Associations between childhood trauma and adolescent psychiatric disorders in Brazil: a longitudinal, population-based birth cohort study

Megan Bailey, Graeme Fairchild, Gemma Hammerton, Andreas Bauer, Marina Xavier Carpena, Joseph Murray, Ina S. Santos, Aluísio J.D. Barros, Luciana Tovo Rodrigues, Andrea Danese, Sarah Halligan, Alicia Matijasevich

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The mental health consequences of exposure to childhood trauma have been little studied among adolescents in low-income and-middle-income countries (LMICs), despite a relatively high burden of trauma in LMIC populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil. Methods: In the 2004 Pelotas Birth Cohort, current psychiatric diagnoses (anxiety, mood, attention–hyperactivity, and conduct–oppositional disorders) were assessed at age 15 years (caregiver-report Development and Well-being Assessment), and age 18 years (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver report up to age 11 years and combined self-report and caregiver-report thereafter. Exposure to 12 trauma types were assessed (serious accident, fire, other disaster, attack or threat, physical abuse, sexual abuse, witnessed domestic violence, witnessed attack, witnessed accident, heard about attack, heard about accident, and parental death). Due to the high prevalence of trauma exposure in the sample, the number of different types of trauma exposure reported was extracted as a proxy for cumulative trauma load. We assessed both cross-sectional and longitudinal associations between cumulative trauma load and psychiatric disorders during adolescence using logistic regression, adjusting for confounders and pre-existing child psychopathology at 48 months. We also computed population attributable fractions (PAFs) for trauma–mental health associations at age 18 years. Findings: 4229 adolescents (51·9% male, 48·1% female) were included in logistic regression analyses based on imputed data. Trauma exposure affected 81·2% of adolescents by age 18 years. At age 15 years, the odds of any disorder (adjusted odds ratio [aOR] 1·19 [95% CI 1·03–1·38]), anxiety disorders (1·45 [1·21–1·75]), and conduct–oppositional disorders (1·60 [1·13–2·27]) increased for each category increase in cumulative trauma, but mood and attention–hyperactivity disorders were not related to cumulative trauma. At age 18 years, the odds of any disorder (1·34 [1·24–1·44]), anxiety disorders (1·23 [1·13–1·34]), mood disorders (1·33 [1·22–1·46]), attention–hyperactivity disorders (1·24 [1·09–1·41]), and conduct–oppositional disorders (1·59 [1·36–1·86]) all increased for each category increase in cumulative trauma. In longitudinal analyses, each category increase in cumulative trauma by age 11 years was associated with an increased odds of any disorder (aOR 1·26 [95% CI 1·11–1·44]), anxiety disorders (1·27 [1·04–1·56]), and conduct–oppositional disorders (1·43 [1·04–1·97]) at 15 years; and trauma up to age 15 years was associated with increased odds of any disorder (1·32 [1·21–1·45]), anxiety disorders (1·27 [1·14–1·40]), mood disorders (1·26 [1·12–1·41]), and conduct–oppositional disorders (1·52 [1·24–1·87]) at age 18 years. Trauma up to age 11 years was not predictive of disorders at age 18 years, and there were no longitudinal associations between trauma and attention–hyperactivity disorders. PAF estimates indicated that trauma exposure accounted for 30·6% (95% CI 21·2–38·7) of psychiatric disorders at age 18 years. Interpretation: Increasing exposure to trauma is associated with mental disorders among Brazilian adolescents. Given the high prevalence of trauma in LMIC populations, strategies to reduce exposure, identify those at greatest risk of mental disorders following trauma, and mitigate the consequences are crucial. Funding: Wellcome Trust, WHO, National Support Program for Centers of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, Children's Pastorate, São Paulo Research Foundation, Rio Grande do Sul Research Foundation, L'Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, All for Health Institute, University of Bath, Economic and Social Sciences Research Council. Translation: For the Portuguese translation of the abstract see Supplementary Materials section.

Original languageEnglish
Pages (from-to)e309-e318
JournalThe Lancet. Global Health
Volume13
Issue number2
Early online date29 Jan 2025
DOIs
Publication statusPublished - 1 Feb 2025

Data Availability Statement

Applications to use the data can be made by contacting the researchers of the 2004 Pelotas Birth Cohort and completing the application form. A list of administered questionnaires at each timepoint can be accessed online. Researchers with successful applications will receive a dataset including the requested variables and unique participant IDs. The analysis code is available through a public GitHub repository at https://github.com/megan-l-bailey/2004Pelotas-Trauma-MentalHealth

Acknowledgements

We thank the young people included in the 2004 Pelotas Birth Cohort Study and their families; this research would not be possible without their ongoing participation. We also thank the 2004 Pelotas Birth Cohort Study research team. This article used data from the 2004 Pelotas Birth Cohort Study, conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association. The Wellcome Trust, WHO, National Support Program for Centers of Excellence, Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children's Pastorate supported previous phases of the study. The 11-year follow-up was supported by the Department of Science and Technology (DECIT) of the Brazilian Ministry of Health, CNPq, and the Research Support Foundation of the State of São Paulo (FAPESP; grant number 2014/13864–6). The 15-year follow-up was supported by the DECIT, CNPq, FAPESP (grant number 2020/07730–8), the Research Support Foundation of the State of Rio Grande do Sul (FAPERGS), and the L’Oréal-Unesco-ABC Program for Women in Science in Brazil-2020. The 18-year follow-up was supported by DECIT, CNPq (grant number 409224/2021–9), FAPERGS, L’Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, and the All for Health Institute, São Paulo, Brazil.

Funding

The current analyses were funded by a studentship awarded to the first author (MB) from the University of Bath and by grant ES/P000630/1 to the South-West Doctoral Training Partnership, awarded to the Universities of Bath, Bristol, Exeter, Plymouth, and the West of England from the Economic and Social Research Council (ESRC)/ UK Research and Innovation (UKRI). GH is supported by a Sir Henry Wellcome Postdoctoral Fellowship (grant number 209138/Z/17/Z). GH is a member of the UK Medical Research Council Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/7). CNPq supports LTR (308319/2021–4), ISS (303042/2018–4), AJDB, and AM (312746/2021–0). SLH and AM also received funding from the UKRI, ESRC, and FAPESP (2023/12905–0). The Wellcome Trust supports MXC (225019/Z/22/Z), JM (210735_A_18_Z), and AM (309183/Z/24/Z). AD received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust (NIHR203318), King's College London, and the Maudsley Charity. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders or institutions.

FundersFunder number
Economic and Social Research CouncilES/P000630/1
UK Research and Innovation FundES/P000630/1

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