interpersonal systems. The lifespan perspective of the sample, spanning ages 8 to 29, captures a window in which prefrontal regulatory networks continue maturing and the primary sources of support shift from parents toward peers, although the study was underpowered to formally test developmental moderation. Limitations also include the absence of baseline sleep measurement, differing symptom instruments across waves, unknown medication status at follow-up, and a clinically enriched sample that may limit generalizability to fully community-based populations.

Even with those caveats, the implications are consequential. As pandemics, climate-related disasters, and political instability make large-scale stressors an increasingly recurring feature of modern life, the study argues for investing in resilience before crises arrive rather than scrambling to treat distress afterward. Emotion regulation is demonstrably amenable to intervention: school-based social-emotional learning programs and transdiagnostic cognitive-behavioral and mindfulness-based therapies have been shown to strengthen regulatory skills across diverse populations. Supportive relationships, meanwhile, can be cultivated through family-level interventions that enhance emotional availability and co-regulation. By showing that qualities measured in ordinary times predicted who fared better during extraordinary ones, the Philadelphia team has provided some of the strongest prospective evidence yet that resilience is not a vague abstraction but a set of identifiable, modifiable, and measurable protective processes with the potential to buffer mental health when the next global storm arrives.

Subject of Research: Prospective prediction of youth mental health during the COVID-19 pandemic from pre-pandemic emotion regulation and supportive close relationships

Article Title: Pre-Pandemic Emotion Regulation and Supportive Relationships as Protective Factors Across Development: Prospective Prediction of Mental Health During the COVID-19 Pandemic

Article References: Kim, I. A., Ered, A., Himes, M. M., Gur, R. E., Rush, S., Moore, T. M., Barzilay, R., Calkins, M. E., & White, L. K. (2026). Pre-Pandemic Emotion Regulation and Supportive Relationships as Protective Factors Across Development: Prospective Prediction of Mental Health During the COVID-19 Pandemic. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-026-02086-4

Image Credits: AI Generated

DOI: 10.1007/s10578-026-02086-4

Keywords: emotion regulation, resilience, COVID-19 pandemic, mental health, supportive relationships, sleep problems, anxiety, psychosis-spectrum symptoms, youth development, protective factors, longitudinal study, Child Psychiatry & Human Development