Psychosocial Adversity Research Articles

Strategic mental health psychosocial responses in times of COVID-19 in India

The magnitude of the mental health problems and the treatment gap has been an unaddressed concern in the Indian public health system. With the arrival of the COVID-19 pandemic, India is at the brink of a mental health crisis. An overburdened health system will have to cater not just to the existing mental health needs, but also to the added psychosocial adversities arising due to the COVID-19 pandemic. The following article aims to describe the mental health needs of the nation at a time of an infectious epidemic. It further outlines the modalities and the process of service delivery using cross-sectoral, multi-tiered, transdisciplinary human resources, and technological interventions.

Biological bases of suicidal behaviours: A narrative review.

Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.

Psychosocial Stress and Adversity: Effects from the Perinatal Period to Adulthood.

Early exposure to stress and adversity can have both immediate and lasting effects on physical and psychological health. Critical periods have been identified in infancy, during which the presence or absence of experiences can alter developmental trajectories. There are multiple explanations for how exposure to psychosocial stress, before conception or early in life, has an impact on later increased risk for developmental delays, mental health, and chronic metabolic diseases. Through both epidemiologic and animal models, the mechanisms by which experiences are transmitted across generations are being identified. Because psychosocial stress has multiple components that can act as stress mediators, a comprehensive understanding of the complex interactions between multiple adverse or beneficial experiences and their ultimate effects on health is essential to best identify interventions that will improve health and outcomes. This review outlines what is known about the biology, transfer, and effects of psychosocial stress and early life adversity from the perinatal period to adulthood. This information can be used to identify potential areas in which clinicians in neonatal medicine could intervene to improve outcomes.

Processes for engaging and retaining women who are experiencing adversity in longitudinal health services research

BackgroundWomen and families experiencing socioeconomic and psychosocial adversity are the least likely to access health care but most likely to benefit. For health services to effectively meet the needs of individuals experiencing adversity, research involving the health services must be truly representative. However, individuals experiencing adversity are typically excluded from or underrepresented in health services research. This paper reports on the implementation of a quality improvement approach designed to support recruitment and retention of pregnant women experiencing adversity in a longitudinal, health services randomized controlled trial (“right@home”).Methodsright@home recruited Australian women from 10 public maternity hospitals across the states of Victoria and Tasmania who were experiencing adversity (≥2 risk factors on screening survey). Regular follow-up assessments were conducted by phone or face-to-face to child age 2 years. Research processes were designed taking heed of previous research demonstrating effective strategies for recruiting and retaining minority groups (e.g. piloting the recruitment process; recruiting via the health service providing care to the subgroup; remunerating participants); however, we were concerned that important information was missing. Therefore, once recruitment began, we conducted a continuous evaluation of the research processes, testing and implementing changes to processes or new strategies to maximize recruitment and retention (e.g. using a suite of strategies to maintain contact with families, using flexible data collection methods, obtaining consent for data linkage for future health and education data).Resultsright@home enrolled a large cohort of women (N = 722) experiencing high levels of adversity according to socioeconomic status and psychosocial risk factors, and achieved excellent retention (83% completion at 2 years). Most strategies appeared to increase recruitment and retention. All required additional time from the research team to develop and test, and some required extra funding, which ranged from minor (e.g. printing) to substantial (e.g. salaries, remuneration).ConclusionsBy taking a quality improvement approach, supported by sufficient resourcing and flexible research processes, it is possible to recruit and retain a large cohort of women experiencing adversity who are typically missed or lost from longitudinal research.

The effects of psychosocial stress on dopaminergic function and the acute stress response.

