Adverse Childhood Experiences and Depression Among Women in Rural Pakistan

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.

Maternal adverse childhood experiences on child growth and development in rural Pakistan: an observational cohort study

“…Although such explorations are beyond the scope of the current paper, important factors, such as maternal depression and parenting practices, may mediate the relationship between maternal ACEs and child outcomes. Previous work from our group demonstrated that ACEs were associated with greater depressive symptoms and major depressive episodes [74]. Studies in Kenya found that maternal mental health mediated the relationship between maternal ACEs and child mental health problems [17,18].…”

Adverse Childhood Experiences and Implications of Perceived Stress, Anxiety, and Cortisol Among Women in Pakistan

“…For instance, Negriff (2020) found that in the United States, experiencing neglect, but not physical abuse, predicted anxiety symptoms in adolescence and ACEs related to child maltreatment were more predictive of mental health outcomes than ACEs related to household dysfunction (12). In our team's prior work with a cohort of women in Pakistan at 36 months postpartum, we have found that exposure to community violence was much more strongly correlated with maternal depression than other domains such as neglect (13). A key potential driver of different ndings is the diversity of social, economic, and cultural contexts in which the ACEs take place.…”