Association of Air Pollution Exposure in Childhood and Adolescence With Psychopathology at the Transition to Adulthood

IMPORTANCE: Air pollution exposure damages the brain, but its associations with the development of psychopathology are not fully characterized. OBJECTIVE: To assess whether air pollution exposure in childhood and adolescence is associated with greater psychopathology at 18 years of age. DESIGN, SETTING, AND PARTICIPANTS: The Environmental-Risk Longitudinal Twin Study is a population-based cohort study of 2232 children born from January 1, 1994, to December 4, 1995, across England and Wales and followed up to 18 years of age. Pollution data generation was completed on April 22, 2020; data were analyzed from April 27 to July 31, 2020. EXPOSURES: High-resolution annualized estimates of outdoor nitrogen oxides (NO(x)) and particulate matter with aerodynamic diameter less than 2.5 μm (PM(2.5)) linked to home addresses at the ages of 10 and 18 years and then averaged. MAIN OUTCOMES AND MEASURES: Mental health disorder symptoms assessed through structured interview at 18 years of age and transformed through confirmatory factor analysis into continuous measures of general psychopathology (primary outcome) and internalizing, externalizing, and thought disorder symptoms (secondary outcomes) standardized to a mean (SD) of 100 (15). Hypotheses were formulated after data collection, and analyses were preregistered. RESULTS: A total of 2039 participants (1070 [52.5%] female) had full data available. After adjustment for family and individual factors, each interquartile range increment increase in NO(x) exposure was associated with a 1.40-point increase (95% CI, 0.41-2.38; P = .005) in general psychopathology. There was no association between continuously measured PM(2.5) and general psychopathology (b = 0.45; 95% CI, −0.26 to 1.11; P = .22); however, those in the highest quartile of PM(2.5) exposure scored 2.04 points higher (95% CI, 0.36-3.72; P = .02) than those in the bottom 3 quartiles. Copollutant models, including both NO(x) and PM(2.5), implicated NO(x) alone in these significant findings. NO(x) exposure was associated with all secondary outcomes, although associations were weakest for internalizing (adjusted b = 1.07; 95% CI, 0.10-2.04; P = .03), medium for externalizing (adjusted b = 1.42; 95% CI, 0.53-2.31; P = .002), and strongest for thought disorder symptoms (adjusted b = 1.54; 95% CI, 0.50-2.57; P = .004). Despite NO(x) concentrations being highest in neighborhoods with worse physical, social, and economic conditions, adjusting estimates for neighborhood characteristics did not change the results. CONCLUSIONS AND RELEVANCE: Youths exposed to higher levels of outdoor NO(x) experienced greater psychopathology at the transition to adulthood. Air pollution may be a nonspecific risk factor for the development of psychopathology.