Latent Profiles of Childhood Adversity, Adolescent Mental Health, and Neural Network Connectivity

Abstract

Importance: Adverse childhood experiences are pervasive and heterogeneous, with potential lifelong consequences for psychiatric morbidity and brain health. Existing research does not capture the complex interplay of multiple adversities, resulting in a lack of precision in understanding their associations with neural function and mental health.

Objectives: To identify distinct childhood adversity profiles and examine their associations with adolescent mental health and brain connectivity.

Design, setting, and participants: This population-based birth cohort used data for children who were born in 20 large US cities between 1998 and 2000 and participated in the Future Families and Child Well-Being Study. Families were interviewed when children were born and at ages 1, 3, 5, 9, and 15 years. At age 15 years, neuroimaging data were collected from a subset of these youths. Data were collected from February 1998 to April 2017. Analyses were conducted from March to December 2023.

Exposures: Latent profiles of childhood adversity, defined by family and neighborhood risks across ages 0 to 9 years.

Main outcomes and measures: Internalizing and externalizing symptoms at age 15 years using parent- and youth-reported measures. Profile-specific functional magnetic resonance imaging connectivity across the default mode network (DMN), salience network (SN), and frontoparietal network (FPN).

Results: Data from 4210 individuals (2211 [52.5%] male; 1959 [46.5%] Black, 1169 [27.7%] Hispanic, and 786 [18.7%] White) revealed 4 childhood adversity profiles: low-adversity (1230 individuals [29.2%]), medium-adversity (1973 [46.9%]), high-adversity (457 [10.9%]), and high maternal depression (MD; 550 [13.1%]). High-adversity, followed by MD, profiles had the highest symptoms. Notably, internalizing symptoms did not differ between these 2 profiles (mean difference, 0.11; 95% CI, -0.03 to 0.26), despite the MD profile showing adversity levels most similar to the medium-adversity profile. In the neuroimaging subsample of 167 individuals (91 [54.5%] female; 128 [76.6%] Black, 11 [6.6%] Hispanic, and 20 [12.0%] White; mean [SD] age, 15.9 [0.5] years), high-adversity and MD profiles had the highest DMN density relative to other profiles (F(3,163) = 11.14; P < .001). The high-adversity profile had lower SN density relative to the low-adversity profile (mean difference, -0.02; 95% CI, -0.04 to -0.003) and the highest FPN density among all profiles (F(3,163) = 18.96; P < .001). These differences were specific to brain connectivity during an emotion task, but not at rest.

Conclusions and relevance: In this cohort study, children who experienced multiple adversities, or only elevated MD, had worse mental health and different neural connectivity in adolescence. Interventions targeting multiple risk factors, with a focus on maternal mental health, could produce the greatest benefits.

Figure 1.. Standardized Values of Each Adversity Indicator in the 4-Class Model of Childhood Adversity Profiles

Of 4210 individuals in the included sample, 1230 (29.2%) experienced the lowest rate of adversity, 1973 (46.9%) were exposed to medium-level adversity risk; and 457 (10.9%) experienced the highest level of risk across the 10 adversity types. A total of 550 individuals (13.1%) had similar levels of exposures with the medium-risk profile but with markedly elevated levels of maternal depression (MD) compared with all other profiles.

Figure 2.. Boxplots Comparing Levels of Internalizing and Externalizing Symptoms

The maternal depression (MD) and high-adversity profiles did not differ for internalizing symptoms but differed among all profiles for externalizing symptoms. Center line of box indicates the median value; edges of boxes, upper and lower quartiles; and whiskers, the minimum and maximum values. NS indicates not significant. ^aP < .001. ^bP < .01. ^cP < .05.

Figure 3.. Brain Connectivity and Profile-Specific Networks

A, The default mode network (DMN) included the bilateral inferior parietal lobule, posterior cingulate cortex, and medial temporal gyrus. The salience network (SN) included the bilateral insula, amygdala, and dorsal anterior cingulate cortex. The frontoparietal network (FPN) included the bilateral dorsolateral prefrontal cortex, anterior inferior parietal lobule, and posterior parietal cortex. B, Center line of boxplot indicates the median value; edges of boxes, upper and lower quartiles; and whiskers, the minimum and maximum values. C, Paths within each network map represent subgroup-specific connections. P values were adjusted for multiple comparisons. MD indicates maternal depression; NS, not significant. ^aP < .001. ^bP < .01.

Figure 4.. Boxplots Showing Differences in Subnetwork-Specific Connections Across Adversity Profiles

DMN indicates default mode network; FPN, frontoparietal network; MD, maternal depression; NS, not significant; SN, salience network. P values shown were adjusted for multiple comparisons. ^aP < .001. ^bP < .01. ^cP < .05.