Depression in New Mothers: The Role of Maternal Adverse Childhood Experiences

Objectives: Exposure to adverse childhood experiences (ACEs), such as childhood maltreatment and family dysfunction, is highly prevalent. Previous research has shown an association between ACEs and adult depression. ACEs have been linked to an increased likelihood of experiencing lifetime depressive disorders, persistence in depression symptoms and recurrence, and a lack of response to depression treatment. Despite the growing recognition of ACEs and associated depression, investigations on this topic during high-risk periods of the life course such as the postpartum period is lacking. Given that several studies have identified ACEs as associated with a younger age at first pregnancy and unintended pregnancy, it is critical to further explore how exposure to ACEs influences the development of postpartum depression (PPD) symptoms. The aim of the current study was to test the association between ACEs and PPD symptoms—including the dose-response relationships between ACEs and PPD symptoms—in an urban, ethnically diverse sample of women.

Methods: Participants (N = 746; ages 18–47; mean age = 27.3) were recruited at a large, urban university medical center as part of the Longitudinal Infant and Family Environment (LIFE) study. The participants completed self-report measures of the ACEs Questionnaire and PPD symptoms. The prevalence of ACEs was calculated and t-tests and analysis of variance (ANOVA) were used to compare PPD symptoms by ACE counts as well as each type of ACEs (e.g., physical abuse). Lastly, the association between ACE counts and PPD symptoms was tested via hierarchical linear regression, controlling for maternal race/ethnicity, age, educational attainment, marital status, family income, and infant gender and birth order.

Results: Most participants (61%) reported experiencing at least one type of ACEs, whereas 18.0% reported four or more types of ACEs prior to age 18. African American women were approximately twice as likely as non-Hispanic White women to be exposed to at least one ACE (OR = 2.43, p = .02). Results showed that most types of ACEs were significantly related to higher levels of PPD symptoms. Moreover, participants exposed to four or more ACEs showed significantly higher levels of PPD symptoms than those reporting none (p < .001), one (p = .02), or three (p = .008) ACEs. Finally, ACEs were positively associated with PPD symptoms (β = .29, p < .001), controlling for maternal and infant demographic variables.

Conclusions: The present study found that ACEs were prevalent among low-income women in urban settings and that racial/ethnic disparities existed in exposure to ACEs. Further, exposure to ACEs was related to PPD symptoms. Consistent with previous literature, there was a graded dose-response relationship between the ACE counts and the level of PPD symptoms: as the total number of ACEs increased, so did the likelihood of experiencing PPD symptoms. The cumulative stressors model posits that the exposure to multiple and severe ACEs leads to dysfunctional parenting behaviors that decrease resilience and increase the probability of developing depressive symptoms. Screenings for ACEs during prenatal checkups can help identify women at risk of depression and facilitate timely prevention and treatment efforts.