29.3 Ghosts in the Nursery: Burden of Adverse Childhood Experiences in Mothers of Children Presenting to a Tertiary Care Hospital in Pakistan and Its Lifelong and Intergenerational Impact

Abstract

The study aims to investigate the prevalence of adverse childhood experiences (ACEs) in mothers and their impact on the psychosocial health of the mothers as well as their children. Following ethical approval and written consent, we obtained retrospective information on ACEs self-reported by 212 mothers of children presenting to a tertiary care hospital setting and their current mental health using the Agha Khan University Anxiety and Depression Scale (AKU-ADS). Mothers’ report of their children’s emotional and behavioral problems was also assessed using the Strengths and Difficulties Questionnaire (SDQ). The mean age of the mothers was 32.6 ± 6.0 years. The majority of the participants were housewives (N = 188; 88.7%) and belonged to a very low socioeconomic status (N = 147; 69.3%). Among mothers, 45.7% (N = 97) reported one or more ACEs in their childhood. Emotional abuse (N = 38; 17.9%), physical neglect (N = 37; 17.5%), physical abuse (N = 35; 16.5%), and emotional neglect (N = 33; 15.6%) were the most frequently reported ACEs. Household incarceration (N = 9; 4.2%) and sexual abuse (N = 8; 3.8%) were the least prevalent ACEs. The prevalence of depression and anxiety in mothers was 45.8% (N = 97). The mean AKU-ADS score was 21.84 ± 14.05. Having 4 or more ACEs was associated with high mean scores of anxiety and depression in mothers (p < 0.01). Children’s SDQ mean score was 17.08 ± 6.06. An increasing number of maternal ACEs was associated with higher total SDQ scores as well as with higher emotional, conduct, and hyperactivity subscale scores in children (p < 0.01). The intergenerational consequences of ACEs cannot be overlooked. The impact of ACEs not only encompasses the entire lifetime of the mothers as psychosocial problems but also transmits to the next generation as emotional and behavioral problems. Therefore, it is extremely important to devise strategies to alleviate the implications of ACEs in mothers and subsequent generations.