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

摘要 早年暴露在母亲抑郁中会增加社会情绪和认知(SEC)的风险 童年和人生道路上的问题。这导致了抑郁症治疗作为一种 关键的儿童早期干预。然而，没有足够的证据表明抑郁症的治疗是否 在其他社会和经济逆境高度不利的低资源环境中，单独降低后代风险 很流行。拟议中的巴基斯坦农村研究将首先检查随机分组的影响 干预措施，扩大到包括产妇抑郁和儿童发展部分，涉及儿童安全委员会 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 哪些母亲抑郁和其他逆境导致SEC出现困难，继续遵循 母亲和儿童，目前在我们的研究中，从出生到三岁，一直到小学早期。 我们目前研究的初步结果，包括一项关于围产期影响的整群随机对照试验 具有代表性的人群出生队列设计中产妇抑郁对儿童发育的干预， 有几个见解：(1)“思考健康计划-同伴传递”(THPP)缩短了最初的 母亲抑郁发作，但其长期影响尚不清楚；(2)尽管THPP没有 在2岁之前对SEC的结果有明显的影响，它确实有利地影响了下丘脑-垂体- 12个月大的儿童的肾上腺(HPA)轴功能；和(3)暴露在逆境中(严重贫困， 亲密伴侣暴力(IPV)和母亲社会支持低)对儿童的影响似乎更大 结果比母亲的抑郁在最早的发展阶段，和孩子的性别可能会影响 出生后某些逆境暴露的流行率及其对儿童结局的影响。的孩子们 这群人即将开始他们的第一次重大生活转变，需要重大的适应--即 正规学校教育。通过跟踪孩子们的这种转变，我们可以测试将富人联系在一起的关键假设 已经收集的关于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 在生命历程的这一重要阶段的机制和结果。这项研究将继续遵循我们独特的 这项拟议研究的具体目的是：(1)评估 持续和扩展的干预(现在称为“THP学前班”(THP-PS))对儿童的社会情绪和 5至8岁的认知(SEC)结果，并确定影响的中介程度 母亲抑郁轨迹；(2)检查逆境暴露的类型和时机，包括 母亲抑郁对儿童HPA轴失调的影响以及HPA轴指标是否起中介作用 逆境暴露对儿童SEC指标的影响。作为这一目标的一部分，我们还将审查 正在进行的对儿童HPA轴生物标志物的干预；以及(3)通过定量和定性的方式探索 调查发现，儿童暴露在逆境中的性别差异及其对儿童结局的影响。

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.