{
  "abstract": "Background: Early life adversity (ELA) is associated with increased internalizing and externalizing behavior in high-income cohorts. However, it is unclear whether these associations generalize to low- and middle-income countries (LMICs). We examined the association between ELA and internalizing and externalizing behaviors in children across three LMIC cohorts.\n\nMethods: Data from three cohorts, the Brazilian High-Risk Cohort (BHRC; n = 1111), Sustainable Programme Incorporating Nutrition and Games (SPRING; n = 601), and Drakenstein Child Health Study (DCHS; n = 708) were pooled. Children (7–10 years) were assessed using the Strengths and Difficulties Questionnaire (SDQ). ELA was measured using a cumulative index. Ordinary Least Squares linear regression models were run to examine the associations of adversity with internalizing and externalizing behaviors while adjusting for child age, sex, and cohort, and to test interactions with child age, sex, and cohort. 2420 children (53.9% boys) were included in analyses.\n\nResults: SDQ measurement invariance was not established across cohorts. ELA associations were strongest in BHRC (SDQ total: B = 6.78, p < .001; internalizing: B = 3.3, p < .001; externalizing: B = 3.48, p < .001), attenuated in SPRING (SDQ total: B = 1.54, p = .014; internalizing: B = 0.81, p < .001; externalizing: B = 0.73, p = .007), and not observed in DCHS (SDQ total: B = 0.12, p = .78; internalizing: B = -0.18, p = .42; externalizing: B = 0.3, p = .29). Interaction analyses indicated cohort heterogeneity and age-related effects, with inconsistent sex moderation across cohorts and outcomes.\n\nConclusions: In Global South cohorts, while there is an association between ELA and psychopathology, there are also important context-dependent differences across cohorts.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13034-026-01139-9.",
  "abstract_shown": true,
  "affiliations": [
    "Neuroscience Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa",
    "Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa",
    "South African Medical Research Council (SAMRC) Unit on Child and Adolescent Health, Cape Town, South Africa",
    "Global Programs, Child Mind Institute, New York, USA",
    "Universidade Federal do Rio Grande do Sul, Hospital de Clínicas, Porto Alegre, Brazil",
    "Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil",
    "Child Development Group, Sangath, India",
    "South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sheri-Michelle Koopowitz"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Richard Shadwell"
    },
    {
      "affs": [
        0
      ],
      "name": "Nadia Hoffman"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Heather J. Zar"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Giovanni Salum"
    },
    {
      "affs": [
        5
      ],
      "name": "Pedro M. Pan"
    },
    {
      "affs": [
        6
      ],
      "name": "Gauri Divan"
    },
    {
      "affs": [
        6
      ],
      "name": "Supriya Bhavnani"
    },
    {
      "affs": [
        0,
        7
      ],
      "name": "Dan J. Stein"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2p5k73hf8nw20.bib",
  "cited_by": 0,
  "doi": "10.1186/s13034-026-01139-9",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13715187/",
  "id": "2p5k73hf8nw20",
  "issns": [
    "1753-2000"
  ],
  "landing_url": "https://doi.org/10.1186/s13034-026-01139-9",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "3203|Child Abuse and Trauma"
    ]
  ],
  "openalex": "W4415975635",
  "pdf_url": null,
  "pmcid": "PMC13715187",
  "pmid": "42947136",
  "published": "2026-07-24",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/2p5k73hf8nw20.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:22:33Z",
      "native_id": "PMC13715187",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13034-026-01139-9"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:3203|Child Abuse and Trauma",
      "subfield": "psychiatry"
    }
  ],
  "title": "Association of early life adversity with internalizing and externalizing behavior across 3 low- and middle-income countries",
  "title_text": "Association of early life adversity with internalizing and externalizing behavior across 3 low- and middle-income countries",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:22:33Z",
  "url": "https://research.draconitic.com/paper/2p5k73hf8nw20",
  "venue": "Child and Adolescent Psychiatry and Mental Health",
  "versions": []
}