Behavioral Inhibition Helps Predict Increased Anxiety Due to COVID-19 Pandemic

Selin Zeytinoglu, PhD

While the coronavirus disease 2019 (COVID-19) pandemic has increased the stress and anxiety for virtually everyone across the globe, a select few particularly prone to heightened anxiety may have struggled the most.

A team, led by Selin Zeytinoglu, PhD, Department of Human Development and Quantitative Methodology, University of Maryland, examined a developmental pathway from behavioral inhibition (BI), a temperament characterized by a fearful response toward novelty, to changes in young adult individuals’ anxiety during the initial period of the pandemic.

Currently, there is little known about the early life predictors of anxiety during a pandemic like what has occurred worldwide in the last year. Going into the study, the researchers believed a stable pattern of behavioral inhibition across early childhood could predict greater adolescent worry dysregulation, which could help forecast increases in young adult anxiety during a stressful phase of the pandemic.

Behavioral Inhibition

Behavioral inhibition, characterized by high levels of cautious, fearful, and avoidant responses to unfamiliar people, objects, and situations is considered 1 of the best childhood predictors of later anxiety.

This type of patient can manifest in specific ways, leading to heightened anxiety in young adulthood with difficulties regulating worry and negative emotions during adolescence.

The measure is predictive of a 3-4 fold increased risk of developing anxiety disorders, with approximately 40% of children high in behavioral inhibition will develop clinical levels of anxiety.

There is also evidence suggesting that emotion dysregulation mediates the relation between early BI and later socioemotional problems, while children who demonstrate a stable pattern of BI may be at a greater risk for later difficulties managing worry and displaying inappropriate expressions of worry

The Study

The study included 291 patients who were followed from toddlerhood to young adulthood. The researchers observed behavioral inhibition at ages 2-3 and social wariness at age 7. Each participant also rated their worry dysregulation in adolescent at age 15 and anxiety in young adulthood at age 18 with a pair of assessments during the COVID-19 pandemic, 1 month apart.

The researchers found a significant moderated mediation, where a stable pattern of behavioral inhibition from toddlerhood to childhood, which is compared to the absence of this pattern, predicted greater worry dysregulation in adolescence.

“This study identifies a developmental pathway from toddlerhood BI to young adults’ elevated anxiety during the COVID-19 pandemic,” the authors wrote. “Findings have implications for early identification of individuals at risk for dysregulated worry and the prevention of anxiety during stressful life events in young adulthood.”

Government entities have taken a number of measures to limit the spread of COVID-19, particularly during the beginning of the pandemic. These measures including social distancing requirements and shelter-in-place regulations. However, they also have had an impact on the collective mental health globally.

The study, “A Developmental Pathway From Early Behavioral Inhibition to Young Adults’ Anxiety During the COVID-19 Pandemic,” was published online in the Journal of the American Academy of Child & Adolescent Psychiatry.