Chronic psychosocial adversity induces vulnerability to mental illnesses. Animal studies demonstrate that this may be mediated by dopaminergic dysfunction. We therefore investigated whether long-term exposure to psychosocial adversity was associated with dopamine dysfunction and its relationship to psychological and physiological responses to acute stress. Using 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine ([18F]-DOPA) positron emission tomography (PET), we compared dopamine synthesis capacity in n = 17 human participants with high cumulative exposure to psychosocial adversity with n = 17 age- and sex-matched participants with low cumulative exposure. The PET scan took place 2 hr after the induction of acute psychosocial stress using the Montréal Imaging Stress Task to induce acute psychosocial stress. We found that dopamine synthesis correlated with subjective threat and physiological response to acute psychosocial stress in the low exposure group. Long-term exposure to psychosocial adversity was associated with dampened striatal dopaminergic function (p=0.03, d = 0.80) and that psychosocial adversity blunted physiological yet potentiated subjective responses to acute psychosocial stress. Future studies should investigate the roles of these changes in vulnerability to mental illnesses.

Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation.

Background:Psychosocial adversity escalates medical risk for poor outcomes in infants born <30 weeks’ gestation. Neonatal neurobehavior and maternal psychological and socioenvironmental assessments may identify the earliest specific intervention needs. We hypothesized that maternal prenatal anxiety, depression, and adverse medical and socioenvironmental conditions would be associated with less optimal neonatal neurobehavior at NICU discharge.Methods:We studied 665 infants at 9 university NICUs. Risk indices of socioenvironmental, maternal, and neonatal medical factors were obtained from standardized, structured maternal interviews and medical record reviews. Brain injuries were classified by consensus ultrasonogram readings. NICU Network Neurobehavioral Scale (NNNS) exams were conducted at NICU discharge.Results:On the NNNS, generalized estimating equations indicated infants of mothers with prenatal anxiety had less optimal attention, and those born to mothers with prenatal depression had increased lethargy. Maternal medical complications predicted suboptimal reflexes. Socioenvironmental risk predicted lower self-regulation and movement quality. Infants with more severe neonatal medical complications had lower attention, increased lethargy, and suboptimal reflexes.Conclusions:Combined information from the observed associations among adverse prenatal maternal medical and psychosocial conditions, and neonatal complications may assist in the early identification of infants at elevated neurobehavioral risk.

6.59 PSYCHOSOCIAL ADVERSITY FACTORS AND NONSHARED ENVIRONMENTAL DIFFERENCES ASSOCIATED WITH ADHD IN A HIGH-RISK POPULATION

This poster presentation aims to describe the differences between an ADHD index sibling (AIS) and their high-risk siblings (HAS) with and without ADHD, with regard to their perception of nonshared environment and their psychosocial adversity factors.

The Relationship of Early-Life Adversity With Adulthood Weight and Cardiometabolic Health Status in the 1946 National Survey of Health and Development.

Evidence linking early-life adversity with an adverse cardiometabolic profile in adulthood is equivocal. This study investigates early-life adversity in relation to weight and cardiometabolic health status at ages 60 to 64 years. We included 1059 individuals from the 1946 National Survey of Health and Development. Data on adversity between ages 0 to 15 years were used to create a cumulative childhood psychosocial adversity score and a socioeconomic adversity score. Cardiometabolic and weight/height data collected at ages 60 to 64 years were used to create four groups: metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy overweight/obese, and metabolically unhealthy overweight/obese. Associations between the two exposure scores and weight/health status were examined using multinomial logistic regression, with adjustment for sex and age at the outcome visit. Sixty-two percent of normal-weight individuals were metabolically healthy, whereas only 34% of overweight/obese individuals were metabolically healthy. In a mutually adjusted model including both exposure scores, a psychosocial score of ≥3 (compared with 0) was associated with increased risk of being metabolically unhealthy (compared with healthy) in both normal-weight adults (relative risk = 2.49; 95% confidence interval = 0.87-7.13) and overweight/obese adults (1.87; 0.96-3.61). However, the socioeconomic adversity score was more strongly related to metabolic health status in overweight/obese adults (1.60; 0.98-2.60) than in normal-weight adults (0.95; 0.46-1.96). Independently of socioeconomic adversity, psychosocial adversity in childhood may be associated with a poor cardiometabolic health profile, in both normal-weight and overweight/obese adults.

