Adverse childhood experiences and depression among women in rural Pakistan

Katherine LeMasters, Lisa M Bates, Esther O Chung, John A Gallis, Ashley Hagaman, Elissa Scherer, Siham Sikander, Brooke S Staley, Lauren C Zalla, Paul N Zivich, Joanna Maselko, Katherine LeMasters, Lisa M Bates, Esther O Chung, John A Gallis, Ashley Hagaman, Elissa Scherer, Siham Sikander, Brooke S Staley, Lauren C Zalla, Paul N Zivich, Joanna Maselko

Abstract

Background: Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan.

Method: Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity.

Results: The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79).

Conclusions: Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health.

Trial registration: NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.

Keywords: Pakistan; Perinatal depression; adverse childhood experiences; maternal depression.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Maternal ACEs and Depression (SCID) at 36 Months Postpartum, Bachpan Cohort, Pakistan, N = 889. Models account for clustering using cluster robust standard errors, and used weights which were a combination of sample weights and inverse probability of censoring weights. All models were adjusted for age, education, and mental health problems in natal family as confounders, and adjusted for trial arm and assessor. Abbreviations: PR – Prevalence ratio; B – Estimate; CL – Confidence Limit; ACE – Adverse Childhood Experiences For ACE Categorical, 0 ACEs is the reference level
Fig. 2
Fig. 2
Maternal ACEs and Depression (PHQ-9) at 36 Months Postpartum, Bachpan Cohort, Pakistan, N = 889. Models account for clustering using cluster robust standard errors, and used weights which were a combination of sample weights and inverse probability of censoring weights. All models were adjusted for age, education, and mental health problems in natal family as confounders, and adjusted for trial arm and assessor. Abbreviations: B – Estimate; CL – Confidence Limit; ACE – Adverse Childhood Experiences. For ACE Categorical, 0 ACEs is the reference level

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