Cumulative Adversity Research Articles

Linking widowhood and later-life depressive symptoms: Do childhood socioeconomic circumstances matter?

Objectives: Widowhood and adverse childhood socioeconomic circumstances (CSC) have both been linked to increased levels of depressive symptoms in old age. Beyond their independent impact on depressive symptoms, experiencing adverse CSC may also trigger a cascade of cumulative adversity and secondary stressors across the life course that shapes how individuals weather stressful life events later on. Method: We examine whether exposure to adverse CSC moderates the relationship between later-life widowhood and depressive symptoms using data from the Survey of Health, Ageing and Retirement in Europe (2004-2017). Results: Mixed-effects models revealed that both widowhood and adverse CSC were associated with increased levels of depressive symptoms among men and women. Associations between widowhood and depressive symptoms, however, were not moderated by CSC for both genders. Conclusion: Persisting differences in the levels of mental health in response to later-life widowhood did not further widen in the presence of disparities experienced early in the life course. This may reflect the life-altering impact of this age-normative, yet stressful life event across the social strata.

The relationship of cumulative psychosocial adversity with antepartum depression and anxiety.

Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated. Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude. High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.

The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60–64 years of age in the 1946 National Survey of Health and Development

BackgroundEarly life adversity is increasingly prevalent and associated with greater morbidity and mortality. It is hypothesised that the link between psychosocial early life adversity and poor health in adulthood is due to abnormal hypothalamic-pituitary-adrenal (HPA) axis functioning (often measured as cortisol patterning) and inflammation (often measured via c-reactive protein (CRP)). This study aimed to investigate the relationship between early life psychosocial adversity and cortisol patterning and CRP at 60–64 years of age. MethodsThe MRC National Survey of Health and Development (NSHD) was used. The analytic “cortisol sample” included 843 individuals and the “CRP sample” included 1150 individuals. Data on adversity experienced between ages 0–15 years were utilised to compose a cumulative childhood psychosocial early life adversity (ELA) score (0, 1, 2, 3+). CRP and salivary cortisol (waking, 30 min after waking, and evening) were collected at 60–64 years. Associations between the psychosocial ELA score and cortisol outcomes (cortisol awakening response (CAR), diurnal slope (DS), and evening and morning cortisol) were assessed using general linear regression. Tobit regression was used to assess the association between psychosocial ELA score and CRP. Adjustments were made for age at follow-up, sex, childhood maternal education, childhood paternal social class, childhood housing tenure, and birth weight. After testing for sex by ELA score interactions, analyses were repeated stratified by sex for the CRP sample. ResultsIn fully adjusted models, individuals who experienced the highest level of childhood psychosocial adversity (3+) had a 24.63 (−41.49, −7.76) % lower waking cortisol and a 7.30 (1.49, 13.12) % lower decline in cortisol across the day compared to those with a psychosocial ELA score of zero. In females, the highest level of childhood psychosocial adversity, compared to the lowest, was associated with 32.61 (2.98, 62.25) % higher CRP at 60–64 years, which attenuated to 20.38% (−9.38, 50.14) upon adjustment for measures of early life socioeconomic position. Conversely, the association between childhood psychosocial adversity and CRP in males was null. ConclusionsOur results suggest that high-levels of psychosocial adversity in childhood might result in a lower morning cortisol and flatter DS in mid-to-late-adulthood. The finding that adversity was related to higher CRP in females but not males requires replication and further investigation.

Understanding the relations among adverse childhood experiences (ACE), substance use, and reoffending among detained youth

BackgroundSystem-involved youth experience elevated rates of exposure to adverse childhood experiences (ACE), which is related to reentry in the criminal legal system and increased risk of using substances, but there is little research on the indirect role of substance use in the relation between adversity and offending in youth offenders. Notably, the majority of youth report exposure to multiple adverse events and these experiences vary by gender. ObjectiveThe present study aimed to expand upon current literature by evaluating gender differences in the relations among cumulative ACEs, substance use severity, and reoffending in a sample of rural detained youth (N = 417). Methods and ResultsUsing Poisson (count) regression analyses, cumulative adversity significantly predicted reoffending among girls and boys. Additionally, there was a significant indirect effect of ACEs on reoffending via substance use. Girls reported higher exposure to adversity and substance use, and gender significantly interacted with ACEs to predict substance use and reoffending. ConclusionsThese findings demonstrate the importance of cumulative experiences of adversity in childhood and substance use as predictors of youth reentry into the criminal legal system. Understanding the role of substance use in the relation between ACEs and reoffending has the potential to contribute to our knowledge of detained youth's treatment needs and reoffending risk.

