Fig. 4: Associations between ACEs, hypervigilance regarding COVID-19, inflammation, social networks, and psychological distress over time.

The hypothesized paths of (A) ACEs → hypervigilance regarding COVID-19/inflammation → baseline/changes in social networks → psychological distress and (B) ACEs → baseline/changes in social networks → hypervigilance regarding COVID-19/inflammation → psychological distress are shown. Thick lines show the paths with p < 0.05, thin lines show the paths with p < 0.10, and dashed lines show the paths with p > 0.10. ^†p < 0.10, *p < 0.05, **p < 0.001. Models were adjusted for age, sex, household income, and household education (n = 436 participants were included). The model for CRP was additionally adjusted for smoking and BMI. ACEs adverse childhood experiences, PD psychological distress, CRP C-reactive protein, SNS social network size, SND social network diversity.