Early life adversities and the emergence of risk and resilience: a longitudinal study of child development

摘要 在生命早期暴露于母亲抑郁症会增加社会情绪和认知（SEC）的风险 童年和整个生命过程中的问题。这导致了抑郁症治疗的推广， 关键的早期儿童干预。然而，没有足够的证据表明抑郁症治疗是否 在其他社会和经济逆境高度集中的低资源环境中， 普遍存在。在巴基斯坦农村进行的拟议研究将首先检查随机分组的影响， 对儿童SEC的干预，扩展到包括母亲抑郁症和儿童发育组成部分 5-8岁的结果。第二，我们将通过以下方式仔细研究心理社会和生物过程： 母亲抑郁症和其他逆境导致新出现的SEC困难，继续遵循 母亲和孩子，目前我们的研究从出生到三岁，通过小学早期。 我们目前研究的初步结果，包括一项研究围产期 在一个具有代表性的出生队列设计中，母亲抑郁干预对儿童发育的影响， 已经产生了几个见解：（1）“思考健康计划-同行传递”（THPP）缩短了最初的 母亲抑郁发作，但其长期影响尚不清楚;（2）虽然THPP没有 在2岁时，对SEC结果的影响是可以观察到的，它确实对下丘脑-垂体-肾上腺皮质激素的标志物产生了有利的影响。 12个月大的儿童肾上腺（HPA）轴功能;和（3）暴露于逆境（严重贫困， 亲密伴侣暴力（IPV）和低产妇社会支持）似乎对儿童的影响更大 结果比母亲抑郁症在最早的发展时期，和儿童性别可能会影响 出生后某些逆境暴露的普遍性及其对儿童结果的影响。人 这群人即将开始他们的第一个重大的生活转变，需要重大的适应-进入 正规学校教育。通过跟踪孩子们的这一转变，我们可以检验将富人与穷人联系起来的关键假设。 已经收集了关于从怀孕开始的多种逆境、潜在的心理社会和生物学方面的数据， 机制和结果在这个重要的人生阶段。这项研究将继续遵循我们独特的 直到孩子们8岁。拟议研究的具体目标是：（1）评估 对儿童的社会情绪和 认知（SEC）的结果在5岁至8岁，并确定在何种程度上的影响是介导的 母亲抑郁轨迹;（2）研究逆境暴露的类型和时间，包括 母亲抑郁症，影响HPA轴失调的儿童，以及是否HPA轴指标介导 逆境暴露对儿童SEC指标的影响。作为这一目标的一部分，我们还将研究 对儿童HPA轴生物标志物的持续干预;（3）通过定量和定性研究， 调查，暴露于逆境的儿童性别差异及其对儿童结果的影响。

Abstract Exposure to maternal depression in early life increases the risk of socioemotional and cognitive (SEC) problems in childhood and over the lifecourse. This has led to the promotion of depression treatment as a critical early childhood intervention. However, there is insufficient evidence on whether depression treatments alone reduce offspring risk in low resource settings where other social and economic adversities are highly prevalent. The proposed study in rural Pakistan will, first, examine the impact of a cluster randomized intervention, extended to include both maternal depression and child development components, on child SEC outcomes at ages 5-8. Second, we will closely examine the psychosocial and biological processes through which maternal depression and other adversities lead to emerging SEC difficulties by continuing to follow the mothers and children, currently in our study from birth to age three, through early primary school years. Preliminary findings from our current study, consisting of a cluster-RCT examining the impact of a perinatal maternal depression intervention on child development within a population representative birth cohort design, have yielded several insights: (1) the “Thinking Healthy Program - Peer delivered” (THPP) shortened the initial maternal depression episode but its longer term impact is unclear; (2) although the THPP did not have an observable impact on SEC outcomes through age 2, it did favorably impact markers of hypothalamic–pituitary– adrenal (HPA)-axis function in children at 12 months of age; and (3) exposure to adversities (acute poverty, intimate partner violence (IPV), and low maternal social support) appear to be more impactful on child outcomes than maternal depression during the earliest developmental period, and child sex may influence the prevalence of certain adversity exposures after birth as well as their impact on child outcomes. The children of this cohort are about to embark on their first major life transition requiring significant adaptation – that into formal schooling. Following the children through this transition allows us to test key hypotheses linking the rich data already collected on multiple adversities beginning in pregnancy, potential psychosocial and biological mechanisms, and outcomes at this important stage of life course. This study will continue to follow our unique cohort until the children turn 8. The specific aims of the proposed study are to: (1) evaluate the impact of the ongoing and extended intervention (now called “THP Preschool” (THP-PS) on child socioemotional and cognitive (SEC) outcomes at ages 5 through 8, and determine the extent to which the impact is mediated by maternal depression trajectories; (2) examine how the type and timing of adversity exposures, including maternal depression, impacts HPA-axis dysregulation in children, and whether HPA-axis indicators mediate the effect of adversity exposures on child SEC indicators. As part of this aim we will also examine the impact of the ongoing intervention on child HPA-axis biomarkers; and (3) explore, through quantitative and qualitative inquiry, emerging child sex differences in exposure to adversities and their effects on child outcomes.