Maternal Mental Health and Infant Parasympathetic Activity in the Context of Forced Displacement: Insights From the Rohingya Camps and Surrounding Communities in Cox's Bazar, Bangladesh

Maternal mental health has been linked to early physiological regulation in infants, with depression, anxiety, and PTSD shaping autonomic nervous system development. Respiratory sinus arrhythmia (RSA), an index of parasympathetic control, reflects infants' ability to regulate arousal and predicts later self-regulation. While maternal prenatal distress has been implicated in fetal autonomic programming, the extent to which these effects persist postnatally remains unclear. In the Rohingya camps in Bangladesh, home to nearly 1 million people fleeing genocide, children are exposed to extreme conditions that can undermine biopsychosocial development. This study examines associations between prenatal and postnatal mental health and infant RSA at 6 weeks of age in a sample of Rohingya refugee and Bangladeshi host community mothers in Cox's Bazar, Bangladesh. Findings indicate that postnatal-but not prenatal-distress is associated with lower infant RSA, with postnatal anxiety predicting lower RSA when infants were held and postnatal depression predicting lower RSA across both held and alone conditions. PTSD symptoms were not significantly associated with RSA. These results suggest that postnatal maternal distress may play a more proximal role in shaping infant autonomic function than prenatal exposure alone, underscoring the need for perinatal mental health interventions in displaced populations to support resilience.