Expanded adverse childhood experiences and postpartum mental health among an under-resourced sample of Spanish- and English-speaking mothers referred for community-based mental health services during pregnancy

Adverse childhood experiences (ACEs) historically include 10 types of adversities (the “Conventional 10”), developed in the context of the landmark CDC-Kaiser ACEs study. These 10 ACEs are associated with an increased risk of perinatal depression and anxiety, but they may also overlook traumas that harm disadvantaged and minoritized groups. This study investigated an Expanded set of ACEs (the Conventional 10 plus five additional) among a sample of Spanish- and English-speaking postpartum mothers who had previously received a referral for a prenatal mental health concern from a community-based service providing care to under-resourced populations. Specific aims were to: (1) Describe the Conventional 10 and Expanded 15 ACEs in this sample, and compare the Conventional 10 in this sample to that of the existing landmark CDC-Kaiser ACEs study sample (reference sample), (2) Investigate demographic variation in the Conventional 10 and Expanded 15 ACE scores in this sample, and (3) Examine associations between ACEs and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) at 6–12 weeks postpartum in this sample.

Participants included 244 Spanish- and English-speaking mothers from under-resourced communities who were previously referred for a mental health concern during pregnancy. Participants reported on their ACEs and their 6-to-12-week postpartum mental health including depression, anxiety, and post-traumatic stress symptoms. Reference sample data (descriptives of the Conventional 10 ACEs in the CDC-Kaiser ACEs study sample women) were obtained from a publicly available report.

The proportion of mothers reporting each of the Conventional 10 ACEs was greater in this sample than that of the reference CDC-Kaiser sample. Among the present study sample, mothers who came to the United States (US) in adulthood reported fewer ACEs compared to mothers born in the US. Additionally, among the present study sample, correlations with the postpartum mental health outcomes were slightly larger for the Expanded 15 ACE score than the Conventional 10 (rs = 0.31–0.42 and 0.26–0.37, respectively).

Future studies should consider the context of how and with whom ACEs measures are developed.

ClinicalTrials.gov (ID NCT02724774 registration date 3242016).