Time-Dependent Effects of Exposure to Physical and Sexual Violence on Psychopathology Symptoms in Late Childhood: In Search of Sensitive Periods in Development

doi:10.1016/j.jaac.2019.02.022

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 59, Issue 2, February 2020, Pages 283-295.e4

https://doi.org/10.1016/j.jaac.2019.02.022 Get rights and content

Objective

Exposure to interpersonal violence is a known risk factor for psychopathology. However, it is unclear whether there are sensitive periods when exposure is most deleterious. We aimed to determine whether there were time periods when physical or sexual violence exposure was associated with greater child psychopathology.

Method

This study (N = 4,580) was embedded in Generation R, a population-based prospective birth cohort. Timing of violence exposure, reported through maternal reports (child age, 10 years) was categorized by age at first exposure, defined as: very early (0−3 years), early (4−5 years), middle (6−7 years), and late (8+ years) childhood. Using Poisson regression, we assessed the association between timing of first exposure and levels of internalizing and externalizing symptoms, using the Child Behavior Checklist at age 10 years.

Results

Violence exposure at any age was associated with higher internalizing (physical violence: risk ratio [RR] = 1.46, p < 0.0001; sexual violence: RR = 1.30, p < .0001) and externalizing symptoms (physical violence: RR = 1.52, p < 0.0001; sexual violence: RR = 1.31, p = 0.0005). However, the effects of violence were time dependent: compared to children exposed at older ages, children first exposed during very early childhood had greater externalizing symptoms. Sensitivity analyses suggested that these time-based differences emerged slowly across ages 1.5, 3, 6, and 10 years, showing a latency between onset of violence exposure and emergence of symptoms, and were unlikely to be explained by co-occurring adversities.

Conclusion

Interpersonal violence is harmful to childhood mental health regardless of when it occurs. However, very early childhood may be a particularly sensitive period when exposure results in worse psychopathology outcomes. Results should be replicated in fully prospective designs.

Section snippets

Sample and Procedures

Data came from Generation R, a population-based prospective study of children followed from fetal life onward in Rotterdam, the Netherlands. The goal of Generation R was to examine the social, biological, and environmental factors shaping child growth, health, and development. Details about the cohort have been described elsewhere.35, 36, 37, 38 In brief, 9,778 mothers living in Rotterdam at the time of their estimated delivery date (between April 2002 and January 2006) were enrolled during

Results

The mean age of the analytic sample was 9.7 years (SD = 0.3). As shown in Table 1, the analytic sample was approximately half girls (50.7%), and mostly Dutch (65.5%). The sample varied with respect to maternal education (52.0% had mothers with middle-high to high education) and household income level (53.5% had high income), with the majority of mothers reporting either being married (46.8%) or living with a partner (37.9%). Most children (93.3%) were born full term. Maternal psychopathology

Discussion

The main finding from this study is that very early childhood, here defined as the time period from birth to the third birthday, may be a sensitive period when exposure to interpersonal violence is associated with the greatest risk for psychopathology symptoms in later childhood. These results did not appear to be explained by a greater number of exposures to multiple types of adversity. That is, even after controlling for the effects of exposure to other co-occurring early life adversities, we

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Citation Excerpt :
The Bucharest Early Intervention Project has provided evidence on a potential sensitive period of socio-emotional development during the first two years of life: Youth from orphanages with very poor quality care improved more in cognitive and emotion regulatory functions if placed into foster care before they were two years old, as compared to those who were placed later (McLaughlin et al., 2015b). Some studies on mental health outcomes also implicate early childhood as a sensitive period (Dunn et al., 2020), whereas others point more to middle childhood or adolescence (Gerke et al., 2018; Schalinski et al., 2016; Yoon, 2020). Overall, childhood adversity likely impacts multiple developmental periods, rendering it unlikely that there is only one narrow window during which adversity affects psychobiological processes (Nelson and Gabard-Durnam, 2020).
Childhood adversity (CA) is associated with increased risk for physical and mental health problems, with alterations in vagal regulation (an aspect of autonomic functioning indexed by vagally-mediated heart rate variability [vmHRV]) implicated as a mechanism. Three-level meta-analyses were conducted to synthesize research on the relationship between CA and 1) baseline vagal activity, and 2) vagal reactivity to challenges including stress tests, emotion-eliciting tasks and cognitive tasks. No significant overall association was found between CA and vagal activity (r = −.015; p = .11) or vagal reactivity (r = −.017; p = .13). However, analyses controlling for moderator interrelatedness revealed an association between CA and lower baseline vagal activity in samples including participants diagnosed with a psychiatric disorder, and for direct adversities such as maltreatment. For vagal reactivity, CA was associated with lower reactivity if the adversity was experienced less recently, and for studies operationalizing reactivity using task mean levels of vmHRV. These findings indicate that small alterations in vagal functioning occur for specific CA subtypes and subgroups of individuals.
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: Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award no. K01MH102403 (Dunn) and 1R01MH113930 (Dunn). A. Neumann and H. Tiemeier are supported by a grant of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant no. 024.001.003, Consortium on Individual Development). The work of H. Tiemeier is further supported by the Gravitation program of the Dutch Ministry of Education, Culture, and Science and the Netherlands Organization for Scientific Research (NWO grant no. 024.001.003) and NWO-VICI grant (NWO-ZonMW: 016.VICI.170.200). C. Cecil has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement no. 707404.

