Adverse childhood experiences and depression among women in rural Pakistan

Abstract

Background Adverse 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. Method Data 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. Results The 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). Conclusions Findings 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 registration NCT02111915. Registered 11 April 2014. NCT02658994. Registered 22 January 2016. Both trials were prospectively registered.

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

“… 23 In our team’s prior work with a cohort of women in Pakistan at 36 months post partum, we have found that exposure to community violence was much more strongly correlated with maternal depression than other domains such as neglect. 24 A significant potential driver of different findings is the diversity of social, economic and cultural contexts in which the ACEs take place. Hence, studies from multiple geographic regions and population groups make important contributions towards better understanding of how various ACEs may differentially impact mental health.…”

Evolution and Emerging Trends in Depression Research From 2004 to 2019: A Literature Visualization Analysis

“…Depression is influenced by environmental factors related to social issues, such as childhood experiences, social interactions, and lifestyles. Adverse childhood experiences are risk factors for depression and anxiety in adolescence (37) and are a common pathway to depression in adults (38). Poor interpersonal relationships with classmates, family, teachers, and friends increase the prevalence of depression in adolescents (39).…”

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].…”