Abstract
Background: Childhood trauma is a proposed transdiagnostic risk factor for psychopathology, but epidemiological evidence from low-income and middle-income countries (LMICs) is scarce. We investigated associations between trauma and child psychiatric disorders in a birth cohort in Brazil.
Methods: The 2004 Pelotas Birth Cohort is an ongoing, population-based, prospective birth cohort, including all hospital births occurring between Jan 1 and Dec 31, 2004, in the city of Pelotas, Brazil. When the children were aged 6 and 11 years, trained psychologists administered the Development and Well-Being Assessment clinical interview to caregivers to assess current child psychiatric disorders (anxiety disorders, mood disorders, ADHD and hyperactivity disorders, and conduct and oppositional disorders), and lifetime trauma exposure (ie, experiencing or witnessing life-threatening events) including interpersonal and non-interpersonal events. Analyses used multiple imputation and logistic regression models.
Outcomes: Of 4263 live births, 4231 children were included in the study sample, and 4229 (2195 [51·9%] boys and 2034 [48·1%] girls; 2581 [61·7%] with White mothers and 1600 [38·3%] with Black or mixed race mothers) were included in the imputed analyses. 1154 (34·3%) of 3367 children with complete data at age 11 years had been exposed to trauma by that age. After adjusting for confounders, at age 6 years, trauma was associated with increased odds of anxiety disorders (adjusted odds ratio 1·79 [95% CI 1·33–2·42]) and any psychiatric disorder (1·59 [1·22–2·06]), and at age 11 years, with any psychiatric disorder (1·45 [1·17–1·79]) and all four specific diagnostic classes of anxiety disorders (1·47 [1·04–2·09]), mood disorders (1·66 [1·08–2·55]), ADHD and hyperactivity disorders (1·47 [1·01–2·13]), and conduct and oppositional disorders (1·76 [1·19–2·61]). Interpersonal trauma and non-interpersonal trauma were each associated with increased odds of multiple psychiatric disorders, even when adjusting for their co-occurrence.
Interpretation: A considerable mental health burden associated with childhood trauma is already evident by middle childhood in this sample from Brazil. Evidence-based efforts to reduce the incidence of childhood trauma in Brazil and address its consequences are urgently needed.
Funding: Children's Pastorate, WHO, National Support Program for Centres of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, São Paulo Research Foundation, University of Bath, Wellcome Trust. Translation: For the Portuguese translation of the abstract see Supplementary Materials section.
| Original language | English |
|---|---|
| Pages (from-to) | 969-977 |
| Number of pages | 9 |
| Journal | The Lancet Psychiatry |
| Volume | 9 |
| Issue number | 12 |
| Early online date | 31 Oct 2022 |
| DOIs | |
| Publication status | Published - 31 Dec 2022 |
Bibliographical note
Funding Information:This article was conducted with data from the 2004 Pelotas Cohort Study, conducted by the Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, with the support of the Brazilian Association of Public Health (ABRASCO). Previous phases of the study were funded by the Children's Pastorate; WHO (grant number 03014HNI); the National Support Program for Centers of Excellence (PRONEX; grant number 04/0882.7); the Brazilian National Research Council (CNPq; grant numbers 481012-2009-5; 484077-2010-4; 470965-2010-0; 481141-2007-3; and 426024/2016-8); the Brazilian Ministry of Health (grant number 25000.105293/2004-83) and the São Paulo Research Foundation (FAPESP; grant numbers 2014/13864-6; 2017/22723-5; and 2020/07730-8). The present analyses were funded by CNPq (grant 409224/2021-9). AB was supported by a University Research Studentship Award from the University of Bath. JM is supported by the Wellcome Trust (investigator award 210735_Z_18_Z). GH is supported by a Sir Henry Wellcome Postdoctoral Fellowship (grant number 209138/Z/ 17/ZAM). AM, ISS, JM and AJDB are supported by the Brazilian National Council for Scientific and Technological Development (CNPq). The authors thank the children and families for their participation, without whom this research would not be possible. The authors also thank the 2004 Pelotas Birth Cohort research team. This research was funded in whole, or in part, by the Wellcome Trust (210735_Z_18_Z; 209138/Z/ 17/Z).
Data sharing
Applications to use the data can be made by contacting the researchers of the 2004 cohort (see http://www.epidemio-ufpel.org.br/site/content/ faculty/ for a list of key faculty members) and completing the application form (http://www.epidemio-ufpel.org.br/site/content/studies/ formularios.php). A list of administered questionnaires at each timepoint can be accessed online (http://www.epidemio-ufpel.org.br/ site/content/coorte_2004-en/questionnaires.php). Researchers with successful applications will receive a dataset including the requested variables and unique participant IDs.
