Associations Between Adverse Childhood Experiences and Prenatal Depression Mediated Through Family Communication in Chinese Pregnant Women: Causal Mediation Analysis.

BACKGROUND

Adverse childhood experiences (ACEs) have shown impacts on prenatal depression. Most studies examined the cumulative risk of ACE scores, though impacts of different ACE types can vary. And less is known about the psychosocial mechanisms underlying the impacts. Supportive communication within a family formed through marriage may serve as a psychosocial resource for pregnant women.

OBJECTIVES

To differentiate the associations of ACE scores and types with prenatal depression. The mediation effect of family communication was further investigated.

STUDY

DESIGN

A cross-sectional study in 873 Chinese pregnant women (mean age 30.89 [SD 3.93] years).

METHODS

ACEs, family communication, and prenatal depression were measured using the ACE International Questionnaire (ACE-IQ), Family Communication Scale (FCS), and Edinburgh Postnatal Depression Scale (EPDS), respectively. Specifically, 13 types of ACEs included physical abuse, emotional abuse, sexual abuse, physical neglect, emotional neglect, domestic violence, parental death or separation, family substance use, family mental illness, family incarceration, bullying, collective violence, and community violence. Multivariable linear regression examined the associations of ACE scores and types with prenatal depression, adjusting for demographic, lifestyle, and pregnancy-related covariates. Causal mediation analysis investigated the mediation effect of family communication.

RESULTS

Childhood abuse (physical, emotional, and sexual), neglect (physical and emotional), domestic violence, collective violence, and bullying showed associations with prenatal depression (adjusted b range 1.34-3.28, all ps <0.05). ACE scores were associated with prenatal depression (adjusted b = 0.55, 95% confidence interval [CI] 0.38, 0.72). Family communication mediated the associations of ACE scores (proportion of total effect [TE] mediated = 22%), physical (26%) and emotional abuse (15%), physical (57%) and emotional neglect (31%), and domestic violence (22%) with prenatal depression.

CONCLUSIONS

Associations with prenatal depression were observed with ACE scores and were various across ACE types, which were medicated through family communication. Pregnant women with high ACE scores and specific ACE types can be vulnerable groups for prenatal depression, and interventions for promoting family communication are needed.