: The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the Erasmus University Rotterdam, Faculty of Social Sciences, the Municipal Health Service Rotterdam area, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond (STAR), Rotterdam. The Generation R Study is made possible by financial support from Erasmus Medical Center, Rotterdam, and the Netherlands Organization for Health Research and Development (ZonMw). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

: Garrett Fitzmaurice, ScD, of Harvard University T.H. Chan School of Public Health, served as the statistical expert for this research.

: The authors gratefully acknowledge the contribution of general practitioners, hospitals, midwives, and pharmacies in Rotterdam.

: Disclosure: Drs. Dunn, Cecil, Susser, Tiemeier, Ms. Nishimi, Mr. Neumann, and Ms. Renaud have reported no biomedical financial interests or potential conflicts of interest.

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New researchTime-Dependent Effects of Exposure to Physical and Sexual Violence on Psychopathology Symptoms in Late Childhood: In Search of Sensitive Periods in Development

Objective

Method

Results

Conclusion

Section snippets

Sample and Procedures

Results

Discussion

J Affect Disord

Am J Prev Med

J Affect Disorders

J Adolesc Health

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Child Abuse Negl

Child Abuse Negl

Neurosci Biobehav Rev

Front Neuroendocrinol

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

Lancet

Child Abuse Negl

J Am Acad Child Adolesc Psychiatry

J Clin Epidemiol

J Am Acad Child Adolesc Psychiatry

Biol Psychiatry

Biol Psychiatry

Child Abuse Negl

Child Adolesc Psychiatr Clin North Am

J Affect Disord

Trends Neurosci

Lancet

Sensitive periods in the development of the brain and behavior

J Cogn Neurosci

Sensitive periods in development: structural characteristics and causal interpretations

Psychol Bull

Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: results from the National Longitudinal Study of Adolescent Health

Depress Anxiety

The impact of exposure to interpersonal violence on gender differences in adolescent-onset major depression: results from the National Comorbidity Survey Replication (NCS-R)

Depress Anxiety

Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication II: associations with persistence of DSM-IV disorders

Arch Gen Psychiatry

A prospective investigation of major depressive disorder and comorbidity in abused and neglected children grown up

Arch Gen Psychiatry

Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication I: associations with first onset of DSM-IV disorders

Arch Gen Psychiatry

Childhood neglect, internalizing symptoms and adolescent substance use: does the neighborhood context matter?(clinical report)

J Youth Adolesc

Age of onset of child maltreatment predicts long-term mental health outcomes

J Abnorm Psychol

The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems

Dev Psychopathol

The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes

Dev Psychopathol

What life course theoretical models best explain the relationship between exposure to childhood adversity and psychopathology symptoms: recency, accumulation, or sensitive periods?

Psychol Med

Effects of chronic maltreatment and maltreatment timing on children's behavior and cognitive abilities

J Child Psychol Psychiatry

Childhood adversities and adolescent depression: a matter of both risk and resilience

Dev Psychopathol

Cumulative adversity in childhood and emergent risk factors for long-term health

J Pediatr

The deprived human brain: developmental deficits among institutionalized Romanian children—and later improvements—strengthen the case for individualized care

Am Scientist

New research
Time-Dependent Effects of Exposure to Physical and Sexual Violence on Psychopathology Symptoms in Late Childhood: In Search of Sensitive Periods in Development