Resilient Emotion Regulation Development in a South African Birth Cohort

Resilience—successful development despite adversity—is mostly studied in high- income countries (HICs); however, most at-risk children live in low- and middle-income countries (LMICs). This study addresses that gap by examining emotion regulation (ER) resilience in adolescents from the Philani birth cohort in Cape Town, South Africa. This deeply characterised, longitudinal cohort includes youth exposed to significant adversity, with protective and risk exposures comprehensively tracked from birth. We use longitudinal multimodal brain imaging, behavioural assessments, and a prospective design to explore how environmental factors shape ER and mental health outcomes at the behavioural and neurobiological level. Our goal is to identify mechanisms of resilience that can inform scalable, culturally grounded interventions. Aim I identifies brain circuitry associated with resilient ER in 525 adolescents (aged 13–14). Aim II identifies how protective factors promote brain development over two years to strengthen ER, preventing anxiety, depression, and PTSD. By integrating advanced statistical methods and machine learning together with this rare adolescent sample exposed to cumulative high adversity, we seek to improve the precision and inclusivity of resilience research in LMICs. This work aligns with Wellcome’s Mental Health strategy to reveal multi-level causal mechanisms and accelerate impact in underserved settings and global inequalities.