Type and developmental timing of childhood adversity predicts psychopathology symptoms in a South African birth cohort

Sherief Y. Eldeeb; Brooke G. McKenna; Marilyn T. Lake; Nadia Hoffman; Alexandre A. Lussier; Esther Walton; Andrew J. Simpkin; Andrew D.A.C. Smith; Heather J. Zar; Dan J. Stein; Erin C. Dunn

doi:10.1111/jcpp.70148

Type and developmental timing of childhood adversity predicts psychopathology symptoms in a South African birth cohort

Sherief Y. Eldeeb
, Brooke G. McKenna
, Marilyn T. Lake
, Nadia Hoffman
, Alexandre A. Lussier
, Esther Walton
, Andrew J. Simpkin
, Andrew D.A.C. Smith
, Heather J. Zar
, Dan J. Stein
, Erin C. Dunn

Purdue University
Harvard University
University of Cape Town
Maynooth University
Mathematics and Statistics Research Group
University of the West of England

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Childhood adversity is widespread globally and is one of the strongest predictors of later psychopathology. However, the differential effects of type and timing of childhood adversities on childhood psychopathology remain unclear, highlighting the need to explore which life-course hypotheses (sensitive periods, accumulation of exposure, and/or recency of exposure) best explain these associations. Of particular importance, there is a lack of research in low- and middle-income countries (LMIC), where children experience higher rates of adversity relative to children in high-income countries (HIC). Methods: Participants included 787 children and their mothers from a South African birth cohort, the Drakenstein Child Health Study. Mothers reported child exposure to adversity from birth to 8 years of age across six adversity categories. We used the two-stage Structured Life-Course Modeling Approach (SLCMA) to examine life-course associations between childhood adversity exposures and internalizing/externalizing symptoms measured using the Child Behavior Checklist at age 8 years. Results: Maternal psychopathology, maternal adverse events, child food insecurity, and child exposure to community/domestic violence had the strongest associations with child psychopathology symptoms, with varying life-course models selected. The accumulation hypothesis best explained associations of maternal adverse events (partial R² = 2.3%) and child exposure to community/domestic violence (partial R² = 1.6%) with internalizing symptoms. The combined middle childhood sensitive period (age > 5–8) and recency hypotheses model best explained associations between maternal psychopathology and internalizing (partial R² = 7.0%) or externalizing (partial R² = 5.1%) symptoms. Conclusions: We identified that different types and timing of childhood adversity confer differential risk for childhood psychopathology symptoms in this LMIC sample. Our work has implications for strategically-timed intervention and prevention strategies to improve mental health, which may need to be specifically designed for children in LMIC.

Original language	English
Number of pages	15
Journal	Journal of Child Psychology and Psychiatry and Allied Disciplines
DOIs	https://doi.org/10.1111/jcpp.70148
Publication status	Published - 29 Apr 2026

Data Availability Statement

The Drakenstein Child Health Study is committed to the principle of data sharing. De-identified data will be made available to requesting researchers as appropriate. Requests for collaborations are welcome. More information can be found on our website [http://www.paediatrics.uct.ac.za/scah/dclhs].

Funding

The Drakenstein Child Health Study (DCHS) was funded by the Bill and Melinda Gates Foundation (OPP1017641 and OPP1017579), the National Institute of Mental Health (1R21MH098662‐01), the National Institutes of Health (NIH) of the United States of America (USA) through the H3Africa initiative (1U01AI110466‐01A1), the National Research Foundation, the South African Medical Research Council, and the Wellcome Trust (221372/Z/20/Z). Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health (R01 MH113930, PI: ECD). The NIMH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This manuscript reflects the views of the authors and may not reflect the opinions or views of the NIH. EW received funding from UK Research and Innovation (UKRI) under the UK government's Horizon Europe / ERC Frontier Research Guarantee [BrainHealth, grant number EP/Y015037/1]. AAL is supported by an MQ Fellows Award from the MQ Foundation (MQF22‐9). The authors greatly thank the parents and children who participated in this study. They would also like to thank the study staff in Paarl, the study data and laboratory teams, and the clinical and administrative staff of the Western Cape Government Health Department at Paarl Hospital and at the clinics for support of the study. Additionally, they would like to thank Alison Hoffnagle, Samantha Stoll, Isabel Schuurmans, Anke Hüls, and Anna Ruehlmann for their assistance in preparing this manuscript. The authors have declared that they have no competing or potential conflicts of interest.

