Children resilient to early adversity at risk for anxiety, depression in adulthood

It is not common to see children who have resilience to early adversity, and those who appear to be resilient in childhood are at increased risk of delayed poorer outcomes in adulthood, suggests a study.

“Some children are unaffected by mental illness despite exposure to childhood adversity,” according to investigators. “These children are typically considered resilient.”

This study followed such children in adulthood to characterize mental health status, substance use, and functional outcomes. The analysis was based on the prospective, representative Great Smoky Mountains Study, which included a total of 1,420 participants.

The investigators assessed participants for psychiatric disorders and exposure to adversity with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9‒16 years; 6,674 observations). A total of 1,266 participants (86.3 percent) were followed up in adulthood at ages 25 and 30 years.

Of the participants, 75 percent met the criteria for a psychiatric disorder or displayed subthreshold psychiatric problems by age 16 years. The number of adverse childhood experiences showed a strong association with childhood psychiatric status.

Of the 650 children with exposure to multiple adversities, 63 (12.2 percent) did not show any psychiatric problem. This group met common definitions of childhood resilience.

These individuals with childhood resilience were at greater risk of anxiety (risk ratio [RR], 2.9, 95 percent confidence interval [CI], 1.0‒9.1) and depression (RR, 4.5, 95 percent CI, 1.1‒16.7), as well as worse physical health (means ratio, 0.7, 95 percent CI, 0.5‒0.9) and financial or educational functioning (means ratio, 0.6, 95 percent CI, 0.5‒0.7) in adulthood relative to those exposed to fewer childhood adversities.

Participants who were resilient to childhood adversity, however, were not at increased risk of substance use disorders.

“Public health efforts should prioritize minimizing early adversity exposure over promoting resilience,” the investigators said.