Association of early life adversity with internalizing and externalizing behavior across 3 low- and middle-income countries

IntroductionEarly life adversity (ELA) is associated with increased internalizing and externalizing behavior in high-income cohorts. It is unclear to what extent these associations generalize to low- and middle-income countries (LMICs). We examined the association between ELA and internalizing and externalizing behaviors in children across three LMIC cohorts. MethodsData from three LMIC cohorts, the Brazilian High-Risk Cohort (BHRC; n = 1111), Sustainable Programme Incorporating Nutrition and Games (SPRING; n = 601), and Drakenstein Child Health Study (DCHS; n = 708) were pooled. Children (7-10 years) were assessed using the Strengths and Difficulties Questionnaire (SDQ). ELA (first 24 months) was assessed using a cumulative index. Ordinary Least Squares linear regression models were run to examine the associations of adversity with internalizing and externalizing behaviors while adjusting for child age, sex, and cohort, and to test interactions with child age and cohort. ResultsMeasurement invariance did not hold across cohorts, necessitating within-cohort analyses. 2420 children (53.9% boys) were included in analyses. ELA was associated with higher SDQ total scores (B = 1.97, 95% CI: 1.16, 2.78, p < .001), internalizing (B = 0.84, 95% CI: 0.41, 1.27, p < .001), and externalizing behaviors (B = 1.13, 95% CI: 0.62, 1.64, p < .001) in the full sample. Cohort-specific associations were strongest in the BHRC, with attenuated effects in SPRING and DCHS. Girls and older children exhibited fewer behavior problems. Interaction analyses indicated that the associations of adversity with behavior were stronger at younger ages and varied across cohorts. ConclusionIn cohorts from the Global South, while there is an association between early life adversity and psychopathology, there are also important context-dependent differences across cohorts.