Funders	Funder number
South African Medical Research Council
HORIZON EUROPE Framework Programme
National Research Foundation
UK Research and Innovation
National Institute of Mental Health	1R21MH098662‐01
MQ Foundation	MQF22‐9
National Institutes of Health	1U01AI110466‐01A1
Wellcome Trust	R01 MH113930, 221372/Z/20/Z
Bill and Melinda Gates Foundation	OPP1017579, OPP1017641
European Research Council	EP/Y015037/1

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being
SDG 5 Gender Equality
SDG 16 Peace, Justice and Strong Institutions

Keywords

Childhood adversity
life-course hypotheses
low- and middle-income countries (LMIC)
sensitive period
SLCMA

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Developmental and Educational Psychology
Psychiatry and Mental health

Access to Document

10.1111/jcpp.70148Licence: CC BY

Cite this

Eldeeb, S. Y., McKenna, B. G., Lake, M. T., Hoffman, N., Lussier, A. A., Walton, E., Simpkin, A. J., Smith, A. D. A. C., Zar, H. J., Stein, D. J., & Dunn, E. C. (2026). Type and developmental timing of childhood adversity predicts psychopathology symptoms in a South African birth cohort. Journal of Child Psychology and Psychiatry and Allied Disciplines. https://doi.org/10.1111/jcpp.70148

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abstract = "Background: Childhood adversity is widespread globally and is one of the strongest predictors of later psychopathology. However, the differential effects of type and timing of childhood adversities on childhood psychopathology remain unclear, highlighting the need to explore which life-course hypotheses (sensitive periods, accumulation of exposure, and/or recency of exposure) best explain these associations. Of particular importance, there is a lack of research in low- and middle-income countries (LMIC), where children experience higher rates of adversity relative to children in high-income countries (HIC). Methods: Participants included 787 children and their mothers from a South African birth cohort, the Drakenstein Child Health Study. Mothers reported child exposure to adversity from birth to 8 years of age across six adversity categories. We used the two-stage Structured Life-Course Modeling Approach (SLCMA) to examine life-course associations between childhood adversity exposures and internalizing/externalizing symptoms measured using the Child Behavior Checklist at age 8 years. Results: Maternal psychopathology, maternal adverse events, child food insecurity, and child exposure to community/domestic violence had the strongest associations with child psychopathology symptoms, with varying life-course models selected. The accumulation hypothesis best explained associations of maternal adverse events (partial R2 = 2.3\%) and child exposure to community/domestic violence (partial R2 = 1.6\%) with internalizing symptoms. The combined middle childhood sensitive period (age > 5–8) and recency hypotheses model best explained associations between maternal psychopathology and internalizing (partial R2 = 7.0\%) or externalizing (partial R2 = 5.1\%) symptoms. Conclusions: We identified that different types and timing of childhood adversity confer differential risk for childhood psychopathology symptoms in this LMIC sample. Our work has implications for strategically-timed intervention and prevention strategies to improve mental health, which may need to be specifically designed for children in LMIC.",

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author = "Eldeeb, \{Sherief Y.\} and McKenna, \{Brooke G.\} and Lake, \{Marilyn T.\} and Nadia Hoffman and Lussier, \{Alexandre A.\} and Esther Walton and Simpkin, \{Andrew J.\} and Smith, \{Andrew D.A.C.\} and Zar, \{Heather J.\} and Stein, \{Dan J.\} and Dunn, \{Erin C.\}",

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AU - Eldeeb, Sherief Y.

AU - McKenna, Brooke G.

AU - Lake, Marilyn T.

AU - Hoffman, Nadia

AU - Lussier, Alexandre A.