Understanding mental health difficulties and associated psychosocial outcomes in HIV positive adolescents visiting the HIV clinic in Kenyatta National Hospital, Kenya

Background Kenya is amongst six countries worldwide that contributes about half of the deaths due to AIDS related illnesses among adolescents which is the leading cause of mortality among this age group. Adolescents living with HIV face numerous challenges; key amongst them being HIV status disclosure, stigma & discrimination and adherence to medication. Tracking psychosocial adversities and behavioral outcomes in young people living with HIV provides unique insight into developing curative and preventative interventions and allow us to rethink pathways to various services and …

Community beliefs, HIV stigma, and depression among adolescents living with HIV in rural Uganda

The availability of and increased access to antiretroviral therapy (ART) has significantly reduced the morbidity and mortality associated with HIV. As a result, perinatally infected youth are increasingly able to reach adolescence. There is limited information about the psychosocial challenges facing adolescents living with HIV (ALWH) in rural settings of sub-Saharan Africa. We sought to understand psychosocial challenges facing ALWH in rural Uganda and their effects on mental health and HIV treatment outcomes. We conducted 5 focus group discussions and 40 one-on-one in-depth interviews in Mbarara, Uganda with adolescents (aged 13–17 years) and adult women caregivers. All interviews were audio-recorded, transcribed directly into English, and coded using thematic analysis to identify themes related to psychosocial adversities and mental health. Adversities faced by adolescents included negative community perceptions (perceived aggression, presumed early mortality), HIV stigma (enacted and internalized), vulnerability factors (loss of parents, poverty), and health challenges (depression, ART non-adherence). In the conceptual model that emerged from the findings, negative community perceptions (about perceived aggression or presumed early mortality) predisposed ALWH to experience enactments and internalization of stigma that led to depression and ART non-adherence. The data also identified several protective factors, including counselling, family and religious support, and timely serostatus disclosure. Interventions to correct community misperceptions about HIV can potentially reduce stigma and thereby improve physical and mental health outcomes of ALWH.

Developmental and mental health characteristics of children exposed to psychosocial adversity and stressors at the age of 18-months: Findings from a population-based cohort study

BackgroundPrior research on adverse experiences in early childhood has mainly focused on at-risk populations while studies of unselected populations are scarce. This topic therefore remains to be elucidated in broader child populations. Accordingly, the aim of this study was to examine if and to what extent children from a general population sample are exposed to psychosocial adversity and stressors in early childhood and whether the development and mental health of children with and without such exposure differ at the age of 18-months. MethodsA random sample of the Copenhagen Child Cohort (CCC2000) comprising 210 children and their parents participated in the study when the children were approximately 18-months. Information on exposures was obtained from a semi-structured interview including the Mannheim Parent Interview (MPI) and classified in agreement with the Multiaxial Classification of Child and Adolescent Psychiatric Disorders (ICD-10), and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). Child development was assessed with the Bayley Scales of Infant and Toddler Development – Second Edition (BSID-II), while mental health was measured using the Child Behavior Check List (CBCL 1½-5). ResultsAmong the 210 children, 91 (43%) had been exposed to psychosocial adversity and persistent stressors. The exposed children differed from the non-exposed children by poorer cognitive development and behavioral regulation, as well as more attention problems and anxious/depressed symptoms. The children exposed to adverse caregiving environments were specifically more likely to have delayed cognitive development than the rest of the sample. ConclusionsIn a general population sample of children aged 18-months, exposure to psychosocial adversity and stressors was associated with poorer development and mental health in cognitive and affective domains. These findings highlight an avenue for further research with potential implications for early preventative practices.

