Multiple Adverse Childhood Experiences and Maternal Mental Health Outcomes Among Kenyan Mothers With and Without HIV

Adverse childhood experiences (ACEs) reflect childhood exposure to abuse, neglect, and family stressors and are associated with subsequent poor mental health. Maternal ACEs can have lasting effects for mothers and their children. Few studies of maternal ACEs have been conducted in low- and middle-income countries. We aimed to determine the relationship between maternal ACEs and mental health among postpartum mothers in Kenya with and without HIV. This nested cross-sectional study used data from mothers attending 6-week postnatal care visits enrolled in the HOPE study. Outcomes of interest were maternal mental health (depression symptoms, psychological distress, and well-being), and the exposure of interest was self-reported ACEs. High ACEs were defined as four or more ACEs. Log binomial regression models were used to calculate prevalence ratios (PRs) and 95% confidence intervals (CIs). ACEs domain (abuse, neglect, and household dysfunction) was a secondary exposure of interest. Of the 1988 mothers, 49.9% were living with HIV, 17.2% had high ACEs, 3.1% had moderate/severe depression (MSD) symptoms, 3.0% had moderate/severe psychological distress (MPD), and 77.6% had moderate/high psychological well-being (MPW). Mothers with high ACEs had a higher prevalence of MSD symptoms (PR: 3.73 [95% CI: 2.29, 6.08], p < .001), and MPD (PR: 3.68 [95% CI: 2.24, 6.06], p < .001) and a lower prevalence of MPW (PR: 0.75 [95% CI: 0.69, 0.82], p < .001). Findings remained when stratified by HIV status and perceived social support. Peripartum ACEs screening may be useful to identify women who may benefit from mental health support.