Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study

Abstract

ObjectivesAdverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan.DesignThis study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum.SettingAll participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers.ParticipantsData were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol.Primary and secondary outcomes measuresACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables.ResultsAll models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production.ConclusionsAll four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.

Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study

“…The connection between depression and anxiety and ACEs was well established in this study. The results of this study, while supporting previous reports that ACEs are associated with psychological disturbances, such as depressive feelings, stress, and anxiety [ 20 ], do not support a connection between ACEs and the development of physiological or medical disorders [ 14 ]. One explanation for this is related to the age group of this study; the majority of the sample were young people, which resulted in a lack of effect or connection between chronic illness and ACEs.…”

“…According to the researchers, poverty was a possible mitigation factor of the high experiences of ACEs among rural children [ 19 ]. Another study conducted in rural Pakistan found ACEs to be associated with higher levels of perceived stress, anxiety, and cortisol [ 20 ].…”

Exploring the Co-occurrence and Latent Class Analysis of Adverse Childhood Experiences in University Students in Lahore, Pakistan

“…Multiple studies have shown that there is an association between ACEs and health problems in adulthood, such as obesity, mental disorders, high blood pressure 4, depression, diabetes, irregular sleep patterns 5, lung cancer, metabolic issues, in ammation, liver diseases 6 , and mental health issues 7 .…”

Adverse childhood experiences, psychological well-being, and substance use in Pakistani university students

“…Research conducted in sub-Saharan Africa (Amone-P' Olak & Letswai, 2020;Naicker et al, 2022) and Asia (Ikram et al, 2022;LeMasters et al, 2021), and other places around the globe (De et al, 2013;Zarse et al, 2019) illustrates consistent associations between exposure to ACEs and heightened mental health problems, diminished psychological well-being, and substance use. The current investigation drew on the developmental cascade theory to potentially explain associations between ACEs, well-being, and substance use.…”

“…Furthermore, there is a growing literature linking ACEs and health behaviors, including maladaptive substance use and addiction (Zarse et al, 2019). However, despite the explosion of research on ACEs since the publication of Felitti et al’s (1998) seminal paper, as several researchers have noted, relatively fewer studies of ACEs have been conducted in sub-Saharan Africa (Amone-P’Olak & Letswai, 2020; Manyema & Richter, 2019; Naicker et al, 2022) or large parts of Asia, including Pakistan (Ikram et al, 2022; LeMasters et al, 2021). Reviews of prevalence rates of ACEs across countries have reported fewer ACEs on average in high-income compared to low- and middle-income countries (Hughes et al, 2017).…”