A cross-lagged panel analysis of children's sleep, attention, and mood in a prenatally stressed cohort: the QF2011 Queensland flood study

Background: It is well recognized that childhood sleep, attention and mood problems increase risk for multiple adverse outcomes across the life-span; therefore, understanding factors, such as prenatal maternal stress, that underlie these types of childhood problems is critical for developing interventions that may optimize longer-term functioning. Our goal was to determine the association between disaster-related stress in pregnancy and young children's sleep, attention, and anxious/depressed symptoms. Methods: Soon after a major flood in Australia in 2011, we assessed various aspects of disaster-related prenatal maternal stress (PNMS) in women who had been pregnant at the time. Mothers rated several domains of their children's development with the Child Behavior Checklist (CBCL) at ages 2½ (n = 134) and 4 years (n = 118). Results: The primary finding was that more severe objective flood-related hardship in pregnancy predicted higher sleep problem scores at 2½ years, and that a negative maternal cognitive appraisal of the flood predicted lower attention problem scores at 2½ years. A cross-lagged panel analysis examined the association between children's sleep, attention, and anxious/depressed symptoms within and across ages. Results showed that these problems were likely to co-occur at each age, and that they were stable from 2½ to 4 years. Additionally, anxious/depressed scores at age 2½ predicted sleep problem scores at 4 years, all else being equal. Limitations: Limitations of the study include a relatively small sample size and the children's outcome data relied on maternal report using the CBCL, rather than independent observation of the children's functioning, which may have introduced reporter bias. Conclusions: These findings highlight the importance of early intervention for these childhood problems to optimize long-term mental health, particularly under conditions of prenatal stress