Adverse Childhood Experiences, Intimate Partner Violence, and Mental Health: Main Effects and Mediating Mechanisms

Background and Purpose:  The seminal Adverse Childhood Experiences study demonstrated that exposure to abuse, neglect, and household dysfunction increases the risk of poor health in later life. Less is known about these adverse childhood experiences (ACEs) and their specific effects on (a) young adults, (b) low-income populations, and (c) women. The field also lacks knowledge of mechanisms that link childhood adversity to adult consequences. To address these research gaps, we examined the following questions:

1. How does the prevalence of ACEs in a sample of low-income, young women compare to prevalence estimates from the Adverse Childhood Experiences study?
2. Do ACEs increase the risk of intimate partner violence (IPV), prenatal stress and depression, and postpartum depression in adulthood?
3. Is the association between ACEs and postpartum depression mediated by IPV as well as prenatal stress and depression?

Methods:  This study analyzed 730 women that received home visiting services between April, 2014 and February, 2015. Client and household data were gathered from a state-administered public health database. Participants completed the Childhood Experiences Survey, a measure of childhood adversity that yielded a 10-item ACE index. We constructed a dichotomous measure of adult IPV from prenatal responses to the Abuse Assessment Screen. We derived a continuous measure of perceived stress from prenatal responses to the Perceived Stress Scale.  Continuous measures of prenatal and postnatal depression were based on responses to the Edinburgh Postnatal Depression Scale.

For question 1, we conducted descriptive analyses of study variables (e.g., means; standard deviations). For question 2, we used linear and logistic regression to estimate main-effect associations between ACEs and study outcomes, controlling for demographic characteristics (e.g., age; race/ethnicity; poverty). For question 3, we conducted path analyses in Mplus Version 7.11 using a robust weighted least square estimator.  

Results:  We found a high prevalence of ACEs in this sample; 31.2% were exposed to 5 or more ACEs, as compared to 12.5% of women in the Adverse Childhood Experiences study. Regression analyses revealed that higher ACE scores were significantly associated with IPV (p = .003), prenatal stress (p < .001), prenatal depression (p < .001), and postpartum depression (p< .001). 

Path analyses confirmed the connection between ACEs and IPV. IPV was significantly associated with prenatal stress (p < .001) and depression (p < .001).  Prenatal stress and depression were significantly associated with postpartum depression (p< .001, respectively). The mediators explained roughly half (50.4%) of the effect of ACEs on postpartum depression. The direct effect of ACEs on postpartum depression remained significant in the full model, signifying partial mediation. The model fit the data well (e.g., CFI = .995; RMSEA = .013) and explained 37.6% of the total variance in postpartum depression. 

Conclusions and Implications:  We discovered that ACEs were prevalent in this sample of low-income women, increasing their risk of IPV and mental health disturbances as a result. The findings have implications for home visiting programs—two-generation interventions that have the potential to enhance the well-being of ACE-exposed adults and protect their children from exposure to ACEs.