Katherine LeMasters1,2, Lisa M Bates3, Esther O Chung4,5, John A Gallis6,7, Ashley Hagaman8, Elissa Scherer4,9, Siham Sikander10,11, Brooke S Staley4, Lauren C Zalla4, Paul N Zivich4,5, Joanna Maselko4,5. 1. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA. Katherine.lemasters@unc.edu. 2. Carolina Population Center, Chapel Hill, North Carolina, USA. Katherine.lemasters@unc.edu. 3. Department of Epidemiology,Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY, 10032, USA. 4. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall, CB# 7435, Chapel Hill, NC, 27599, USA. 5. Carolina Population Center, Chapel Hill, North Carolina, USA. 6. Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC, 27705, USA. 7. Duke Global Health Institute, Duke University, Durham, North Carolina, USA. 8. Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 135 College St., Suite 200, Room 230, New Haven, CT, 06510, USA. 9. RTI International, 3040 E Cornwallis Rd, Durham, NC, 27709, USA. 10. Human Development Research Foundation, H 06, Street 55, Sector F-7/4, Islamabad, 44000, Pakistan. 11. Health Services Academy, Islamabad, Pakistan.
Abstract
BACKGROUND: Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan. METHOD: Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity. RESULTS: The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79). CONCLUSIONS: Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health. TRIAL REGISTRATION: NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.
BACKGROUND: Adverse Childhood Experiences (ACEs) are a common pathway to adult depression. This pathway is particularly important during the perinatal period when women are at an elevated risk for depression. However, this relationship has not been explored in South Asia. This study estimates the association between ACEs and women's (N = 889) depression at 36 months postpartum in rural Pakistan. METHOD: Data come from the Bachpan Cohort study. To capture ACEs, an adapted version of the ACE-International Questionnaire was used. Women's depression was measured using both major depressive episodes (MDE) and depressive symptom severity. To assess the relationship between ACEs and depression, log-Poisson models were used for MDE and linear regression models for symptom severity. RESULTS: The majority (58%) of women experienced at least one ACE domain, most commonly home violence (38.3%), followed by neglect (20.1%). Women experiencing four or more ACEs had the most pronounced elevation of symptom severity (β = 3.90; 95% CL = 2.13, 5.67) and MDE (PR = 2.43; 95% CL = 1.37, 4.32). Symptom severity (β = 2.88; 95% CL = 1.46, 4.31), and MDE (PR = 2.01; 95% CL = 1.27, 3.18) were greater for those experiencing community violence or family distress (β = 2.04; 95%; CL = 0.83, 3.25) (PR = 1.77; 95% CL = 1.12, 2.79). CONCLUSIONS: Findings suggest that ACEs are substantively distinct and have unique relationships to depression. They signal a need to address women's ACEs as part of perinatal mental health interventions and highlight women's lifelong experiences as important factors to understanding current mental health. TRIAL REGISTRATION: NCT02111915 . Registered 11 April 2014. NCT02658994 . Registered 22 January 2016. Both trials were prospectively registered.
Authors: M Alan Brookhart; Sebastian Schneeweiss; Kenneth J Rothman; Robert J Glynn; Jerry Avorn; Til Stürmer Journal: Am J Epidemiol Date: 2006-04-19 Impact factor: 4.897
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Authors: Sara N Naicker; Marilyn N Ahun; Sahba Besharati; Shane A Norris; Massimiliano Orri; Linda M Richter Journal: Int J Environ Res Public Health Date: 2022-02-05 Impact factor: 3.390