ABSTRACT
Background: During the COVID-19 pandemic, healthcare workers (HCWs) were required to make flexible decisions in a rapidly changing environment under significant stress. Linking subjective and physiological markers of stress to quantitative measures of decision-making is critical for understanding the resilience of healthcare workers during the pandemic. The aim of this study was to utilize an explore-exploit computational psychiatry paradigm to measure the effects of COVID-19 related stress on decision-making flexibility. Methods: We utilized biomarker and survey data to query chronic stress;123 participants completed the survey and 54 hair samples were collected. Cortisol was measured with LC/MS/MS. We evaluated explore/exploit behavior with a resting three-arm bandit task, and 66 completed the task. Results: Eighty-seven met criteria for COVID-19 related PTSD, however, we found no significant correlation between hair cortisol and symptoms measures. In contrast, we found that participants with higher hair cortisol exhibited greater exploitation (Pearsons’ r=-0.36, p=0.046). Additionally, explore-state reward-dependent switching behavior, a state-specific measure of learning from reward, significantly decreased with increasing cortisol (r=-0.49, p=0.007). Further, in a basic 3-parameter reinforcement learning model, the learning rate alpha inversely correlated with cortisol (r =-0.467, p=0.007). Conclusions: Computational model-derived decision-making variables demonstrated a robust correlation with hair cortisol concentrations. Without this task, biomarker data may appear independent of chronic stress. This study highlights the importance of quantitative behavioral tasks and physiological signals to understanding the interaction of mood and cognition with stress. Supported By: This work was supported by the University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant. Research in this publication was also supported in part by the Office Of The Director, National Institutes of Health under Award Number P51OD011106 to the Wisconsin National Primate Research Center, University of Wisconsin-Madison. This research was conducted in part (as applicable) at a facility constructed with support from Research Facilities Improvement Program grant numbers RR15459-01 and RR020141-01. Keywords: Cognitive Flexibility, Hair Cortisol, COVID-19 Pandemic, Computational Psychiatry