175 The association between adverse childhood experiences and postpartum depression

Abstract

Adverse childhood experiences (ACEs) are linked to worsening overall health outcomes and psychological diagnoses. Routine screening in patients with postpartum depression (PPD) could identify patients who would benefit from interventions to prevent the perpetuation of ACEs and establish a system of preventative care to mitigate the risks of adverse health outcomes associated with high ACE scores. The purpose of this study is to explore the link between ACEs and PPD and propose the use of the ACE questionnaire as a routine screening tool in all patients diagnosed with PPD. We hypothesize that patients with PPD will be more likely to have higher ACE scores than the general population. An IRB approved, retrospective cohort study identified all patients diagnosed with PPD at an academic medical center between January 2015 and December 2019. We included patients diagnosed with PPD by ICD-10 codes as documented in their electronic medical record. Subjects were then recruited via telephone and asked to complete an ACE questionnaire. Questionnaires were sent via the REDCap (v.9.5.33) application. ACE scores were calculated, dichotomized based on cut-points of >1, >2, >3 and >4, and compared to the prevalence in the original Kaiser-CDC ACE study using two-sided binomial tests. A p-value of <0.05 was considered significant. There were 132/225 surveys completed (58% response rate). Respondents had a mean age of 32 years (range 21-48 years) and were primarily Caucasian (92.1%). In our PPD population, 80.3% had >1 ACE, 62.1% had >2 ACEs, 48.5% had >3 ACEs, and 31.8% had >4 ACEs. These percentages were significantly higher than the null hypothesis values obtained from the Kaiser-CDC ACE Study percentages of 64%, 38%, 22%, and 12.5%, respectively (all p<0.001). Women with PPD are more likely to have higher ACE scores than the general population. This finding has important implications in regards to counseling, interventions to prevent perpetual ACEs, and establishing important provider-patient relationships for life-long preventative care.