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

生命早期的逆境以及风险和复原力的出现：儿童发展的纵向研究

• 批准号: 9889487
• 负责人: Joanna Maselko
• 金额: $ 66.11万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9889487
• 关键词: 8 year old; Acute; Age; Age-Months; Biological; Biological Markers; Biological Process; Birth; Brain; Child; Child Development; Child Support; Childhood; Cognitive; Data; Development; Economics; Evaluation; Exposure to; Generations; Goals; Health; Intervention; Knowledge; Lead; Life; Life Cycle Stages; Link; Longitudinal Studies; Mediating; Mental Depression; Mental Health; Methods; Morbidity - disease rate; Mothers; Nursery Schools; Outcome; Pakistan; Perinatal; Personal Satisfaction; Physiological; Population; Poverty; Pregnancy; Preschool Child; Prevalence; Primary Schools; Randomized; Research; Resources; Risk; Role; Rural; Schools; Sex Differences; Social Environment; Social support; Stress; Structure; Symptoms; Testing; Thinking; Time; boys; cognitive development; cohort; design; early childhood; early life adversity; girls; hypothalamic-pituitary-adrenal axis; improved; innovation; insight; intergenerational; intimate partner violence; maternal depression; maternal outcome; offspring; peer; peripartum depression; programs; psychosocial; resilience; sex; social; transmission process

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.

抽象的 早期生物抑郁症的暴露会增加社会情感和认知的风险（SEC） 童年和生命之后的问题。这导致促进抑郁症治疗作为 关键的幼儿干预。但是，没有足够的证据表明抑郁症治疗是否 仅在其他社会和经济逆境中，降低了低资源环境中的后代风险 流行。首先，在巴基斯坦农村的拟议研究将检查一个随机的簇的影响 干预措施，扩展到包括重大抑郁症和儿童发育部门，对儿童SEC 5-8岁的结果。其次，我们将通过 哪些遗产抑郁症和其他逆境导致了新兴的SEC难度，继续遵循 母亲和儿童，目前正在我们从出生到三岁到小学早期的研究中。 我们当前研究的初步发现，由群集RCT组成，研究了围产期的影响 孕产妇抑郁干预代表出生队列设计的人群中儿童发育的干预， 已经产生了多个见解：（1）“思考健康计划 - 交付的同伴”（THPP）缩短了初始 孕产妇抑郁发作，但长期影响尚不清楚。 （2）尽管THPP没有 可观察到对2岁以下的SEC结果的影响，它确实会影响下丘脑 - 垂体 - 12个月大的儿童肾上腺（HPA）轴功能； （3）暴露于逆境（急性贫困， 亲密的伴侣暴力（IPV）和低母亲社会支持）似乎对儿童有影响 在最早的发育时期，结果比严重抑郁症的结果，儿童性别可能会影响 出生后某些广告暴露及其对儿童结果的影响。孩子的孩子 这个队列即将开始进行他们的第一个重大生活过渡，需要大量适应 - 正规教育。跟随孩子进行这种过渡，使我们能够测试将富人联系起来的关键假设 从怀孕，潜在的社会心理和生物学开始的多个逆境收集的数据 机制，以及在这一重要阶段的生活阶段的结果。这项研究将继续遵循我们的独特 队列直到孩子们满8岁。拟议的研究的具体目的是：（1）评估评估的影响 正在进行的和扩展的干预措施（现在称为“ THP幼儿园”（THP-PS），对儿童社会情感和 5至8岁的认知（SEC）结局，并确定影响的程度 母体抑郁轨迹； （2）检查广告暴露的类型和时间，包括 孕产妇抑郁症会影响儿童的HPA轴失调，以及HPA轴指标是否介导 广告暴露对儿童SEC指标的影响。作为此目标的一部分，我们还将研究 对儿童HPA轴生物标志物的持续干预； （3）通过定量和定性探索 询问，新兴的儿童性别差异在逆境暴露及其对儿童结果的影响。