The Link between ACEs, Income, and Maternal Depressive Symptoms through a Racial and Ethnic Lens: A Moderated-Mediation Analysis

Background and Purpose: Social work science is well-positioned to study and reduce the public health malady that is maternal depression. In the U.S., people that experience a high number of adverse childhood experiences (ACEs) are more likely to develop depression later in life. However, other social determinants of health also contribute to depression, including income level, being a woman, and being a person of color. While numerous studies have examined the relationship between ACEs and depression, few studies have examined the roles that income and race/ethnicity play, especially among mothers. To respond to these gaps, this study examined a) whether family income is a mediator in the relationship between ACEs and depressive symptoms and b) whether race/ethnicity moderates the relationships between ACEs, income, and depressive symptoms.

Methods: Data on mothers came from the Geographic Research of Wellbeing (GROW) Survey (N=3,016), which was conducted in California from 2012-2013. The dependent variable, depressive symptoms, was dichotomous (0=no depressive symptoms, 1=any depressive symptoms) measured through two dichotomous items that assessed depressive symptoms in the past year. Participants who endorsed at least one of the items were coded as having depressive symptoms. The independent variable, ACEs, was measured through the Adverse Childhood Experiences through Age 13 Adapted Scale and ranged from 0-7. The mediator, income, was measured through a 20-category indicator of family income and was treated as continuous. The moderators (racial categories) were Asian, Black, U.S.-born Latina, immigrant Latina, and White. Pathways predicting depressive symptoms were estimated with logistic regression using Monte Carlo integration in Mplus, elucidating log-odds (LO) and odds ratios (OR). Income was tested as a mediator between ACEs and depressive symptoms. Moderated mediation was tested using multiple-group analysis, which allowed us to test for structural invariance across racial/ethnic groups for each pathway in the mediation analysis.

Results: ACEs were associated with decreases in income (B = -0.03, p < .01); income was associated with decreases in the odds of endorsing depressive symptoms (LO = -0.06, OR = 0.94, p < .001); and ACEs were associated with increases in the odds of endorsing depressive symptoms (LO = 0.29, OR = 1.33, p < .001). Mediation testing revealed a small indirect effect (b = 0.012, SE = 0.01, p = .012). Moderated mediation testing revealed differences between immigrant Latina and White participants, in that the relationship between childhood ACEs and depression was stronger among immigrant Latina participants (b = 0.25, p < .001) compared to White participants (b = 0.12, p < .001).

Conclusions and Implications: The strong relationship between ACEs and depressive symptoms across racial groups indicates the importance of the social determinants of mental health. The statistically significant mediation of income on the relationship between ACES and depressive symptoms indicates the importance of considering economic mediators for mental health outcomes. Future research and interventions should consider the role of income as a mediator and examine ways to mitigate racial/ethnic disparities in depression, particularly for immigrant Latinas.