Prenatal exposure to a natural disaster and early development of psychiatric disorders during the preschool years: stress in pregnancy study

Abstract

Background: Growing evidence shows an association between in utero exposure to natural disasters and child behavioral problems, but we still know little about the development of specific psychopathology in preschool-aged children.

Methods: Preschool children (n = 163, mean age = 3.19, 85.5% racial and ethnic minorities) and their parents (n = 151) were evaluated annually at ages 2-5 to assess the emergence of psychopathology using the Preschool Age Psychopathological Assessment (PAPA), a parent-report structured diagnostic interview developed for preschool-age children. Sixty-six (40.5%) children were exposed to Sandy Storm (SS) in utero and 97 (59.5%) were not. Survival analysis evaluated patterns of onset and estimated cumulative risks of psychopathology among exposed and unexposed children, in total and by sex. Analyses were controlled for the severity of objective and subjective SS-related stress, concurrent family stress, and demographic and psychosocial confounders, such as maternal age, race, SES, maternal substance use, and normative prenatal stress.

Results: Exposure to SS in utero was associated with a substantial increase in depressive disorders (Hazard Ratio (HR) = 16.9, p = .030), anxiety disorders (HR = 5.1, p < .0001), and attention-deficit/disruptive behavioral disorders (HR = 3.4, p = .02). Diagnostic rates were elevated for generalized anxiety disorder (GAD; HR = 8.5, p = .004), attention-deficit/hyperactivity disorder (ADHD; HR = 5.5, p = .01), oppositional-defiant disorder (ODD; HR = 3.8, p = .05), and separation-anxiety disorder (SAD; HR = 3.5, p = .001). Males had distinctively elevated risks for attention-deficit/disruptive behavioral disorders (HR = 7.8, p = .02), including ADHD, CD, and ODD, whereas females had elevated risks for anxiety disorders (HR = 10.0, p < .0001), phobia (HR = 2.8, p = .02) and depressive disorders (HR = 30.0, p = .03), including SAD, GAD, and dysthymia.

Conclusions: The findings demonstrate that in utero exposure to a major weather-related disaster (SS) was associated with increased risk for psychopathology in children and provided evidence of distinct psychopathological outcomes as a function of sex. More attention is needed to understand specific parent, child, and environmental factors which account for this increased risk, and to develop mitigation strategies.

Keywords: Natural disasters; anxiety; developmental psychopathology; disruptive behavior; sex differences.

Figure 1

SIP Study – Exposure to Superstorm Sandy in utero

Figure 2.

The test of equality on survival distributions by Superstorm Sandy exposure status for anxiety disorders, disruptive behavioral disorders, and any disorder by Superstorm Sandy exposure (A.1, B.1, C.1) and by Superstorm Sandy exposure and child sex (A.2, B.2, C.2). Legends for A.1., B.1, and C.1: A. Anxiety disorders (X²=16.95, df=1, p<.0001); B. Disruptive behavioral disorders (X²=12.13, df=1, p=.0005); and C. any disorder (X²=4.60, df=1, p=.03). Legends for A.2., B.2., and C.2: Boys: A. anxiety disorders (X²=1.37, df=1, p=.24), B. disruptive behavioral disorders (X²=11.71, df=1, p=.001), and C. any disorder (X²=0.45, df=1, p=.50). Girls: A. anxiety disorders (X²=16.91, df=1, p<.0001), B. disruptive behavioral disorders (X²=2.61, df=1, p=.11), and C. any disorder (X²=5.58, df=1, p=.02). Panel A for anxiety disorders, panel B for disruptive behavioral disorders, and panel C for any disorder. Solid lines represent exposed [SS(+)] and dotted lines unexposed [SS(−)]. Red lines represent girls and blue lines boys. Anxiety disorders include separation anxiety, generalized anxiety disorder, selective mutism, and posttraumatic stress disorder. Disruptive behavioral disorders include conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder. Any disorder includes any of the above disorder. Results for single disorders that are a part of anxiety disorders (separation anxiety disorder, generalized anxiety disorder, selective mutism) and disruptive disorders (conduct disorder, oppositional defiant disorder, and attention deficit/hyperactivity disorder) can be found in Table S2.