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 there is consistent evidence that ACEs are associated with subsequent poor mental health outcomes. ACEs experienced by women who are mothers (referred to as maternal ACEs) can have lasting effects for mothers and may have impacts transmitted to their children. Few studies of maternal ACEs have been conducted in low- and middle-income countries (LMIC), and mothers in LMICs may have high likelihood of ACEs due to resource deprivation. We aimed to determine the relationship between maternal ACEs and mental health among postpartum mothers in Kenya. Methods: This nested cross-sectional study used data from the HOPE study in Nairobi and Western Kenya. Mothers attending 6-week postnatal care visits were enrolled between February 2021 and June 2022. Outcomes of interest were maternal mental health outcomes (depressive symptoms [PHQ-9 scores], psychological distress [K10 scores], and well-being [WHO well-being index scores]), and the primary exposure of interest was self-reported past 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). Results: Overall, among 1988 enrolled mothers, median age was 29 (interquartile range [IQR] 24-33) and 342 (17.2%) had high ACEs, 110 (5.5%) had moderate to severe depression (MSD) symptoms, 61 (3.1%) had moderate to severe psychological distress, and 1536 (77.3%) had high well-being. Mothers with high ACEs had a higher prevalence of MSD symptoms (PR: 2.86 [95% CI: 1.98, 4.13], p < .001), and moderate/severe psychological distress (PR: 3.68 [95% CI: 2.24, 6.06], p < .001) and a lower prevalence of well-being (PR: 0.75 [95% CI: 0.69, 0.82], p < .001). These patterns were maintained in analyses stratified by HIV status and perceived social support. Conclusion: Regardless of HIV status, High maternal ACEs were associated with poorer mental health outcomes among mothers in Kenya. Peripartum ACEs screening may be useful to identify women who may benefit from timely mental health support to address psychological distress and mitigate forward going transmission that may impact mother-child health and relationships.