Psychosocial adversity and allostatic load burden in midlife and older ages.

To investigate the individual and cumulative impact of childhood and adulthood adversity on allostatic load (AL) burden. Retrospective cross-sectional study design involving 4,165 participants from the first wave of The Irish Longitudinal study on Ageing (TILDA). AL was operationalized using 12 biomarkers across four physiological systems (cardiovascular, metabolic, renal, and immune). Measures of psychosocial adversity included poverty, abuse, loss, and illness. Negative binomial regression models estimated the relationship of individual adversities and a cumulative count of adversities with AL burden, controlling for age and sex. Multivariable models adjusted additionally for a range of other sociodemographic and lifestyle factors. Childhood poverty, childhood physical abuse, and having a spouse/partner/child experience a life-threatening illness/accident were associated with 10% (95% CI [1.04, 1,16]), 10% (95% CI [1.01, 1.18]), and 6% (95% CI [1.01, 1.11]) greater AL burden, respectively. Cumulative adversity was associated with 3% (95% CI [1.01, 1.04]) higher AL burden. Adjusting for sociodemographic and lifestyle covariates rendered the association of childhood poverty (IRR= 1.04, 95% CI [.98, 1.09]; p = .190) and childhood physical abuse (IRR= 1.07, 95% CI [.99, 1.15]; p = .081) with AL burden nonsignificant, while the association of having an ill spouse/partner/child on AL persisted (IRR= 1.06, 95% CI [1.01, 1.11]; p = .021). This study provided limited support for the idea that psychosocial stress leads to higher AL, with just three out of 11 adversities associated with AL. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Toward the assessment of adverse adult experiences: An initial validation study of the adult experiences survey.

The current investigation is a validation study of the Adult Experiences Survey, a seminal assessment of adverse adult experiences. Data were collected between July 2015 and June 2019 from a sample of 1,747 low-income women as part of a longitudinal study in Wisconsin, United States. Analyses of 10 adversities were conducted to assess item prevalence and internal consistency in the full sample and test-retest reliability in a subsample of 90 participants. Exploratory and confirmatory factor analyses were performed to examine the factor structure of the measure, and multivariate regressions were conducted to estimate the effects of adult adversity on 3 health-related outcomes: poor physical health, depression, and posttraumatic stress disorder. Most participants (86%) endorsed at least 1 adversity. Each item demonstrated good test-retest reliability except crime victimization, and the full measure had sound internal consistency. Each adversity was associated with all health-related outcomes at the bivariate level, and most were linked to 1 or more outcomes in multivariate analyses. Exploratory and confirmatory factor analyses validated 1- and 2-factor solutions with good fit. A cumulative adult adversity score was associated with all study outcomes controlling for adverse childhood experiences, and effects associated with a latent adversity score were even larger in magnitude. Extending research on adverse childhood experiences, the findings indicate that adverse adult experiences can be measured reliably and validly using a brief assessment. Implications are discussed, including opportunities to advance the study of trauma and resilience over the life course. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents.

Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences. Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth-5 years, 6-10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates. Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively). Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.

Disentangling adversity timing and type: Contrasting theories in the context of maternal prenatal physical and mental health using latent formative models.

Research on the effects of adversity has led to mounting interest in examining the differential impact of adversity as a function of its timing and type. The current study examines whether the effects of different types (i.e., physical, sexual, and emotional abuse) and timing (i.e., early, middle childhood, adolescence, or adulthood) of adversity on maternal mental and physical health outcomes in pregnancy, are best accounted for by a cumulative model or independent effects model. Women from a prospective pregnancy cohort (N =3,362) reported retrospectively on their experiences of adversity (i.e., physical, sexual, and emotional abuse) in early childhood (0-5 years], middle childhood (6-12 years], adolescence (13-18 years], and adulthood (19+ years]. Measures of overall health, stress, anxiety, and depression were gathered in pregnancy. Results showed that a cumulative formative latent model was selected as more parsimonious than a direct effects model. Results also supported a model where the strength of the effect of adversity did not vary across abuse timing or type. Thus, cumulative adversity resulted in greater physical and mental health difficulties. In conclusion, cumulative adversity is a more parsimonious predictor of maternal physical and mental health outcomes than adversity at any one specific adversity timing or subtype.

