Comparing childhood, chronic, and recent adversity on internalizing symptoms and hypothalamic-pituitary-adrenal axis functioning.

Objective: Examine how childhood, chronic, and recent adversity associate with internalizing symptoms and hypothalamic-pituitary-adrenal axis activity among women in a low-resourced context.Method: Data come from the Bachpan Study (2014-2022), a longitudinal cohort of mothers in rural Pakistan.Childhood adversity was assessed using retrospective reports of adverse childhood experiences.Chronic adult adversity was defined as adversities experienced across two or more prior study waves (baseline, 1 year, 2 years, and 3 years), and recent adversity was assessed at the 6-year wave.Outcomes, measured at the 6-year wave, included depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), and hair cortisol.Generalized linear models examined associations for each adversity separately and simultaneously.Results: In our sample of 900 mothers, we find that childhood, chronic, and recent adversity were each associated with higher depressive and anxiety symptoms, particularly at the highest levels of exposure.Chronic adult adversity and recent adversity showed dose-response relationships with internalizing symptoms.When examined together, recent adversity was the most robust predictor of depressive and anxiety symptoms.Meanwhile, associations between adversity and cortisol were more modest but suggest evidence of blunted cortisol levels at the highest levels of childhood and recent adversity exposure.Conclusions: Findings highlight the importance of considering the differential effects of childhood, chronic, and recent adversity for health.Although early intervention remains critical, addressing ongoing stressors may yield meaningful health benefits.Even if adversities are not eliminated, reducing them can have a significant impact on health. Public Significance StatementThis study clarifies how childhood, chronic, and recent adversity relate to psychological and physiological outcomes.Findings suggest that childhood, chronic, and recent adversity are associated with poorer mental health, with recent adversity showing particularly strong associations with current mental health.These results highlight the importance of addressing ongoing stressors, alongside early prevention efforts, to improve health outcomes.