Effects of Psychosocial Adversity on School Maladjustment: A Follow-up of Primary School Students

espanolLa inadaptacion escolar (IE) se entiende como un conjunto de dificultades de comportamiento, sociales y emocionales que impiden que los estudiantes cumplan con las expectativas de su contexto escolar. Su aparicion durante los primeros anos de escolaridad esta relacionada con el fracaso y el abandono escolar, los comportamientos violentos, los problemas de salud mental y las trayectorias de mala adaptacion que persisten durante el resto de la vida del individuo. El objetivo de este estudio fue identificar variables de adversidad psicosocial capaces de predecir la aparicion de inadaptacion escolar durante los primeros tres anos de escolarizacion. Al recopilar datos sobre el desajuste escolar, las experiencias adversas en la infancia y la disfuncion psicosocial, se aplico un proceso de seguimiento longitudinal a una cohorte de 26,108 estudiantes chilenos (50.7% mujeres) desde el inicio de sus estudios (6.3 anos de edad en primer grado) hasta dos anos mas tarde (8.4 anos de edad en tercer grado). A traves de regresiones logisticas binarias, los resultados obtenidos muestran que el embarazo adolescente de la madre, la ausencia biologica del padre, la patologia mental en un familiar, la disfuncion psicosocial y la percepcion negativa del profesor del desempeno academico y del comportamiento de los estudiantes predicen la aparicion de inadaptacion escolar despues de tres anos en el sistema escolar. El articulo analiza estos resultados y sus implicaciones para el desarrollo de programas preventivos dirigidos a reducir los problemas de inadaptacion escolar y de salud mental durante la infancia EnglishSchool maladjustment (SM) is understood as a set of behavioral, social, and emotional difficulties that prevent students from meeting the expectations of their school context. Its appearance during the first years of schooling is linked to school failure and dropout, violent behaviors, mental health problems, and maladaptive trajectories that persist for the rest of an individual’s life. The goal of this study was to identify psychosocial adversity variables capable of predicting the appearance of SM during the first three years of school. By collecting data on school maladjustment, adverse childhood experiences and psychosocial dysfunction, a longitudinal follow-up process was applied to a cohort of 26,108 Chilean students (50.7% female) from the start of their schooling (6.3 years of age in 1st grade) until two years later (8.4 year age mean in 3st grade). Through binary logistic regressions, the results obtained show that mother’s adolescent pregnancy, biological father’s absence, mental pathology in a relative, psychosocial dysfunction, and teacher’s negative perception of students’ academic and behavioral performance predict the appearance of SM after three years in the school system. The article discusses these results and their implications for the development of preventive programs aimed at reducing SM and mental health problems during childhood.

Cumulative psychosocial risk and early child development: validation and use of the Childhood Psychosocial Adversity Scale in global health research

BackgroundEvidence suggests that cumulative early psychosocial adversity can influence early child development (ECD). The Childhood Psychosocial Adversity Scale (CPAS) is a novel measure of cumulative risk designed for use in global ECD research. We describe its development and assess validity from its first application in Bangladesh, where it predicts cognitive development scores among young children.MethodsItems were generated from literature review and qualitatively assessed for local relevance. Two-hundred and eighty-five mother–child dyads from an urban slum of Dhaka completed the CPAS at child ages 18, 24, 48, and/or 60 months. The CPAS was assessed for internal consistency, retest reliability, and convergent, incremental, and predictive validity.ResultsThe CPAS includes subscales assessing child maltreatment, caregiver mental health, family conflict, domestic violence, and household/community psychosocial risks. In Bangladesh, subscales had good internal consistency (Cronbach’s α > 0.70). Full-scale score had good 2-week test–retest reliability (intra-class correlation coefficient = 0.89; F(38,38) = 8.45, p < 0.001). Using multivariate regression, 48-month CPAS score significantly predicted 60-month intelligence quotient, accounting for more variance than socioeconomic status or malnutrition.ConclusionsThe CPAS is a novel tool assessing cumulative childhood psychosocial risk. Evidence supports validity of its use in ECD research in Bangladesh, and ongoing work is applying it in additional countries.