Childhood adversity correlates with stable changes in DNA methylation trajectories in children and converges with epigenetic signatures of prenatal stress

Childhood maltreatment (CM) is an established major risk factor for a number of negative health outcomes later in life. While epigenetic mechanisms, such as DNA methylation (DNAm), have been proposed as a means of embedding this environmental risk factor, little is known about its timing and trajectory, especially in very young children. It is also not clear whether additional environmental adversities, often experienced by these children, converge on similar DNAm changes.Here, we calculated a cumulative adversity score, which additionally to CM includes socioeconomic status (SES), other life events, parental psychopathology and epigenetic biomarkers of prenatal smoking and alcohol consumption. We investigated the effects of CM alone as well as the adversity score on longitudinal DNAm trajectories in the Berlin Longitudinal Child Study. This is a cohort of 173 children aged 3–5 years at baseline of whom 86 were exposed to CM. These children were followed-up for 2 years with extensive psychometric and biological assessments as well as saliva collection at 5 time points providing genome-wide DNAm levels.Overall, only a few DNAm patterns were stable over this timeframe, but less than 10 DNAm regions showed significant changes. At baseline, neither CM nor the adversity score associated with DNAm changes. However, in 6 differentially methylated regions (DMRs), CM and the adversity score significantly moderated DNAm trajectories over time. A number of these DMRs have previously been associated with adverse prenatal exposures. In our study, children exposed to CM also presented with epigenetic signatures indicative of increased prenatal exposure to tobacco and alcohol, as compared to non-CM exposed children. These epigenetic signatures of prenatal exposure strongly correlate with DNAm regions associated with CM and the adversity score. Finally, weighted correlation network analysis revealed a module of CpGs exclusively associated with CM.While our study identifies DNAm loci specifically associated with CM, especially within long non-coding RNAs, the majority of associations were found with the adversity score with convergent association with indicators of adverse prenatal exposures. This study highlights the importance of mapping not only of the epigenome but also the exposome and extending the observational timeframe to well before birth.

Introducing two types of psychological resilience with partly unique genetic and environmental sources

Psychological resilience is indicated when individuals demonstrate good mental health despite exposure to significant stress or adversity. Good mental health may involve low levels of illbeing and/or high levels of wellbeing. There is still very limited knowledge about the potential differences between these outcomes in relation to stressors. We propose a distinction between type 1 and type 2 resilience, examine their underlying genetic and environmental architecture, and identify modifiable resilience factors. The data come from a population-based twin sample (N = 1987, mean age = 63) in the Norwegian Twin Registry. Type 1 and type 2 resilience are operationalised as the residual of anxiety/depression symptoms and life satisfaction, respectively, after lifetime cumulative adversity has been regressed out. We used biometric modelling and cotwin-control linear mixed models to estimate underlying factors and identify predictors while controlling for genetic confounding. The results support the notion of two separate, but partly overlapping types of resilience. We find heritabilities of 0.30 (type 1) and 0.24 (type 2) and a genetic correlation of 0.43. Potentially causal resilience factors include, but are not limited to, meaning in life, physical activity, positive affect and relationship satisfaction. Whereas some factors are associated with both resilience types, other factors are unique to each type.

Influence of Childhood Adversity and Infection on Timing of Menarche in a Multiethnic Sample of Women.

Childhood adversities (CAs) and infections may affect the timing of reproductive development. We examined the associations of indicators of CAs and exposure to tonsillitis and infectious mononucleosis (mono) with age at menarche. A multiethnic cohort of 400 women (ages 40–64 years) reported exposure to parental maltreatment and maladjustment during childhood and any diagnosis of tonsillitis and/or mono; infections primarily acquired in early life and adolescence, respectively. We used linear and relative risk regression models to examine the associations of indicators of CAs individually and cumulatively, and history of tonsillitis/mono with an average age at menarche and early onset of menarche (<12 years of age). In multivariable models, histories of mental illness in the household (RR = 1.44, 95% CI: 1.01–2.06), and tonsillitis diagnosis (RR = 1.67, 95% CI: 1.20–2.33) were associated with early menarche (<12 years), and with an earlier average age at menarche by 7.1 months (95% CI: −1.15, −0.02) and 8.8 months (95% CI: −1.26, −0.20), respectively. Other adversities indicators, cumulative adversities, and mono were not statistically associated with menarcheal timing. These findings provided some support for the growing evidence that early life experiences may influence the reproductive development in girls.

Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: Intersectional analysis of a nationally representative sample

BackgroundAdverse childhood experiences (ACEs) are disturbingly common and consequential. Priority should be given to identifying populations that bear a disproportionate share of the burden of ACEs, but such disparities have received limited attention to date. ObjectiveThis study analyzes data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample in the U.S., to explore variation in ACEs by race/ethnicity, economic status, and gender. MethodsIn addition to using conventional statistical methods to generate unadjusted and adjusted estimates, we conduct an intercategorical intersectional analysis of variation in ACEs using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). ResultsDescriptively, we find that ACEs are more prevalent overall among the poor than the non-poor, among most racial/ethnic minority groups than non-Hispanic Whites, and among females than males. However, multivariate regression results indicate that gender is not a robust correlate of cumulative adversity and that economic status moderates racial/ethnic differences. MAIHDA models further expose heterogeneity in aggregate ACE scores between intersectional strata representing unique combinations of gender, race/ethnicity, and economic status. ConclusionsThe MAIHDA results confirm that conclusions based on unadjusted group differences may be spurious. While most variance in ACE scores is explained by additive main effects, accounting for intersections among social categories generates a more complex portrait of inequality. We compare our work to prior studies and discuss potential explanations for and implications of these findings for research on disparities.

Exposure to Suicidal Behavior and Social Support Among Sexual- and Gender-Minority Youth.

In this study, we examine reports of exposure to suicidal behavior by youth sexual and gender identity. We explore how exposure is related to depressed mood in the context of high social support while accounting for cumulative adversity. Data from a large national sample of youth aged 14 to 15 years in the United States (N = 3979) were collected online in 2018-2019. Sexual- and gender-minority youth were more likely to know someone close to them who attempted suicide, relative to cisgender heterosexual youth. Cisgender heterosexual youth were buffered from recent depressed mood when they endorsed having high social support in the context of exposure to suicidal behavior; less social support did not provide such a buffer. For cisgender sexual-minority male and female youth, exposure to suicidal behavior was related to recent depressed mood regardless of the level of social support. For gender-minority youth assigned female at birth, the combination of exposure and high social support was significantly associated with elevated depressed mood. Cumulative adversity accounted for some but not all of these relationships, indicating the influential role of exposure to suicidal behavior on depressed mood for some youth. These findings illustrate the complexities of social support and raise questions about its potential to magnify stress rather than serve as a buffer for some youth. Although findings need to be replicated, suicide prevention efforts should carefully consider how to promote resilience among these suicide-exposed sexual- and gender-minority youth who may themselves be at risk for suicidal ideation and behavior.

Trajectories of Childhood Adversity and Type 1 Diabetes: A Nationwide Study of One Million Children.

Experiencing adversities in childhood may increase the risk of type 1 diabetes through hyperactivation of the stress response system, but the empirical evidence is conflicting. We aim to describe the age-specific incidence of type 1 diabetes for males and females separately in five predefined groups covering the most common trajectories of adversity among Danish children. We included all 1,081,993 children without parental type 1 diabetes born in Denmark from 1980 to 1998. We used register data to estimate age-specific incidence rates of type 1 diabetes in five trajectory groups of adversity characterized by 1) low adversity, 2) early life material deprivation, 3) persistent material deprivation, 4) loss or threat of loss in the family, and 5) cumulative high adversity. All analyses were stratified by sex. In total, 5,619 people developed type 1 diabetes before 2016. We found only minor differences when comparing the incidence rates of type 1 diabetes between the trajectory groups. The only clear exceptions were in the high versus low adversity group, in which males had a higher incidence of type 1 diabetes in childhood (<11 years [incidence rate ratio (IRR) 1.78 (95% CI 1.31-2.42)]) and females had a higher incidence in early adulthood (≥16 years [IRR 2.19 (95% CI 1.57-3.07)]). Childhood adversities were generally not associated with age-specific incidence of type 1 diabetes except among those exposed to a very high and increasing annual rate of childhood adversities. Differences between highly exposed males and females seem to depend on age at onset of type 1 diabetes.

Does Early Life Racial Discrimination Explain a Mental Health Paradox among Black Adults?

