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

Background: Depression impacts the health and safety of women globally, with the WHO citing depression as one of the top ten causes of disease and the National Violent Death Reporting System citing depression as a primary reason for the 47,000+ deaths by suicide during 2018. Given that mothers may face higher rates of depressive symptoms in the years following childbirth compared to the postpartum period it is also important to examine the intermediary role of economic resources in the relationship between childhood trauma and depression among mothers. Social workers are often present in spaces where maternal depression is prevalent or they contribute to the creation and implementation of policies that could affect maternal depression. Prior research suggests adverse childhood experiences (ACEs) are an important social determinant of depression; however, few studies have examined the roles that income and race/ethnicity play in this relationship, though Black women and Latinas are more likely to experience depression than their white counterparts.

Methods: Using a life-course perspective, this article examined whether adult family income mediated the relationship between ACEs and adult depressive symptoms among 3,106 mothers from the prospective Geographic Research on Wellbeing survey. We also examined whether race/ethnicity moderated the relationships between ACEs, income, and symptoms. We used both mediation and moderated mediation to conduct secondary data analysis.

Results: Each additional ACE was associated with a .03 standard deviation decrease in income (β = -0.03, p < .01), an increase of one income category was associated with a 6% decrease in the odds of endorsing depressive symptoms (LO = -0.06, OR = 0.94, p < .001). Further, each additional ACE was associated with a 33% increase in the odds of endorsing depressive symptoms (LO = 0.29, OR = 1.33, p < .001). Income significantly mediated the relationship between ACEs and depressive symptoms (b = 0.012, p = .012). The relationship between ACEs and depressive symptoms was stronger among immigrant Latina participants compared to non-Latina White participants (b = 0.25, p < .001).

Conclusion: The findings of this study provide evidence of the childhood and economic determinants of maternal depression across racial and ethnic groups. This study demonstrates the importance of policies that consider economic determinants of mental health—something that has widely been neglected. To decrease maternal depressive symptoms, policymakers may need to focus on decreasing income inequality. As social workers are often at the macro and meso levels where policies are being created and implemented, it is imperative that social workers be aware that these racial/ethnic factors exist and work to decrease economic disparities. Social work practitioners should consider the role of income as a social determinant of maternal depression, promote policies that decrease income inequality, and further examine how race/ethnicity impacts the relationship between childhood adversity and maternal mental health. Additionally, social workers should consider how the stress of being a Latina immigrant may affect mothers' mental health in the U.S.