Adverse childhood experiences and depression among women in rural Pakistan

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

doi:10.1186/s12889-021-10409-4

Abstract

BackgroundAdverse 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.MethodData 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.ResultsThe 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).ConclusionsFindings 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 registrationNCT02111915. Registered 11 April 2014. NCT02658994. Registered 22 January 2016. Both trials were prospectively registered.

Highlights

Adverse Childhood Experiences (ACEs) are a common pathway to adult depression
Our findings suggest that interventions aimed at both reducing the occurrence of ACEs and mitigating their deleterious impact would be promising in reducing women’s mental health risk in high adversity settings [23]
These interventions are needed in the current global context of the novel coronavirus pandemic, which poses significant mental health threats, for those that have been exposed to ACEs [45]

Summary

Introduction

Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is important during the perinatal period when women are at an elevated risk for depression. This relationship has not been explored in South Asia. Adverse childhood experiences (ACEs), measured by the ACE questionnaire and classified as abuse, neglect, household dysfunction, and community disfunction, are LeMasters et al BMC Public Health (2021) 21:400 a common pathway to long-term social, emotional, and cognitive impairments, including depression [1, 5]. There is a dose-response relationship between how many ACEs a woman experiences and the likelihood of perinatal depressive symptoms [9]

Methods

Results

Discussion

Conclusion