Objectives: To evaluate the impact of early life racial discrimination (ELRD) on mental health among Black adults. Methods: Data were from the Nashville Stress and Health Study (n = 618). Ordinary least squares regression models examined the relationship between ELRD and adult psychological distress; logistic regression estimated the probability of past-year major depressive disorder (MDD). We also assessed whether ELRD moderated the relationship between adult discrimination and mental health. Results: Childhood (b = 1.07, SE = .51, p = .04) and adolescent ELRD (b = 1.32, SE = .42, p = .002) were associated with adult distress. Individuals who experienced childhood ERLD had 88% lower odds of adult MDD than individuals with no ELRD. Significant interactions showed that childhood and adolescent ELRD was protective against adult discrimination. Discussion: While ELRD importantly shapes distress and MDD among Black adults, patterns vary by outcome. Results indicate that adult distress and MDD develop through cumulative adversity processes that are further influenced by sensitive periods in the life course.

Cumulative exposure to socioeconomic and psychosocial adversity and hair cortisol concentration: A longitudinal study from 5 months to 17 years of age

BackgroundExposure to early adversity has been associated with long-lasting risks for poor health and functioning. Prior research suggests that the hypothalamic-pituitary-adrenal (HPA) axis, and its main end-product glucocorticoid hormone cortisol, may be at play. This study tested whether an index of cumulative socioeconomic and psychosocial adversity assessed prospectively, from infancy to adolescence, was associated with hair cortisol concentration (HCC), and if this association differed by sex. MethodsThe sample comprised 556 adolescents (42.0% males) who provided hair for cortisol measurement at 17 years of age. Adversity indicators (young and single motherhood, low socioeconomic status (SES), maternal alcohol use, hostile-reactive parenting, and depressive symptoms, as well as peer victimization and neighborhood dangerousness) were repeatedly reported by mothers or youths between the ages of 5 months and 15 years. ResultsChronic adversity was non-linearly associated with HCC; youth exposed to lower and higher levels of adversity had moderate-to-higher HCC compared to lower HCC noted in participants with moderate levels of adversity, for both males and females. None of the indicators taken separately, except the perception of neighborhood dangerousness, were significantly associated with HCC. ConclusionOur findings support the hypothesis that HPA axis activity varies according to cumulative adversity, albeit non-linearly, which may bear consequences for later health and functioning.

How childhood trauma and recent adverse events are related to hair cortisol levels in a large adult cohort

BackgroundExposure to adversity is a risk factor for many mental and somatic health problems. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is a potential mechanism linking adversity exposure and negative health outcomes. However, associations between adversity exposure and HPA-axis activity have been inconsistent. To understand the impact of adversity on the HPA-axis, we examined associations between early-life and recent adversity with hair cortisol concentration, an indicator of long-term systemic cortisol levels. MethodsWe included 1166 adult participants of the Netherlands Study of Depression and Anxiety (NESDA). Hair cortisol was measured in 3 cm of proximal hair, representing cortisol exposure during the previous 3 months. Childhood maltreatment, childhood negative life events, and recent negative life events were retrospectively assessed using interview and self-report questionnaires. Linear regression analyses were performed to assess the associations between childhood maltreatment, childhood life events and recent life events with hair cortisol. Associations with cumulative adversity exposure and with subtypes of childhood maltreatment, childhood and recent negative life events were also investigated, as were interaction effects between adversity and sex, age and psychopathology. ResultsChildhood maltreatment (β = 0.034, p = 0.243), childhood life events (β = − 0.017, p = 0.544), and recent life events (β = − 0.021, p = 0.456) were not significantly associated with hair cortisol levels. Subtypes of childhood maltreatment and specific childhood and recent life events were not significantly associated with hair cortisol (pFDR>0.05). There were no significant interaction effects between adversity exposure and sex, age or depression/anxiety diagnostic status on hair cortisol. ConclusionsThere were no significant associations between childhood and recent adversity with systemic cortisol levels in adults. Effects of early-life and adult adversity are complex and may not directly impact on long-term systemic cortisol levels as measured in hair.

Externalizing and Internalizing Problems: Associations with Family Adversity and Young Children's Adrenocortical and Autonomic Functioning.

