Abstract
Background. The mental health consequences of childhood trauma exposure have been little studied among low-and-middle-income country (LMIC) adolescents, despite a relatively high burden of trauma in such populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil.
Methods. Current psychiatric diagnoses (anxiety, mood, attention/hyperactivity, conduct/oppositional disorders) were assessed at age 15 (caregiver-report Development and Well-being Assessment), and age 18 (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver-report up to age 11 and combined self/caregiver report thereafter. 4229 adolescents (51·9% boys) were included in logistic regression analyses based on imputed data. Population attributable fractions (PAFs) were computed for trauma-mental health associations at age 18.
Findings. Trauma exposure affected 81·2% of adolescents by age 18. Concurrent trauma-disorder associations were robust across all disorder categories except attention/hyperactivity disorders which were only associated with age 18 trauma. Each category increase in cumulative trauma by age 11 increased the odds of ‘any disorder’ (adjusted OR 1·26 [95% CI 1·11-1·44]), anxiety (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 was associated with increased odds of ‘any disorder’ (1·32 [1·21-1·45]), anxiety (1·27 [1·14-1·40]) mood (1·26 [1·12-1·41]), and conduct/oppositional disorders (1·52 [1·24-1·87]) at age 18. Trauma up to age 11 was not predictive of age 18 disorders; and there were no longitudinal trauma-attention/hyperactivity associations. PAF estimates indicated that trauma exposure accounted for ≥31% of age-18 psychiatric disorders. Sensitivity analyses highlighted potential informant effects on trauma-mental health associations.
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/or mitigate the consequences are critical.
Methods. Current psychiatric diagnoses (anxiety, mood, attention/hyperactivity, conduct/oppositional disorders) were assessed at age 15 (caregiver-report Development and Well-being Assessment), and age 18 (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver-report up to age 11 and combined self/caregiver report thereafter. 4229 adolescents (51·9% boys) were included in logistic regression analyses based on imputed data. Population attributable fractions (PAFs) were computed for trauma-mental health associations at age 18.
Findings. Trauma exposure affected 81·2% of adolescents by age 18. Concurrent trauma-disorder associations were robust across all disorder categories except attention/hyperactivity disorders which were only associated with age 18 trauma. Each category increase in cumulative trauma by age 11 increased the odds of ‘any disorder’ (adjusted OR 1·26 [95% CI 1·11-1·44]), anxiety (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 was associated with increased odds of ‘any disorder’ (1·32 [1·21-1·45]), anxiety (1·27 [1·14-1·40]) mood (1·26 [1·12-1·41]), and conduct/oppositional disorders (1·52 [1·24-1·87]) at age 18. Trauma up to age 11 was not predictive of age 18 disorders; and there were no longitudinal trauma-attention/hyperactivity associations. PAF estimates indicated that trauma exposure accounted for ≥31% of age-18 psychiatric disorders. Sensitivity analyses highlighted potential informant effects on trauma-mental health associations.
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/or mitigate the consequences are critical.
| Original language | English |
|---|---|
| Journal | The Lancet Global Health |
| Publication status | Accepted/In press - 9 Oct 2024 |