Adverse Childhood Experiences and Postpartum Depressive Symptoms in Low-Income Women

Background and purpose: Adverse childhood experiences (ACEs), such as childhood maltreatment and family dysfunction, are common and have a long-lasting mental health impact. ACEs have been long linked to an increased likelihood of experiencing lifetime depressive disorders, persistence in depression symptoms and recurrence, and a lack of response to depression treatment. An emerging body of studies have also reported that maternal ACEs are related to depression during the postpartum period. When individuals are exposed to ACEs, the majority of them suffer not just one but several types of ACEs. Therefore, it is important to examine how different patterns of ACEs exposures influence the development of postpartum depression (PPD) symptoms. The current study aimed to investigate how distinct patterns of maternal ACEs are related to PPD symptoms and screening services.

Methods: A diverse sample of young women (N = 427; M(age) = 26.5) was recruited at a large, urban university hospital as part of the Longitudinal Infant and Family Environment (LIFE) study. The participants retrospectively reported their ACEs. The Pregnancy Risk Assessment Monitoring System (PRAMS) measures were used to assess PPD symptoms. We also collected data on whether they received PPD screening services. Using the manual maximum likelihood (ML) three-step approach, latent class analysis (LCA) was performed to identify groups of women with distinct patterns of ACEs. Once the best-fitting model was selected, Wald test was applied to determine the statistical significance of the differences in class-specific intercepts for PPD symptoms and screening service utilization. Maternal race/ethnicity, educational attainment, family income, and infant birth order were used as covariates.

Results: The results of LCA indicated that the three-class model is best fit with data. Low ACEs class (57% of the sample) was characterized by low probabilities of endorsing any ACEs. High Parental Separation/Divorce class (30%) had a high probability of exposure to parental separation/divorce and low probabilities of exposure to all other ACEs. High Multiple ACEs (13%) had moderate to high probabilities of exposure to nine ACEs. Controlling for maternal race/ethnicity, educational attainment, and family income, participants in both High Parental Separation/Divorce (p = .031) and High Multiple ACEs classes (p < .001) showed higher levels of PPD symptoms compared to participants in the Low ACEs class. Additionally, women in the High Multiple ACEs class reported higher levels of PPD symptoms than those in the High Parental Separation/Divorce class (p = .021). On the other hand, there was no significant difference in receiving a PPD screening across three classes.

Conclusions and Implications: The current study found that maternal ACEs are related to PPD symptoms among low-income women. Our findings suggest that women with a history of multiple types of ACEs are particularly at risk of developing PPD symptoms. Given that no group difference was found in PPD screening services use among three classes, screening for ACEs in OB-GYN settings might be an effective strategy to prevent PPD among low-income women.