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Free keywords:
Institutional deprivation,
depression,
anxiety,
emotional problems,
developmental cascades,
neurodevelopmental problems,
longitudinal,
prospective,
natural experiment
Abstract:
Background: Using data from the English & Romanian Adoptees (ERA) study, we recently reported that early timelimited
exposure to severe institutional deprivation is associated with early-onset and persistent neurodevelopmental
problems and later-onset emotional problems. Here, we examine possible reasons for the late emergence of emotional
problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of
early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative
pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their
early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK
adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15
anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety
were assessed by both parent and self-reports; young adults also completed measures of stress reactivity, exposure
to adverse life events, and functioning in work and interpersonal relationships. Results: The path between early
institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental
problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with
regard to early deprivation, later life stress reactivity, and emotional problems were inconclusive. Conclusions: Our
analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is
explained through the effects of early neurodevelopmental problems on later social and vocational functioning.
Future research should more fully examine the role of stress susceptibility in this model. Keywords: Institutional
deprivation; depression; anxiety; emotional problems; developmental cascades; neurodevelopmental problems;
longitudinal; prospective; natural experiment.