AU - Walton, Esther

AU - Simpkin, Andrew J.

AU - Smith, Andrew D.A.C.

AU - Zar, Heather J.

AU - Stein, Dan J.

AU - Dunn, Erin C.

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N2 - Background: Childhood adversity is widespread globally and is one of the strongest predictors of later psychopathology. However, the differential effects of type and timing of childhood adversities on childhood psychopathology remain unclear, highlighting the need to explore which life-course hypotheses (sensitive periods, accumulation of exposure, and/or recency of exposure) best explain these associations. Of particular importance, there is a lack of research in low- and middle-income countries (LMIC), where children experience higher rates of adversity relative to children in high-income countries (HIC). Methods: Participants included 787 children and their mothers from a South African birth cohort, the Drakenstein Child Health Study. Mothers reported child exposure to adversity from birth to 8 years of age across six adversity categories. We used the two-stage Structured Life-Course Modeling Approach (SLCMA) to examine life-course associations between childhood adversity exposures and internalizing/externalizing symptoms measured using the Child Behavior Checklist at age 8 years. Results: Maternal psychopathology, maternal adverse events, child food insecurity, and child exposure to community/domestic violence had the strongest associations with child psychopathology symptoms, with varying life-course models selected. The accumulation hypothesis best explained associations of maternal adverse events (partial R2 = 2.3%) and child exposure to community/domestic violence (partial R2 = 1.6%) with internalizing symptoms. The combined middle childhood sensitive period (age > 5–8) and recency hypotheses model best explained associations between maternal psychopathology and internalizing (partial R2 = 7.0%) or externalizing (partial R2 = 5.1%) symptoms. Conclusions: We identified that different types and timing of childhood adversity confer differential risk for childhood psychopathology symptoms in this LMIC sample. Our work has implications for strategically-timed intervention and prevention strategies to improve mental health, which may need to be specifically designed for children in LMIC.

AB - Background: Childhood adversity is widespread globally and is one of the strongest predictors of later psychopathology. However, the differential effects of type and timing of childhood adversities on childhood psychopathology remain unclear, highlighting the need to explore which life-course hypotheses (sensitive periods, accumulation of exposure, and/or recency of exposure) best explain these associations. Of particular importance, there is a lack of research in low- and middle-income countries (LMIC), where children experience higher rates of adversity relative to children in high-income countries (HIC). Methods: Participants included 787 children and their mothers from a South African birth cohort, the Drakenstein Child Health Study. Mothers reported child exposure to adversity from birth to 8 years of age across six adversity categories. We used the two-stage Structured Life-Course Modeling Approach (SLCMA) to examine life-course associations between childhood adversity exposures and internalizing/externalizing symptoms measured using the Child Behavior Checklist at age 8 years. Results: Maternal psychopathology, maternal adverse events, child food insecurity, and child exposure to community/domestic violence had the strongest associations with child psychopathology symptoms, with varying life-course models selected. The accumulation hypothesis best explained associations of maternal adverse events (partial R2 = 2.3%) and child exposure to community/domestic violence (partial R2 = 1.6%) with internalizing symptoms. The combined middle childhood sensitive period (age > 5–8) and recency hypotheses model best explained associations between maternal psychopathology and internalizing (partial R2 = 7.0%) or externalizing (partial R2 = 5.1%) symptoms. Conclusions: We identified that different types and timing of childhood adversity confer differential risk for childhood psychopathology symptoms in this LMIC sample. Our work has implications for strategically-timed intervention and prevention strategies to improve mental health, which may need to be specifically designed for children in LMIC.

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KW - low- and middle-income countries (LMIC)

KW - sensitive period

KW - SLCMA

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M3 - Article

AN - SCOPUS:105038094786

SN - 0021-9630

JO - Journal of Child Psychology and Psychiatry and Allied Disciplines

JF - Journal of Child Psychology and Psychiatry and Allied Disciplines

ER -

Type and developmental timing of childhood adversity predicts psychopathology symptoms in a South African birth cohort

Abstract

Data Availability Statement

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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