Abstract: Timing of Maternal Psychopathology on Child Behavioral Outcomes: Evidence from a Prospective Birth cohort study In Lima, Peru. (Society for Social Work and Research 31st Annual Conference)

Schedule:

Friday, January 22, 2027

Union Station 23 (Hilton San Francisco Union Square)

* noted as presenting author

Xixi Kang, MSW, MSP, PhD student, New York University, NY

Diana Juvinao-Quintero, PhD, Research Scientist, Harvard University, MA

Maria Luisa Jimenez Sanchez, BA, Research Assistant, Asociación Civil Proyectos en Salud, Lima, Peru

Sixto Sanchez, MD, MPH, Physician and Researcher, Facultad de Medicina Humana, Instituto de Investigación, Universidad de San Martin de Porres, Lima, Peru

Marta Rondon, MD, MSc, Physician and Researcher, Facultad de Medicina Humana, Instituto de Investigación, Universidad de San Martin de Porres, Lima, Peru

Andrew Smith, PhD, Associate Professor, University of the West of England, Bristol, United Kingdom

Henning Tiemeier, MD, PhD, Sumner and Esther Feldberg Professor of Maternal and Child Health, Harvard University, MA

Karestan Koenen, PhD, Professor, Harvard University, MA

Alicia Smith, PhD, Professor, Emory University, GA

Archana Basu, PhD, Research Scientist, Harvard University, MA

Bizu Gelaye, PhD, Associate Professor, Harvard University, MA

Background and Purpose: Maternal psychopathology is associated with child behavioral problems, yet little research has examined when exposure matters most across development. Prior studies often rely on limited timepoints and do not formally test life-course hypotheses. Guided by the Developmental Origins of Health and Disease (DOHaD) framework and life course theory, this study applies a life-course framework to examine the timing of maternal psychopathology across three periods: pregnancy, early childhood (ages 3–4), and middle childhood (ages 5–12), on child behaviors. We tested three sensitive period hypotheses to assess whether exposure during a specific developmental window has the strongest impact, and a recency hypothesis to assess whether a more proximal exposure exerts greater influence.

Methods: Data from 1,470 Peruvian mother–child dyads from the Pregnancy Outcomes, Maternal and Infant Study (PrOMIS), a longitudinal birth cohort study, was used. Mothers have been followed from pregnancy through middle childhood. Maternal depression (PHQ-9) and PTSD (PCL-C) were assessed during pregnancy, early childhood, and middle childhood. Child behavioral outcomes were measured at middle childhood using the Child Behavior Checklist (CBCL/6–18) T-scores (internalizing, externalizing, and total problems). We applied a two-stage Structured Life Course Modeling Approach (SLCMA) using the Least Angle Regression (LARS) to identify the best-fitting life-course model(s). Selective inference was used to estimate coefficients and statistical significance. Models were adjusted for maternal (age, parity, pre-pregnancy BMI, financial hardship, childhood abuse), and child covariates (age and sex). Missing data (0.2%-70.2%; primarily in maternal depression and PTSD during the early childhood period, and selected covariates such as BMI and financial hardship) were handled using multiple imputation. Analyses were conducted for each behavioral outcome and stratified by child sex. All analyses were conducted in R version 5.1.3.

Results: Mean maternal age was 28 years (SD=6.12); 48% were nulliparous, 47% reported financial hardship, and 63% had experienced childhood abuse. Children had a mean age of 9 years (SD=1.63), including 722 girls (49%) and 748 boys (51%). Across outcomes, the recency hypothesis was consistently selected, while the prenatal sensitive-period hypothesis was not supported. For total problems, recency indices for depression (β=0.36, p<.001) and PTSD (β=0.39, p<.001) surpassed multiple-testing, with some effects from middle childhood exposure (e.g., depression β=3.80, p<.001). For internalizing problems, recency effects remained robust (depression β=0.44, PTSD β=0.50, both p<.001). For externalizing problems, middle childhood was the primary predictor for exposure to depression (β=3.82, p<.001), while both recency and middle childhood exposure were significant for PTSD. Sex-stratified analyses showed stronger recency effects among girls and stronger middle childhood effects among boys.

Conclusions and Implications: Findings support a recency model, indicating that maternal psychopathology throughout life, but particularly during middle childhood, had the greatest influence on child behavior problems. Results highlight the importance of a sustained maternal mental health support beyond the perinatal period. Applying SLCMA in a longitudinal cohort, this study underscores the need for developmentally timed interventions to improve child well-being.