Childhood behavioural and emotional problems: exploring developmental trajectories and early risk and protective factors within the Chilean context

Abstract

Substantial research in the mental health field has raised awareness about the early onset, high prevalence, and long-lasting consequences of childhood behavioural and emotional problems. A growing body of work has emerged studying the origins and course of these problems across childhood, including identifying developmental trajectories and risk and protective factors. However, several research gaps remain. For example, there is sparse evidence examining trajectories of co-occurring behavioural and emotional problems, particularly for common childhood problems (e.g., anxious/depressed, aggressive, hyperactivity/inattention problems). The specificity of long-term impacts of perinatal risk factors also warrants further clarification. For instance, relating to environmental stressors, little is known about the impact of natural disasters during the gestational period on children’s behavioural and emotional outcomes. Additionally, although maternal depression has been widely studied, there are ambiguities around the role of timing and chronicity of perinatal depression for children’s behavioural and emotional problems. Furthermore, most research to date has only utilised samples from high-income western countries, and the extent to which these findings translate to populations in the global South with different socioeconomic structures is unclear. Chile, for example, represents an excellent context for studying the origins and course of behavioural and emotional problems since it is a region with high childhood behavioural and emotional problems, natural disaster exposure, and perinatal depression rates. Therefore, this thesis includes four independent studies largely focused on the Chilean context to address these research gaps.

The first study explored the course and origins of children’s behavioural and emotional problems by examining multi-trajectories of aggression, hyperactivity/inattention, and anxious/depressed problems from three to eleven years old in the Chilean context. Further, it aimed to identify risk and protective factors for group membership at the perinatal, child, and family levels. The sample included 2,857 children in Chile enrolled in the Encuesta Longitudinal de la Primera Infancia (ELPI) cohort. A group-based multi-trajectory analysis indicated that a five-group model best fit the data, with all groups evidencing co-occurring symptoms. Risk factors for membership in the most elevated groups included child sex, maternal age, single parent status, and maternal education, whilst children’s receptive language, maternal vocabulary skills, not having early attendance in the educational system, and parental acceptance reactions towards children’s behaviours were protective factors.

The following three studies delved into the origins of children’s behavioural and emotional problems, with a specific focus on perinatal risk factors. The second study explored the effect of prenatal earthquake exposure on children’s behavioural and emotional problems between one and a half and three years old using exposure to the 27F Chilean earthquake of 2010 and a quasi-experimental statistical technique (i.e., propensity score matching). Participants included 1,549 families from the ELPI cohort. After the matching procedure, results showed greater difficulties for prenatally exposed children, which included higher levels of emotional reactivity, anxious/depressed, sleep problems, attention problems, and aggression.

The last two studies aimed to examine in more depth the role of maternal depression starting in the perinatal period. The first study focused on the global context of maternal depression to explore whether differences would emerge in different regions by conducting a systematic review. This study aimed to synthesise the evidence for associations between different presentations of maternal depression from the perinatal period and later stages of motherhood and children’s internalising, externalising, and social competence outcomes between three to 12 years old. Additionally, it evaluated the evidence for associations between timing, chronicity, and severity of maternal depressive symptoms and children’s outcomes. Twenty-four studies met inclusion criteria, with findings supporting the validity of different presentations of maternal depression, including consistent identification of a group of chronically depressed mothers across countries, both in the global South and North. Mothers within this group reported poorer internalising, externalising, and social competence outcomes for their offspring, with more child problems associated with greater maternal chronicity and symptom severity. However, evidence for associations was less clear when teacher reports were used to measure children’s outcomes.

Then, after exploring the global picture, maternal depression was examined specifically within the Chilean context. This study modelled the impact of antenatal and postnatal depression on children’s behavioural and emotional problems between one and a half and three years old using a quasi-experimental statistical technique (i.e., propensity score matching). Participants included 5,054 families from the ELPI cohort. Additionally, the study assessed the role of recurrent perinatal depressive symptoms on children’s behavioural and emotional problems. Findings showed that exposure to maternal depression across the antenatal and perinatal (i.e., recurrent antenatal and postnatal) periods was associated with greater behavioural and emotional problems. This pattern was absent when assessing exposure to postnatal depression only.

Overall, the thesis’ findings make important contributions to the study of the origins and course of behavioural and emotional problems by (i) identifying developmental heterogeneity, (ii) highlighting the importance of assessing childhood co-occurring problems, (iii) showing that behavioural and emotional problems are multidetermined by several antecedents at different ecological levels and developmental periods, (iv) emphasising that distal and proximal in utero experiences may have long-term consequences for infants’ well-being (e.g., earthquake prenatal exposure, antenatal depression), (v) stressing the importance of chronic maternal depression for children’s developmental outcomes, (vi) highlighting potential differences between informants of children’s outcomes when assessing associations with maternal depression, and (vii) adding to the global evidence of behavioural and emotional problems. Moreover, findings have important practical implications for Chile and South American policies, targeting the prevention of and early intervention for behavioural and emotional problems in childhood.