Depressive symptoms in disadvantaged women receiving prenatal care: the influence of adverse and positive childhood experiences.
OBJECTIVE
To determine the association between adverse childhood experiences (ACEs), positive influences in childhood (PICs), and depressive symptoms among low-income pregnant women.


METHODS
Face-to-face survey of women receiving prenatal care at Philadelphia community health centers. We conducted surveys at the first prenatal care visit and at a mean age +/- standard deviation of 11 +/- 1 months postpartum, and obtained information on sociodemographic characteristics and childhood experiences before age 16. Group differences were tested with respect to a cutpoint of 23 on the Center for Epidemiologic Studies-Depression scale (CES-D), with the chi(2) test used for categorical variables and the Student's t test used for continuous variables. Logistic regression analyses were conducted to adjust for potential confounding variables.


RESULTS
The sample consisted of 1476 mostly young, African American, low-income women. The majority (70% and 90%, respectively) of women reported at least one ACE and one PIC. For each ACE, affected women were more likely to have depressive symptoms than their counterparts. There was a dose-response effect in that a higher number of ACEs was associated with a higher likelihood of having depressive symptoms. PICs, on the other hand, were associated with a lower likelihood of having depressive symptoms.


CONCLUSIONS
Among low-income women, ACEs were associated with a higher likelihood of having depressive symptoms in a dose-response fashion, and PICs were associated with a lower risk. Efforts to prevent ACEs and to promote PICs might help reduce the risk of depressive symptoms and their associated problems in adulthood.
Chung
Esther K
EK
Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. echung@nemours.org
Mathew
Leny
L
Elo
Irma T
IT
Coyne
James C
JC
Culhane
Jennifer F
JF
D000293:Adolescent; D000328:Adult; D002649:Child Abuse / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007182:Income; D008016:Life Change Events; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011295:Prenatal Care; D035862:Vulnerable Populations