Trajectories of caregiver psychosocial stress and child psychiatric risk: The role of preterm birth and racial socioenvironmental inequity

The current study examines trajectories of caregiver psychosocial stress in a large (N=288) and representative longitudinal sample of families impacted by very preterm (VPT) birth, including a group of VPT infants with white matter injury (WMI), and a group of term control (TC) families followed from birth to age 9/10 years. We examine trajectories of caregiver psychosocial stress as a function of caregiver race, the extent to which Social Determinants of Health (SDoH) factors mitigate or exacerbate differences in caregiver psychosocial stress trajectories, and whether these trajectories relate to child psychopathology outcomes. Using multigroup (birth group: TC, VPT, and WMI) latent growth models, we show that trajectories of caregiver anxiety and total stress, but not depression, varied across birth groups. Specifically, caregivers of VPT and WMI infants reported higher levels of early anxiety and total stress (birth and two years postpartum) compared to TC caregivers, but these early high levels of anxiety and stress significantly decreased over time. We also show distinct trajectories of anxiety in Black VPT caregivers compared to White VPT caregivers as a function of health insurance status, such that White VPT caregivers using public insurance experienced more persistent anxiety levels over time while Black VPT caregivers seemed to benefit from both public and private insurance. We also found robust longitudinal associations between caregiver depression and child psychopathology in all birth groups, reiterating the critical need for care and intervention during the postpartum period.