Adverse childhood experiences, adult depression, and suicidal ideation in rural Uganda: A cross-sectional, population-based study

Abstract

Background Depression is recognized globally as a leading cause of disability. Early-life adverse childhood experiences (ACEs) have been shown to have robust associations with poor mental health during adulthood. These effects may be cumulative, whereby a greater number of ACEs are progressively associated with worse outcomes. This study aimed to estimate the associations between ACEs and adult depression and suicidal ideation in a cross-sectional, population-based study of adults in Uganda. Methods and findings Between 2016 and 2018, research assistants visited the homes of 1,626 adult residents of Nyakabare Parish, a rural area in southwestern Uganda. ACEs were assessed using a modified version of the Adverse Childhood Experiences-International Questionnaire, and depression symptom severity and suicidal ideation were assessed using the Hopkins Symptom Checklist for Depression (HSCL-D). We applied a validated algorithm to determine major depressive disorder diagnoses. Overall, 1,458 participants (90%) had experienced at least one ACE, 159 participants (10%) met criteria for major depressive disorder, and 28 participants (1.7%) reported suicidal ideation. We fitted regression models to estimate the associations between cumulative number of ACEs and depression symptom severity (linear regression model) and major depressive disorder and suicidal ideation (Poisson regression models). In multivariable regression models adjusted for age, sex, primary school completion, marital status, self-reported HIV status, and household asset wealth, the cumulative number of ACEs was associated with greater depression symptom severity (b = 0.050; 95% confidence interval [CI], 0.039–0.061, p < 0.001) and increased risk for major depressive disorder (adjusted relative risk [ARR] = 1.190; 95% CI, 1.109–1.276; p < 0.001) and suicidal ideation (ARR = 1.146; 95% CI, 1.001–1.311; p = 0.048). We assessed the robustness of our findings by probing for nonlinearities and conducting analyses stratified by age. The limitations of the study include the reliance on retrospective self-report as well as the focus on ACEs that occurred within the household. Conclusions In this whole-population, cross-sectional study of adults in rural Uganda, the cumulative number of ACEs had statistically significant associations with depression symptom severity, major depressive disorder, and suicidal ideation. These findings highlight the importance of developing and implementing policies and programs that safeguard children, promote mental health, and prevent trajectories toward psychosocial disability.

Defense mechanisms mediate associations between exposure to adverse childhood experiences and anxiety and depression in Kenyan adolescents.

“…The current findings indicated that higher direct exposure to ACEs was associated with higher levels of depression symptoms and higher indirect exposure to ACEs was associated with higher levels of anxiety symptoms. Previous research also noticed that higher exposure to ACEs was associated with increased depression symptoms severity and chronic depression among adolescents from LALMIC (Ashaba et al, 2021; Satinsky et al, 2021; Tsehay et al, 2020). The current findings suggest that direct exposure to ACEs is a risk factor for the development of depression symptoms in adolescents.…”

“…Likewise, the widespread exposure to ACEs in children and adolescents from African countries can have a negative impact on their mental health. Previous research demonstrated strong association between higher exposure to multiple ACEs and higher severity of anxiety and depression symptoms in adolescents' samples from LALMIC (Ashaba et al, 2021;Myers et al, 2021;Satinsky et al, 2021;Tsehay et al, 2020). In LALMIC, it is documented that depression is the leading cause of mental disorders (Patel et al, 2009) and it is estimated to be the leading cause of the global burden of disease in 2030 (Mathers et al, 2004).…”

Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, population-based study of adults in rural Uganda

“…In this study, a modified version of the Adverse Childhood Experiences-International Questionnaire was administered in the second wave (2016-18) to assess experiences of abuse, neglect, and household dysfunction during childhood [ 27 ]. The following 16 experiences were queried: 1) verbal abuse, 2) fear of harm, 3) being pushed/grabbed/slapped/hit by an object, 4) scarring from physical abuse, 5) sexually abused, 6) raped, 7) parental divorce, 8) pushed/grabbed/slapped/thrown an object at one’s mother, 9) kicked/bit/punched one’s mother, 10) threatened mother with weapon, 11) lived with an alcohol/drug abuser, 12) lived with adult with mental illness, 13) incarcerated family member, 14) experienced an entire day without food, 15) went to bed hungry, and 16) went to bed thirsty.…”

Sex Differences in Depression Caused by Early Life Stress and Related Mechanisms

“…Recent studies have shown that individuals who experience ELS are more likely to suffer from depression than those who do not ( LeMoult and Gotlib, 2019 ). Whether it is the depression among the Uganda ( Satinsky et al, 2021 ) or Iraq youth ( Al Shawi et al, 2019 ), or the PTSD and TRD of American veterans ( Aronson et al, 2020 ; Yrondi et al, 2021 ), ELS is regarded as a risk factor in depression ( Macedo et al, 2019 ). The different contents of ELS (physical or sexual abuse, neglection, loss, etc.)…”