In a compelling new study published in BMC Psychiatry, researchers have uncovered profound long-term effects of early-life famine exposure on adult mental health, shedding light on the complex intersections of nutrition, ethnicity, and gender. Utilizing the extensive China Multi-Ethnic Cohort (CMEC), the investigation reveals that individuals molded by famine during their formative years face significantly altered risks of depression and anxiety well into adulthood. This groundbreaking work not only reinforces the longstanding hypothesis that early nutritional adversity can imprint enduring psychological scars but also elucidates how these effects manifest differently across ethnic groups and between sexes.
Depression and anxiety disorders rank among the most pervasive mental health challenges worldwide, representing a substantial public health burden across demographic and geographic boundaries. Early-life experiences, particularly those involving severe nutritional deprivation such as famine, have gained increasing attention as potential contributors to adult psychopathology. By analyzing a cohort born between 1939 and 1978 who experienced the catastrophic famines in China, this study embarks on a rigorous examination of the latent psychological consequences of malnutrition during critical developmental windows.
The researchers relied on baseline data from 18,376 participants in the CMEC, a rich epidemiological resource capturing the health profiles of diverse ethnic minorities across China. Using structured face-to-face interviews combined with physical assessments, mental health status was evaluated through standardized screening instruments—the Patient Health Questionnaire-2 (PHQ-2) and the Generalized Anxiety Disorder 2-item scale (GAD-2)—which provide robust, validated metrics of depressive and anxiety symptomatology, respectively. This methodological rigor ensured the reliability of the subsequent statistical analyses.
Employing multivariable logistic regression models to adjust for potential confounders, the study delineated a stark association between childhood and adolescent famine exposure and elevated risks of depressive symptoms in adulthood. Notably, individuals suffering famine during childhood exhibited an odds ratio (OR) of 1.65 for developing depression, highlighting a substantial increase compared to non-exposed counterparts. Adolescents exposed experienced similarly heightened vulnerability, underscoring the critical sensitivity of mental health trajectories to nutritional insults during these developmental stages.
Gender-specific analyses uncovered that females are disproportionately impacted by famine exposure in early life, with childhood famine conferring an OR of 1.87 for depression and adolescence exposure showing an OR of 1.96. The accentuated susceptibility among women points toward potential interactions involving sex-linked biological pathways, psychosocial factors, or stress response systems that modulate depression risk differently than in males.
Ethnicity emerged as a significant modifier in the famine-depression nexus. Whereas the Han ethnic majority demonstrated a pronounced link between childhood famine exposure and adult depressive symptoms (OR = 1.92), the Yi ethnic minority displayed an even more complex pattern. Here, fetal famine exposure—not merely childhood or adolescence—was significantly correlated with not only depression (OR = 2.33) but also anxiety symptoms (OR = 1.99), suggesting that prenatal undernutrition exerts potent, lasting neurodevelopmental effects among this group. Conversely, the Bai ethnic minority displayed no significant associations, indicative of potential genetic, environmental, or cultural resilience factors buffering the impact of famine.
Intriguingly, the study revealed a paradoxical finding regarding anxiety symptoms in males subjected to childhood or adolescent famine exposure, who manifested a reduced risk of anxiety in adulthood (ORs of 0.53 and 0.32, respectively). This counterintuitive outcome warrants further exploration into gender-specific neuroendocrine adaptations or survival strategies that could mitigate anxiety disorders following early adversity. In contrast, the Yi group reaffirmed the detrimental psychiatric sequela of fetal malnutrition with heightened anxiety symptom risk.
Mechanistically, early-life famine exposure is hypothesized to incite a cascade of neurobiological changes, including alterations in the hypothalamic-pituitary-adrenal (HPA) axis, neurotransmitter systems, and brain structure development, which in turn influence emotional regulation and susceptibility to mood disorders. Persistent nutritional deficiencies may impair neuronal plasticity, exacerbate inflammatory pathways, and compromise neurogenesis, particularly during sensitive periods such as gestation and puberty. This study’s findings align with emerging epigenetic evidence linking intrauterine and early life environment to adult mental health phenotypes.
The diverse ethnic responsiveness to famine effects likely reflects a confluence of genetic predispositions, cultural practices, dietary patterns, and access to social support systems, highlighting the importance of incorporating ethnic heterogeneity in psychiatric epidemiology. Furthermore, the pronounced female vulnerability underscores the need for sex-stratified approaches in mental health research and intervention design.
From a public health perspective, the research underscores the enduring impact of nutritional crises beyond immediate mortality and morbidity, extending into the psychological well-being of survivors decades later. These insights advocate for enhanced nutritional support during pregnancy and childhood, particularly targeting vulnerable ethnic minorities, to mitigate long-term mental health detriments. Policymakers must consider the intergenerational repercussions of famine in designing health and social welfare programs.
This study also opens avenues for future research to dissect the hormonal, molecular, and psychosocial mediators of the observed associations. Longitudinal designs integrating omics technologies and neuroimaging could unravel the pathophysiological pathways linking famine exposure to adult depression and anxiety. Additionally, evaluating the role of resilience factors and interventions in modulating these risks will be critical for developing targeted therapeutic strategies.
Ultimately, the findings amplify a vital narrative: early-life nutritional environments cast a long shadow on mental health that extends well into adulthood, with nuanced differences shaped by ethnicity and gender. Understanding these patterns equips the scientific community and clinicians with nuanced perspectives for holistic care that addresses the root causes embedded in developmental history.
The China Multi-Ethnic Cohort’s contribution marks a milestone in psychiatric epidemiology, providing robust empirical evidence to an area fraught with historic data gaps. Its meticulous approach reinforces the imperative for integrating early-life conditions into mental health paradigms globally. As famine continues to threaten vulnerable populations worldwide, this research serves as a sentinel warning of the silent, enduring psychological aftermath that demands attention at the highest levels of health governance and scientific inquiry.
Subject of Research: The impact of early-life famine exposure on the risk of depression and anxiety disorders in adulthood across diverse ethnic groups in China.
Article Title: Early-Life famine exposure and the risk of depression and anxiety in adulthood: evidence from the China Multi-Ethnic Cohort (CMEC).
Article References:
Bai, H., Wang, Y., Liu, Y. et al. Early-Life famine exposure and the risk of depression and anxiety in adulthood: evidence from the China Multi-Ethnic Cohort (CMEC).
BMC Psychiatry 25, 967 (2025). https://doi.org/10.1186/s12888-025-07375-1
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