SBSB Research: Social Determinants of Child Development and Mental Health

Health disparities are an intergenerational problem in the United States. Although they begin to form early in life within one generation, health disparities propagate into the next generation through multiple life course pathways, causing socioeconomically disadvantaged groups and members of racial/ethnic minorities to face disproportionate burdens of morbidity and shortened life expectancy. Because of these disparities, the next generation begins life at a health disadvantage.

Our SBSB research group advances understanding of the early life mechanisms that generate health disparities and the pathways through which these disparities continue and expand into adolescence and adulthood. From the prenatal period onward, we seek a better understanding of the positive and negative environmental influences on health development. Our research generates new insights into the early life origins of health disparities, identifies developmentally sensitive periods for the persistence of disparities, and uncovers opportunities for reducing disparities at the population level.

Because early life circumstances shape the course of child development with lifelong consequences, improved understanding of early life mechanisms that generate health disparities is critical for both etiology and prevention. Our work addresses early life mechanisms through research initiated during the prenatal period that includes comprehensive measurement of the social environment, the biological embedding of the environment, and subsequent effect on child development. Parental mental health is also a critical aspect of this work, even though parental psychopathology has been given limited attention as one avenue for the intergenerational transmission of health disparities.

Grounded in the Developmental Origins of Health and Disease and Life-Course Epidemiological approaches, this work adopts multiple approaches to advance knowledge of the social determinants of human development in diverse populations. Our work has two overarching aims:

Aim 1: Investigate prenatal and early life mechanisms for socioeconomic and racial/ethnic disparities in child health and development

Maternal immune activity during pregnancy has been repeatedly linked to neuropsychiatric disorders in offspring such as schizophrenia, autism, and depression. However, much less is known regarding the role of maternal immune activity during pregnancy and variability in children's neurocognitive development. This is an important area of research because impairments in neurocognitive function in domains of intellectual ability, language, and higher order cognitive processes might serve as early markers of vulnerability to lifetime risk of neuropsychiatric disorders. Branch researchers are, therefore, investigating the associations between fetal exposure to biomarkers of maternal immune activity throughout gestation and children's neurocognitive development up to age 7 years.

Participants in the current study are mother-child pairs enrolled in the Collaborative Perinatal Project (CPP) between 1959 and 1965. The CPP was designed to examine the relationships between perinatal events and neurological outcomes among the offspring of 55,908 pregnancies. Offspring were followed through age 7, with approximately 70% retention for the duration of the study. Maternal serum was extracted from blood collected serially during pregnancy from the time of study registration through delivery and stored for later use.

The Rhode Island Children’s Health Equity & Development Study (ENRICHED) will build the foundation for a long-term cohort study on children’s development across socioeconomic and racial/ethnic groups. It will provide evidence on mechanisms leading to disparities through children’s entry into school that could affect school readiness, one of the most important factors in long-term educational success. ENRICHED includes a comprehensive set of social exposures potentially related to disparities, focuses on parental psychopathology as a main factor, and addresses limitations of previous studies that neither fully considered paternal or maternal psychopathology nor measured psychopathology using phenotypically validated approaches. ENRICHED evaluates the extent to which disparities arise from socioeconomically linked exposures across multiple domains: from neighborhoods to families, and from the social and physical environments to individual physiology and behavior. It has been suggested repeatedly that one’s ZIP code carries more predictive power for health than one’s genetic code, and this may particularly apply to early child development. Accordingly, ENRICHED addresses the need for research to identify the contributors to disparities across multiple levels of causation.

Aim 2: Investigate life course pathways underlying health disparities during adolescence and adulthood

The promise of life course research is that, if successful, it will reveal new opportunities for interventions to reverse the downward trajectories established earlier in life. Further, it can shift the path of future trajectories by supporting resiliency and health-related behaviors to promote well-being. In addition to taking steps toward primary prevention of health disparities, interventions during later sensitive periods of the life course may prove beneficial for population health.

Our research in this area involves two projects. First, leveraging unique data collected as part of the 7-year NEXT Generation Health Study, we extended our work on disparities from childhood into adolescence and emerging adulthood. Second, we completed our linkage study of the CPP-offspring cohort to the National Death Index with the aim of investigating the long-term reach of early childhood risk factors for both suicide mortality and all-cause premature mortality in middle adulthood. This second study investigates the prenatal, socioeconomic, behavioral, cognitive, and neurologic risks for completed suicide. It also includes a nested case-controlled study to investigate the contributions of gestational immune activity to the fetal origins of suicide.

Principal Investigator

Stephen E. Gilman, Sc.D.

Division Collaborators

External Collaborators (ENRICHED Study)

Kathy R. Batts, Ph.D., Research Triangle Institute
Christine Brousseau, M.D., Women & Infants Hospital
Melissa Clark, Ph.D., Brown University
Gary Gensler, Ph.D., The Emmes Company
David Savitz, Ph.D., Brown University
Seth Sherman, Ph.D., The Emmes Company
Nedra Whitehead, Ph.D., Research Triangle Institute

Selected Publications

Yu, J., Goldstein, R. B., Haynie, D. L., Luk, J. W., Fairman, B. J., Patel, R. A., Vidal-Ribas, P., Maultsby, K., Gudal, M., & Gilman, S. E. (2021). Resilience factors in the association between depressive symptoms and suicidality. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 69(2), 280–287. PMID: 33431248
Yu, J., Patel, R. A., & Gilman, S. E. (2021). Childhood disadvantage, neurocognitive development, and neuropsychiatric disorders: Evidence of mechanisms. Current Opinion in Psychiatry, 34(3), 306–323. PMID: 33587493
Goldstein, J. M., Cohen, J. E., Mareckova, K., Holsen, L., Whitfield-Gabrieli, S., Gilman, S. E., Buka, S. L., & Hornig, M. (2021). Impact of prenatal maternal cytokine exposure on sex differences in brain circuitry regulating stress in offspring 45 years later. Proceedings of the National Academy of Sciences of the United States of America, 118(15), e2014464118. PMID: 33876747
Yu, J., Ghassabian, A., Chen, Z., Goldstein, R. B., Hornig, M., Buka, S. L., Goldstein, J. M., & Gilman, S. E. (2020). Maternal immune activity during pregnancy and socioeconomic disparities in children's self-regulation. Brain, Behavior, and Immunity, 90, 346–352. PMID: 32919039
Jones, N. L., Gilman, S. E., Cheng, T. L., Drury, S. S., Hill, C. V., & Geronimus, A. T. (2019). Life course approaches to the causes of health disparities. American Journal of Public Health, 109(S1), S48–S55. PMID: 30699022
Santavirta, T., Santavirta, N., & Gilman, S. E. (2018). Association of the World War II Finnish evacuation of children with psychiatric hospitalization in the next generation. JAMA Psychiatry, 75(1), 21–27. PMID: 29188292
Gilman, S. E., Sucha, E., Kingsbury, M., Horton, N. J., Murphy, J. M., & Colman, I. (2017). Depression and mortality in a longitudinal study: 1952-2011. CMAJ: Canadian Medical Association Journal = Journal de l'Association Medicale Canadienne, 189(42), E1304–E1310. PMID: 29061855
Gilman, S. E., Hornig, M., Ghassabian, A., Hahn, J., Cherkerzian, S., Albert, P. S., Buka, S. L., & Goldstein, J. M. (2017). Socioeconomic disadvantage, gestational immune activity, and neurodevelopment in early childhood. Proceedings of the National Academy of Sciences of the United States of America, 114(26), 6728–6733. PMID: 28607066