Using Hair Cortisol to Examine the Role of Stress in Children's Health Inequalities at 3 Years

ObjectiveChildren exposed to early adversity (eg, financial hardship, family violence, parent mental health difficulties) are at greater risk of poor health outcomes. Physiological stress is one mechanism thought to explain this pathway. We investigated associations between adversity and young children's health and whether child stress (measured using hair cortisol) mediated these associations. MethodsThis was a cross-sectional study of 3-year-old children whose mothers were recruited during pregnancy, through the right@home trial, for their experience of adversity. Using total counts of 9 sociodemographic and 9 psychosocial indicators of adversity, regression models examined relationships among adversity risk counts, child hair cortisol (potential mediator), and 5 health outcomes: externalizing and internalizing problems, physical and socioemotional wellbeing, and overweight/obesity. ResultsHair cortisol data were available for 297 out of 500 (59%) participating children. When examined separately, sociodemographic adversity risk was associated with higher externalizing problems, and psychosocial adversity risk was associated with higher externalizing problems and poorer physical/socioemotional wellbeing. When examined together in a single model, psychosocial (but not sociodemographic) adversity was associated with higher externalizing problems (unstandardized mean difference [β], 0.53; P = .002) and poorer physical wellbeing (β, 1.19; P = .009); higher hair cortisol was associated with higher externalizing problems (β, 0.76; P = .02). There was no evidence that stress (hair cortisol) mediated associations between adversity and health. ConclusionsIn 3-year-old children, we found no evidence that physiological stress (hair cortisol) mediated associations between adversity risk and children's health. Hair cortisol may be limited as a single measure of stress, or physiological stress may not be a mechanism for explaining the effects of adversity on these young children's health.

Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics From Refugee, Conflict-Affected, and Australian-Born Backgrounds

Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. One-hour interviews covering mental health, intimate partner violence, and other social measures. World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P < .001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P < .001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%]). Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.

Association of Social Adversity with Comorbid Diabetes and Depression Symptoms in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study: A Syndemic Framework.

U.S. Hispanics/Latinos experience high lifetime risk for Type 2 diabetes and concurrent psychological depression. This comorbidity is associated with poorer self-management, worse disease outcomes, and higher mortality. Syndemic theory is a novel social epidemiological framework that emphasizes the role of economic and social adversity in promoting disease comorbidity and health disparities. Informed by the syndemic framework, this study explored associations of socioeconomic and psychosocial adversity (low income/education, trauma history, adverse childhood experiences, ethnic discrimination, neighborhood problems [e.g., violence]) with comorbidity of diabetes and depression symptoms in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and Sociocultural Ancillary Study. Participants were 5,247 Latino adults, aged 18-74, enrolled in four U.S. cities from 2008 to 2011. Participants completed a baseline physical exam and measures of depression symptoms and psychosocial adversity. Multinomial logistic regression analyses were conducted to examine associations of adversity variables with comorbid diabetes and high depression symptoms. Household income below $30,000/year was associated with higher odds of diabetes/depression comorbidity (odds ratio [OR] = 4.61; 95% confidence interval [CI]: 2.89, 7.33) compared to having neither condition, as was each standard deviation increase in adverse childhood experiences (OR = 1.41; 95% CI: 1.16, 1.71), ethnic discrimination (OR = 1.23; 95% CI: 1.01, 1.50), and neighborhood problems (OR = 1.53; 95% CI: 1.30, 1.80). Low household income, adverse childhood experiences, ethnic discrimination, and neighborhood problems are related to comorbid diabetes and depression in U.S. Latinos. Future studies should explore these relationships longitudinally.

Migration in patients with early psychosis: A 3-year prospective follow-up study

Early psychosis programs treat high ratios of migrants, given they display higher rates of psychosis. Studies on this topic are limited and less is known about outcomes. The aim of this study was to compare the premorbid, baseline and outcome profile of patients according to migration (M) and migration in psychosocial adversity (MA) in order to explore if there were differences suggesting particular needs in terms of treatment. 257 early psychosis patients aged 18–35 years old were followed-up over 36 months. MA (29.6%) and M (17.9%) were compared to patients who were born in Switzerland (NM). At entry to the program, MA patients had poorer functional levels and higher symptom intensity. MA patients were more likely to report past exposure to trauma. While M patients have similar outcome compared to NM patients, MA patients were less likely to reach symptom remission, displayed lower functioning and were more likely to relapse. Results suggests that migration in adversity is a potential determinant of functional impairment in early psychosis. While patients who migrated in other contexts have a better outcome, patients who experienced migration in adversity have specific needs considering they are less integrated and more likely to have been exposed to trauma.

