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Principal Investigator: Victoria Baranov
Organization: UNIV OF NORTH CAROLINA CHAPEL HILL
Fiscal Year: 2024
Award: $245,421
Funding agency: National Institute of Mental Health
ABSTRACT
Depressive and anxiety disorders are among the leading contributors to the global disease burden and are
more common in women compared to men. Among women in low-resource contexts, such as low- and middle-
income countries (LMICs), exposure to adversities (e.g., poverty, intimate partner violence, negative life events
such as illness or loss) is a powerful risk factor for developing internalizing symptoms (i.e., depressive and
anxiety symptoms). Dysregulated activity in the hypothalamic pituitary adrenal (HPA) axis may be a
mechanism underlying the onset of internalizing disorders and a novel adjunct target for mental health
interventions in addition to psychological symptoms. However, there is little evidence of the long-term effects of
mental health interventions on either psychological symptoms or HPA axis dysregulation. In addition, more
research is needed to characterize the dynamic role of adverse experiences in shaping women’s internalizing
symptoms and HPA axis activity over time, especially in South Asia, where women may have unique familial
social contexts compared to western counterparts. This work is essential for establishing and improving the
long-term effectiveness of mental health interventions globally. In this R21, we propose leveraging multi-year
experimental and observational data from the Bachpan study, an ongoing longitudinal birth cohort with an
embedded cluster randomized control trial of a maternal depression intervention delivered in rural Pakistan.
Specifically, we will test the effects the intervention on HPA axis regulation and internalizing symptoms 6 years
after intervention onset, as well as whether HPA axis activity mediates the effect of the intervention on
internalizing symptoms. We will also examine how adversity exposure, including chronic adversity experienced
over a six-year period, retrospectively reported childhood adversity, and recent adversity, relate to HPA axis
activity and internalizing symptoms. As part of this analysis, we will also examine how within-person changes in
adversity relate to within-person changes in HPA axis activity and internalizing symptoms over time. The rich,
multi-year dataset includes information on multiple domains of women’s mental health and adverse
experiences, as well as hair-derived HPA axis hormones (cortisol and DHEA). The major public health
contribution of this project is that it will generate knowledge on the longitudinal predictors of stress system
dysregulation and internalizing symptoms among women in a low resource context, as well as the potential
ameliorating role of psychosocial intervention.
Terms: <0-11 years old><3rd trimester><8 year old><8 years of age><Active Follow-up><Adverse Experience><Adverse event><Aeroseb-HC><Androstenolone><Anxiety Disorders><Asia><Birth><COVID-19><CV-19><Cetacort><Child><Child Youth><Children (0-21)><Chronic><Coronavirus Infectious Disease 2019><Cort-Dome><Cortef><Cortenema><Cortisol><Cortispray><Cortril><Cultural Diversity><DHEA><Data><Data Collection><Data Set><Dehydroisoandrosterone><Depressive Syndromes><Depressive disorder><Dermacort><Disease><Disorder><Effectiveness><Eldecort><Emotional Depression><Endocrine Gland Secretion><Ensure><Event><Exposure to><Funding><Gender><Gestation><Goals><HPA axis><Hair><Hormones><Hydrocortisone><Hydrocortone><Hytone><Impoverished><Infrastructure><Intervention><Intervention Strategies><Knowledge><LMIC><Last Trimester><Life><Life Cycle><Life Cycle Stages><Long-Term Effects><Longitudinal Studies><Longterm Effects><Mediating><Mental Depression><Mental Health><Mental Hygiene><Modeling><Multiculturalism><NIH><National Institutes of Health><Nutracort><Pakistan><Parturition><Personal Satisfaction><Persons><Postpartum Period><Poverty><Prasterone><Pregnancy><Proctocort><Psychological Health><Public Health><Randomized><Randomized, Controlled Trials><Regulation><Reporting><Research><Research Resources><Resources><Risk Factors><Role><Rural><Sampling><Shapes><Social Environment><Stress><Symptoms><System><Techniques><Testing><Therapeutic Dehydroepiandrosterone><Therapeutic Hormone><Third Pregnancy Trimester><Third Trimester><Time><United States National Institutes of Health><Woman><Women's study><Work><active followup><age 8 years><anxiety symptoms><anxious symptom><burden of disease><burden of illness><childhood adversity><cohort><comparing females and males><comparing women and men><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><cost effective><dehydroepiandrosterone><depressed mother><depression><depression symptom><depressive><depressive symptoms><disease burden><diversity and equity><early adversity><early childhood adversity><early life adversity><eight year old><eight years of age><experience><female study><females compared to males><females compared with males><females versus males><females vs males><follow up><follow-up><followed up><followup><hypothalamic-pituitary-adrenal (HPA) axis><hypothalamic-pituitary-adrenal axis><hypothalmus-pituitary-adrenal axis><implementation strategy><improved><insight><intervention effect><interventional strategy><intimate partner violence><kids><life course><long-term study><longitudinal outcome studies><longterm study><low and middle-income countries><maternal depression><novel><pediatric adversity><post-partum><protective factors><psychological symptom><psychosocial><randomisation><randomization><randomized control trial><randomly assigned><recruit><social climate><social context><social culture><social role><socio-cultural><sociocultural><socioenvironment><socioenvironmental><strategies for implementation><stressor><study among females><study among women><study in females><study in women><study on females><study on women><study within women><well-being><wellbeing><women compared to men><women compared with men><women versus men><women vs men><youngster>