The development of child mental health problems has been associated with experiences of adversity and dysregulation of stress response systems; however, past research has largely focused on externalizing or internalizing problems (rather than their co-occurrence) and single physiological systems in high-risk adolescent samples. The present study examined whether cumulative family adversity, functioning in the hypothalamic-pituitary-adrenal axis (i.e., cortisol) and the parasympathetic nervous system (i.e., respiratory sinus arrhythmia [RSA]), and their interactions, predicted trajectories of co-occurring externalizing and internalizing problems among young children. Participants included 338 socioeconomically and racially diverse children (M age=5.32 years, SD=.32; male=51.8%) from a community sample. Family adversity (assessed with six measures) and child daily cortisol output and resting RSA were assessed in kindergarten. Parents, teachers, and children reported on children's externalizing and internalizing psychopathology up to three times from kindergarten to grade 1. Latent class growth analyses identified stable trajectories of externalizing and internalizing psychopathology. Trajectories were combined to create groups: co-occurring externalizing and internalizing (13.1%), externalizing-only (14.0%), internalizing-only (11.3%), and low problems (61.3%). Family adversity and resting RSA significantly positively predicted co-occurring group membership. Tests for interactions showed adversity did not significantly interact with physiological indicators to predict group membership. However, the two physiological systems interacted, such that higher and lower daily cortisol predicted internalizing group membership for children with lower and higher resting RSA, respectively. Findings support the importance of considering family context and multiple physiological systems to inform understanding of the development of mental health problems, and their co-occurrence, in early childhood.

“It hurts so much to live for nothing”: Lived Experiences of Substance Use Among Refugee Youth in Displacement

Tremendous traumas relating to refugee situations have substantially hindered the mental and behavioral health of refugee youth. Prolonged and cumulative adversities during forced migration have led refugee populations to be exposed to a high risk of substance misuse as part of a coping mechanism. This study aims to explore the role played by substances within the lives of Somali refugee youth who are displaced in low-resource, urban settings. We conducted in-depth individual interviews with twenty Somali refugee youth who are involved in gang activities in urban Kenya. Using a thematic analysis, this study revealed how substances have been used to cope with the negative impacts of trauma and how substances operate as a strategic tool for survival within the lives of displaced Somali refugees. This study discussed the implications for breaking the cycle of substance use.

Effects of responsive caregiving and learning opportunities during pre-school ages on the association of early adversities and adolescent human capital: an analysis of birth cohorts in two middle-income countries

SummaryBackgroundMillions of children globally are at risk of not reaching their developmental potential because of early adversities. We hypothesised that responsive caregiving and learning opportunities, components of nurturing care, at pre-school ages might mitigate the effects of adversities.MethodsWe analysed longitudinal birth cohort data from Brazil (1993 Pelotas Birth Cohort, n=632) and South Africa (Birth to Twenty Plus [Bt20+] Birth Cohort, n=1130) to assess whether responsive caregiving and learning opportunities at pre-school ages (2–4 years) modified associations between cumulative early adversities and adolescent human capital. The cumulative adversities score (range 0–9) included household wealth and crowding; mothers' schooling, height, age, and mental health; and children's birthweight, gestational age, and length at age 12 months. We extracted data on responsive caregiving and learning opportunities from the Early Childhood Home Observation for Measurement of the Environment inventory, assessed at age 4 years (1993 Pelotas cohort) and 2 years (Bt20+ cohort). We examined three human capital indicators: intelligence quotient (IQ) assessed at age 18 years (1993 Pelotas cohort) and 16 years (Bt20+ cohort); psychosocial adjustment assessed at age 15 years and 14 years, respectively; and height assessed at age 18 years and 16 years, respectively. We used linear models with interaction terms between cumulative adversities, and responsive caregiving and learning opportunities, to predict adolescent human capital.FindingsFor each additional Z score of total cumulative adversity, adolescent IQ decreased by 5·89 (95% CI −7·29 to −4·50) points in the 1993 Pelotas cohort (p<0·0001) and 2·69 (–4·52 to −0·86) points in the Bt20+ cohort (p=0·0039). After adjusting for total cumulative adversities, adolescent IQ points increased by 5·47 (95% CI 4·20 to 6·74) with each additional Z score of learning opportunities and by 2·26 (0·93 to 3·59) with each additional Z score of responsive caregiving in the 1993 Pelotas cohort, but not in the Bt20+ cohort (0·86 [–0·12 to 1·83] and 0·65 [–0·32 to 1·61], respectively). Associations between early adversities and IQ were modified by learning opportunities in the 1993 Pelotas cohort (beta coefficient for interaction 1·74, 95% CI 0·43 to 3·04; p=0·0092) and by responsive caregiving in the Bt20+ cohort (2·24, 0·94 to 3·54; p=0·0075). High nurturing environment attenuated the negative effects of early cumulative adversities on IQ.InterpretationEarly nurturing home environments protect young children against effects of early adversities on adolescent IQ, with long-term positive associations on adolescent cognition in two middle-income countries.FundingBill & Melinda Gates Foundation.