Psychosocial Adversity in Infancy and Mortality Rates in Childhood and Adolescence: A Birth Cohort Study of 1.5 Million Individuals.

Childhood and adolescent mortality accounts for a substantial proportion of years lost prematurely. Reducing childhood and adolescent mortality relies on knowing characteristics of those at elevated risk of dying young. We therefore aimed to identify such characteristics; our main hypothesis is that psychosocial adversity in infancy is linked to increased mortality rates in childhood and adolescence. We conducted a register-based cohort study involving all 1,549,581 children born to Danish-born parents in Denmark between 1 January 1981 and 31 December 2010. For each infant, we extracted data relevant to Rutter's indicators of adversity (low social class, parents not cohabiting, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care). Follow-up began on the cohort member's first birthday. We estimated the association between adversity score (the number of Rutter's indicators of adversity present in infancy) and death via. Cox regression. During follow-up (18,874,589 person-years), 2,081 boys and 1,420 girls died before or on their 18th birthday. The hazard ratios for death were 2.3 (95% CI = 1.9, 2.9) and 2.1 (95% CI = 1.6, 2.7) for boys and girls with adversity scores of 3-6 compared with those with a score of 0. These associations were driven by causes of death with known links to psychosocial adversity. While absolute mortality rates were low, infants with adversity scores of 3-6 were approximately twice as likely to die prematurely compared with infants with adversity scores of 0. Whether these associations generalize to other countries should be subjected to further study.

Stressful life events, inflammation and emotional and behavioural problems in children: A population-based study

ObjectiveTo test the hypothesis that higher plasma levels of inflammatory markers due to exposure to adverse life events may lead to internalising and externalising symptoms in children. MethodUsing data from the Avon Longitudinal Study of Parents and Children, a general population birth cohort, we explored if inflammatory markers [serum C-reactive protein (CRP) and interleukin-6 (IL-6)] at age 9 years explain the longitudinal association between adverse life events (at ages 1–9 and 9–11 years) and internalising and externalising symptoms (at ages 9 and 11 years). Data (n = 4583) were analysed using cross-lagged panel modelling to take into account reciprocal associations and reverse causality, and path analyses to test for mediation. Gender, ethnicity, body mass index, maternal education, paternal social class and maternal depression were used as potential confounders. ResultsCRP was not associated with adverse life events. There was evidence for partial mediation by IL-6 such that exposure to adverse life events was associated with increased levels of IL-6 later, in turn associated with later internalising symptoms. These associations were robust to adjustment for confounders. IL-6 did not explain part of the opposite association, that of earlier internalising symptoms and later life events, nor did it explain either direction of the association between life events and externalising symptoms. ConclusionOur findings suggest a pathway that may connect early psychosocial adversity and childhood internalising symptoms via higher plasma levels of inflammatory markers, such as IL-6.

CARING: The Impact of a Parent-Child, Play-Based Intervention to Promote Latino Head Start Children's Social-Emotional Development.

CARING is a preventive, play-based, parent-child intervention designed to promote preschoolers' social-emotional development by strengthening their bonds with their parents. We describe the qualitative impact of the CARING Preschool program on Latino preschool children and their parents. One hundred and eleven Latino families participated in a larger study of the efficacy of the CARING preschool program. Of these families, 40 participated in this qualitative study. We invited families to participate in a focus group after completing the intervention. We used an inductive approach based on grounded theory to identify thematic categories. Parents reported substantial changes in themselves, their children and the quality of their relationships with their children as a result of their participation in CARING. Parents also reported an increased understanding of their children's needs, their ability to use at home the skills learned during the intervention, and improved parent-child communication. In addition, parents reported the social skills and self-regulation abilities of their children improved. These findings highlight the promise of preventive, low-cost interventions for families facing socioeconomic and psychosocial adversity, and their potential role in strengthening parent-child relationships. Results highlight cultural parenting practices and implications for intervention with Latino families.