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

Abstract Background Early life adversity (ELA) is associated with increased internalizing and externalizing behavior in high-income cohorts. However, it is unclear whether 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. Methods Data from three 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 was measured 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, sex, and cohort. 2420 children (53.9% boys) were included in analyses. Results SDQ measurement invariance was not established across cohorts. ELA associations were strongest in BHRC (SDQ total: B = 6.78, p < .001; internalizing: B = 3.3, p < .001; externalizing: B = 3.48, p < .001), attenuated in SPRING (SDQ total: B = 1.54, p = .014; internalizing: B = 0.81, p < .001; externalizing: B = 0.73, p = .007), and not observed in DCHS (SDQ total: B = 0.12, p = .78; internalizing: B = -0.18, p = .42; externalizing: B = 0.3, p = .29). Interaction analyses indicated cohort heterogeneity and age-related effects, with inconsistent sex moderation across cohorts and outcomes. Conclusions In Global South cohorts, while there is an association between ELA and psychopathology, there are also important context-dependent differences across cohorts.