In the Face of Potential Harm: The Predictive Validity of Neural Correlates of Performance Monitoring for Perceived Risk, Stress, and Internalizing Psychopathology During the COVID-19 Pandemic

Background The COVID-19 pandemic is a major life stressor posing serious threats not only to physical but also to mental health. To better understand mechanisms of vulnerability and identify individuals at risk for psychopathological symptoms in response to stressors is critical for prevention and intervention. The error-related negativity (ERN) has been discussed as a neural risk marker for psychopathology, and this study examined its predictive validity for perceived risk, stress, and psychopathological symptoms during the COVID-19 pandemic.Methods A total of 113 individuals who had participated as healthy control participants in previous electroencephalography studies (2014-2019) completed a follow-up online survey during the first COVID-19 wave in Germany. Associations of pre-pandemic ERN and correct-response negativity (CRN) with perceived risk regarding COVID-19 infection, stress, and internalizing symptoms during the pandemic were examined using mediation models.Results Pre-pandemic ERN and CRN were associated with increased perceived risk regarding a COVID-19 infection. Via this perceived risk, the ERN and CRN were associated with increased stress during the pandemic. Furthermore, risk perception and stress mediated indirect effects of ERN and CRN on internalizing psychopathology, including anxiety, depression, and obsessive-compulsive symptoms, while controlling for the effects of pre-pandemic symptom levels.Conclusions In summary, heightened pre-pandemic performance monitoring showed indirect associations with increases in psychopathological symptoms during the first COVID-19 wave via effects on perceived COVID-19 risk and stress. These results further strengthen the notion of performance monitoring event-related potentials as transdiagnostic neural risk markers and highlight the relevance of stress as a catalyst for symptom development.