Abstract
BackgroundUsing data from the English & Romanian Adoptees (ERA) study, we recently reported that early time‐limited exposure to severe institutional deprivation is associated with early‐onset and persistent neurodevelopmental problems and later‐onset emotional problems. Here, we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early‐appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress.MethodsThe ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self‐reports; young adults also completed measures of stress reactivity, exposure to adverse life events, and functioning in work and interpersonal relationships.ResultsThe path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive.ConclusionsOur analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model.
Highlights
Institutional deprivation is associated with a range of later psychopathology (Bos et al, 2011; Woodhouse, Miah, & Rutter, 2017)
Weighted group comparisons were closely similar (Table S1), and differences between the Rom > 6 m and UK groups in levels of young adult emotional problems remained when adjusted for levels of adolescent depression and anxiety symptoms in adolescence (Depression: incident rate ratios (IRR) = 1.82, confidence intervals (CI) = 1.02, 3.28, p = .043; generalized anxiety disorder (GAD): IRR = 1.76, CI = 1.09, 2.84, p = .021; general emotional problems: IRR = 1.80, CI = 1.07, 3.02, p = .026)
As the proximal mediators we planned to examine derived from young adult reports, we focused on parent ratings of emotional problem symptoms as the main outcome in the remainder of the analyses to avoid problems of shared variance
Summary
Institutional deprivation is associated with a range of later psychopathology (Bos et al, 2011; Woodhouse, Miah, & Rutter, 2017). Emotional difficulties might be expected to be prominent among these risks: Both psychological theories that assign a foundational role to primary carer relationships (Bakermans-Kranenburg et al, 2011) and biological models of stress system programming through early life adversity (Koss & Gunnar, 2018) predict increased rates of emotional difficulties following institutional deprivation Consistent with these views, elevated rates of internalizing problems have been reported in some institutionalized samples in Conflict of interest statement: See Acknowledgements for full disclosures. The recent completion of the young adult follow-up of the English and Romanian Adoptees (ERA) study has made it possible to examine the longer-term impact of severe early institutional deprivation on risk for emotional problems in young adulthood.
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