Prenatal exposure to a natural disaster and early development of psychiatric disorders during the preschool years: stress in pregnancy study

Yoko Nomura, Jeffrey H. Newcorn, Christine Ginalis, Catherine Heitz, Jeenia Zaki, Farzana Khan, Mardia Nasrin, Kathryn Sie, Donato DeIngeniis, Yasmin L. Hurd

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Growing evidence shows an association between in utero exposure to natural disasters and child behavioral problems, but we still know little about the development of specific psychopathology in preschool-aged children. Methods: Preschool children (n = 163, mean age = 3.19, 85.5% racial and ethnic minorities) and their parents (n = 151) were evaluated annually at ages 2–5 to assess the emergence of psychopathology using the Preschool Age Psychopathological Assessment (PAPA), a parent-report structured diagnostic interview developed for preschool-age children. Sixty-six (40.5%) children were exposed to Sandy Storm (SS) in utero and 97 (59.5%) were not. Survival analysis evaluated patterns of onset and estimated cumulative risks of psychopathology among exposed and unexposed children, in total and by sex. Analyses were controlled for the severity of objective and subjective SS-related stress, concurrent family stress, and demographic and psychosocial confounders, such as maternal age, race, SES, maternal substance use, and normative prenatal stress. Results: Exposure to SS in utero was associated with a substantial increase in depressive disorders (Hazard Ratio (HR) = 16.9, p =.030), anxiety disorders (HR = 5.1, p <.0001), and attention-deficit/disruptive behavioral disorders (HR = 3.4, p =.02). Diagnostic rates were elevated for generalized anxiety disorder (GAD; HR = 8.5, p =.004), attention-deficit/hyperactivity disorder (ADHD; HR = 5.5, p =.01), oppositional-defiant disorder (ODD; HR = 3.8, p =.05), and separation-anxiety disorder (SAD; HR = 3.5, p =.001). Males had distinctively elevated risks for attention-deficit/disruptive behavioral disorders (HR = 7.8, p =.02), including ADHD, CD, and ODD, whereas females had elevated risks for anxiety disorders (HR = 10.0, p <.0001), phobia (HR = 2.8, p =.02) and depressive disorders (HR = 30.0, p =.03), including SAD, GAD, and dysthymia. Conclusions: The findings demonstrate that in utero exposure to a major weather-related disaster (SS) was associated with increased risk for psychopathology in children and provided evidence of distinct psychopathological outcomes as a function of sex. More attention is needed to understand specific parent, child, and environmental factors which account for this increased risk, and to develop mitigation strategies.

Original languageEnglish
Pages (from-to)1080-1091
Number of pages12
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number7
StatePublished - Jul 2023


  • Natural disasters
  • anxiety
  • developmental psychopathology
  • disruptive behavior
  • sex differences


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