Associations between Childhood Trauma and Adolescent Psychiatric Disorders in the 2004 Pelotas Birth Cohort

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 (adolescent-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver-report up to age 11 and combined adolescent/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. Each category increase in cumulative trauma by age 11 increased the odds of ‘any disorder’, anxiety, and conduct/oppositional disorders at 15 years (ORs: 1·26-1·43); and trauma up to age 15 was additionally associated with increased odds of mood disorders at age 18 (ORs: 1·26-1·52). Trauma up to age 11 was not predictive of age 18 disorders; and there were no longitudinal trauma-attention/hyperactivity associations. PAFs indicated that trauma exposure explained 31% of age-18 psychiatric disorders. Sensitivity analyses highlighted potential informant effects on trauma-mental health associations. Interpretation: Increasing exposure to trauma is robustly 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.Funding: This article used data from the 2004 Pelotas Birth Cohort Study, conducted by the Postgraduate Program in Epidemiology at Universidade Federal de Pelotas, with the collaboration of the Brazilian Public Health Association (ABRASCO). The Wellcome Trust, World Health Organization, National Support Program for Centers of Excellence (PRONEX), Brazilian National Research Council (CNPq), Brazilian Ministry of Health, and Children’s Pastorate supported previous phases of the study. The 11-year follow-up was supported by the Department of Science and Technology (DECIT) of the Brazilian Ministry of Health, CNPq and the Research Support Foundation of the State of São Paulo (FAPESP; grant number: 2014/13864-6). The 15-year follow-up was supported by the DECIT, CNPq, FAPESP (grant number: 2020/07730-8), the Research Support Foundation of the State of Rio Grande do Sul (FAPERGS), and the L’Oréal-Unesco-ABC Program for Women in Science in Brazil-2020. The 18-year follow-up was supported by DECIT, CNPq (grant number: 409224/2021-9), FAPERGS, L’Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, and the All for Health Institute. The current analyses were funded by a studentship awarded to the first author (MB) from the University of Bath and by grant ES/P000630/1 to the South-West Doctoral Training Partnership, awarded to the Universities of Bath, Bristol, Exeter, Plymouth and West of England (UWE) from the Economic and Social Research Council (ESRC)/UKRI. GH is supported by a Sir Henry Wellcome Postdoctoral Fellowship (grant number: 209138/Z/17/Z). GH is a member of the MRC Integrative Epidemiology Unit at the University of Bristol (MC_UU_00011/7). CNPq supports LTR (308319/2021-4), ISS (303042/2018-4), AJDB, and AM (312746/2021-0). Wellcome Trust supports MXC (225019/Z/22/Z) and JM (210735_A_18_Z). AD received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust (NIHR203318), King’s College London and the Maudsley Charity.Declaration of Interest: We declare no competing interests.Ethical Approval: Assessments were approved by relevant ethics boards at the Universidade Federal de Pelotas and the Universidade de São Paulo, and cohort participants/caregivers provided written informed assent/consent as appropriate at every assessment.