Adverse Childhood Experiences and Changing Levels of Psychosocial Distress Scores across Pregnancy in Kenyan Women

Abstract

Background: Adverse childhood experiences (ACEs) have been associated with deleterious effects on mental health in pregnancy. Methods: The ACE International Questionnaire (ACE-IQ) was used to measure neglect, abuse, and household dysfunction. Longitudinal mixed effect modelling was used to test the effect of ACEs on pregnancy-related anxiety, depressive symptoms, and perceived stress at two time points (12–19 and 22–29 weeks) during pregnancy. Results: A total of 215 women who were predominantly married (81%) and had attained tertiary education (96%) were enrolled. Total ACEs were significantly associated with depressive symptoms (r = 0.23, p < 0.05) and perceived stress (r = 0.18, p < 0.05). As depressive symptoms decreased, t (167) = −8.44, p < 0.001, perceived stress increased, t (167) = 4.60, p < 0.001, and pregnancy-related anxiety remained unchanged as pregnancy progressed. Contact sexual abuse (p < 0.01) and parental death or divorce (p = 0.01) were significantly associated with depression over time (p < 0.01). Total ACEs in this study were associated with depressive symptoms early but not late in pregnancy. Conclusions: Higher total ACEs were positively associated with depressive symptoms and perceived stress during pregnancy, suggesting that mental disorders may have an impact on pregnancy outcomes and ought to be addressed. Further validation of the Edinburgh Postnatal Depression Scale (EPDS) tool in local settings is required.

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress

“…Our findings are consistent with findings from both a low- and middle-income country (Kenya) [ 32 ] and a high-income country (USA) which showed an association between ACEs and depression/anxiety and perceived stress [ 33 , 34 ]. Women who endorsed that their own parents/guardians did not understand their childhood problems and worries also had slightly higher odds of comorbidity than those who endorsed that their parents/guardian understood their problems and worries.…”

The Long-Term Health and Human Capital Consequences of Adverse Childhood Experiences in the Birth to Thirty Cohort: Single, Cumulative, and Clustered Adversity

“…The prevalence of ACEs, both prospectively and retrospectively, is considerably higher than global and meta-analytic estimates [7]. However, ACEs evidence in low-income, high-violence settings with widespread adversity across the life course is slowly emerging [19,[87][88][89] and highlighting important similarities and differences in the field. Bt30 is one of few cohorts in an LMIC that has reached young adulthood-the period in which human capital disparities are likely to emerge [90].…”

“…Hence, a single adversity approach ignores the high probability that adversities co-occur and have an exponential impact. On the other hand, cumulative risk scores assume equal weighting of adversities while a number of studies have shown specific ACEs to be more deleterious than others [17][18][19]. Although there are currently no guidelines on the ACEs scoring in the available literature, some studies point to the 'four or more' cut-off functioning as a threshold level, with noticeable deviations in a range of outcomes at that mark [7].…”

Joint effects of recent stressful life events and adverse childhood experiences on perinatal comorbid anxiety and depression

“…In addition to recent SLEs, adverse childhood experiences (ACEs), which are generally conceptualized as stressful early life events, have been closely linked to PND or PNA [17,18]. ACEs are defined as traumatic experiences that occur before 18 years including exposures to abuse, neglect, and household dysfunction [19], with 40-60% of pregnant women reporting at least one ACE [20][21][22][23]. A few studies have paid attention to the modifying effects of ACEs on SLEs regarding antenatal depression, and have suggested that ACEs could make pregnant women who have experienced SLEs more vulnerable to antenatal depression [24,25].…”