Study investigates risk exposure models for negative COVID-19 impact in youths

In a recent study posted to the Research Square* preprint server and currently under review at Scientific Reports, a team of researchers from Utrecht University, the Netherlands, performed a cross-sectional study to investigate the effect of risk exposure on the negative coronavirus disease 2019 (COVID-19) impact and its consequent association with youth well-being, life satisfaction, and internalizing symptoms.

Study: Examination of risk exposure models during COVID-19 in relation to youth life satisfaction and internalizing symptoms. Image Credit: Halfpoint/Shutterstock
Study: Examination of risk exposure models during COVID-19 in relation to youth life satisfaction and internalizing symptoms. Image Credit: Halfpoint/Shutterstock

They applied four models of risk exposure – additive risk model (ARM), cumulative risk model (CRM), risk clusters, and the most salient risk features.


Several studies have revealed increased loneliness, depression, anxiety, and other negative effects on mental and social health among adolescents due to the restrictions and safety measures imposed during the COVID-19 pandemic. COVID-19-related restrictions and lockdowns have increased the frequency and intensity of the risk factors to which families and youths were exposed.

The effect of the non-exponential sum of risk factors was referred to as ARM and the impact of the exponential accumulation of risk was called CRM. Additive and cumulative risk exposures were associated with stronger COVID-19 impact, which in turn was associated with reduced youth psychological well-being. The present study was designed to assess the effect of additive and cumulative risk exposure on the negative COVID-19 impact.

Study design

In this study, the authors utilized data from an ongoing longitudinal digital family research project on a media platform between April 2020 to July 2020 in Dutch. The participants included families having at least one child between 9-18 years and were recruited through various channels such as Utrecht University media, social media, personal communications, school newsletters, etc.

The authors measured different youth parameters such as life satisfaction, internalizing symptoms, the negative impact of COVID-19 pandemic and related restrictions, self-control, social competence, negative parent-child interaction, parental responsiveness, frequency of parent-child joint activity.

Parental variables like stress, depression, anxiety among mothers and fathers were also measured. Demographic characteristics gathered included variables like educational levels of youth, parental highest achieved education level, socioeconomic status (SES), household size, parent-child ratio, and family composition. Multiple regression analyses examined the mediation effect of ARM and CRM on internalizing symptoms and life satisfaction through negative COVID-19 impact.


The findings of the study demonstrated that negative COVID-19 impact predicted a significant 17.2% and 19.8% variability in life satisfaction and youths internalizing symptoms, respectively. The negative COVID-19-impact was higher for girls as compared to boys. Moreover, regression analysis showed a significant positive association between negative COVID-19 impact and age.

The additive risk model predicted a significant 3.5% variability in life satisfaction and related significantly to negative COVID-19 impact, while the regression model predicted a significant 22% variability in life satisfaction.

On analysis using internalizing symptoms as the outcome variable, the authors observed that additive risk was not significantly associated with internalizing symptoms even after adding negative COVID-19-impact to the model. However additive risk was related significantly to the negative COVID-19 impact with 4.9% variability and the negative impact of COVID-19 was responsible for a significant 21.8% variability in internalizing symptoms.

Hierarchical regression models for risk clusters demonstrated that individual factors were a significant culture. However, self-control was the only statistically significant predictor. In negative COVID-19 impact, parenting constituted a significant 8.4% variability. The significant predictors within the parenting factors were negative interaction with mothers and parental responsiveness.

The authors observed that maternal mental health predicting 2.6% variability was significant as a cluster with no significant factors within the model. Paternal mental health was not significant but paternal depression was significant within the insignificant model.

In negative-COVID-19 impact, family constellation predicted a significant 2.3% variability. In this model, the parent-child ratio was the significant risk factor. Lastly, it was noted that demographic characteristics were significantly associated with the negative COVID-19 impact with predicting 4% variability. Among the demographic factors, paternal educational level and SES were significant.

Intriguingly, a full model of these risk factors explained the significant 22.1% variability in negative-COVID-19 impact. Among the model self-control, SES, parental responsiveness, and negative interaction with mothers remained significant.


Overall, the results of the study highlighted that negative experience related to the COVID-19 pandemic and restrictions was distinctly associated with reduced satisfaction towards life and a rise in internalizing symptoms among youth aged 9 to 18 years. The COVID-19-related negative impact was higher for girls and increased with age. This negative COVID-19 impact was associated with additive and cumulative risk exposure.

The significant risk factors clusters associated with stronger COVID-19 impact were demographic features such as reduced SES and increased paternal educational value, individual factors like reduced self-control, cluster maternal mental health, and parenting including reduced parental response and negative mother-child interaction.

The specific strength of this study included the use of the subject’s natural environment, the use of well-researched and standardized instruments, and the ability to differentiate between additive and cumulative risks. The authors warrant the need for further longitudinal research to unveil the long-term impact of COVID-19 restrictions on the development of youth and its effect on vulnerable populations.

*Important notice

Research Square publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Sangeeta Paul

Written by

Sangeeta Paul

Sangeeta Paul is a researcher and medical writer based in Gurugram, India. Her academic background is in Pharmacy; she has a Bachelor’s in Pharmacy, a Master’s in Pharmacy (Pharmacology), and Ph.D. in Pharmacology from Banasthali Vidyapith, Rajasthan, India. She also holds a post-graduate diploma in Drug regulatory affairs from Jamia Hamdard, New Delhi, and a post-graduate diploma in Intellectual Property Rights, IGNOU, India.


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