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Adverse Childhood Experiences and Postnatal Depression, Anxiety, and Stress in Aotearoa

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Thesis(2.39 MB)

Date

2024

Authors

Coleman, Katrina

Supervisor

Merrick, Eamon
Vorster, Anja

Item type

Thesis

Degree name

Doctor of Health Science

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Publisher

Auckland University of Technology

Abstract

Background Mental illness in the perinatal period can have far-reaching negative consequences. Maternal suicide is the leading cause of death in the perinatal period in Aotearoa, recording mortality rates five times higher per capita than in the United Kingdom. The deleterious effects of maternal depression, anxiety, and stress extend beyond the individual, with studies describing poorer physical, developmental, and emotional well-being in the children of affected mothers. Due to the significant burden that maternal mental illness presents intergenerationally, research that examines potential risk factors for maternal mental health (MMH) dysfunction is of paramount importance. A body of international literature examining mental health in the perinatal period has uncovered a significant relationship between experiences of early life adversity and later maternal mental illness. Methods Following a scoping review of the relevant literature, a cross-sectional study of 506 mothers was undertaken using established self-report-based assessment tools. Aotearoa mothers, in their first postnatal year, engaging with Whānau Āwhina services comprised the participant sample. The prevalence of adverse childhood experiences was measured using the Adverse Childhood Experiences-10 assessment tool (ACE-10). Postnatal mental health outcomes were assessed using the Patient Health Questionnaire 2+ (PHQ2+) screening for symptoms of depression and anxiety and the Depression Anxiety and Stress Scale-21 Scale (DASS-21), assessing for symptoms of depression, anxiety, and stress. Correlation analysis was undertaken to test for associations of the study’s key variables. Results Approximately 72% of the maternal study population reported an ACE score of one or more, with 25% of participants reporting four or more ACEs. The results from the DASS-21 revealed that 39% of participants reported symptoms of depression, 38.5% reported symptoms of anxiety, and 45.7% reported symptoms of stress at the time the survey was conducted. There were significant associations between many of the socio-demographic characteristics measured in the survey and the mother's mental health outcomes; however, ordinal and binomial logistic regression models revealed that even with controlling for significantly correlated socio-demographic variables by adding them into the regression model as covariates, maternal ACEs remained the strongest predictor of maternal depression, anxiety, and stress symptoms in the first postnatal year. Conclusion These findings contribute a uniquely Aotearoa maternal perspective to the international literature that acknowledges that maternal ACEs present a significant risk factor for maternal mental illness in the postnatal period. There are opportunities to apply the results of this study through universal maternal ACE assessment in clinical practice settings, applying a two-generation approach to addressing ACEs. Early maternal ACE assessment would provide maternal and child health services (MCHS) such as Whānau Āwhina with insights into which mothers are most at risk of poor MMH outcomes. There would also be an added benefit of early identification of children with an increased risk of intergenerational ACE consequences due to their mother's ACEs. Maternal ACE assessment would allow for dual healing and prevention pathways, where targeted supports informed by international ACE best practice guidelines could ultimately reduce the impact of harm for ACE-affected women and their children in Aotearoa.

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http://hdl.handle.net/10292/18086

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