Adverse life experiences and common mental health problems in pregnancy: a causal pathway analysis
Risk factors for antenatal common mental problems include a history of depression, lack of social support and a history of both childhood and adulthood sexual and physical abuse. However, it is less clear whether pregnancy is a time of particular susceptibility to mental disorders due to prior childhood experiences. The aim of the paper was to investigate the potential pathways to antenatal mental health problems. A total of 521 women attending prenatal care attended a clinical interview and answered psychological questionnaires. Univariate analysis, sequential binary logistic regression and structural equation modelling (SEM) were used to analyse the relationships between variables. Having experienced parental maladjustment, maltreatment and serious physical illness in childhood and domestic violence, financial difficulties and serious spousal substance abuse in adulthood significantly predicted antenatal common mental health symptoms. SEM showed that history of depression and adverse experiences in adulthood had mediating effects on the relationship between adverse childhood events and symptoms of antenatal common mental disorders. Adverse childhood experiences are distal risk factors for antenatal common mental health problems, being significant indicators of history of depression and adverse experiences in adulthood. We therefore conclude that pregnancy is not a time of particular susceptibility to common mental health problems as a result of childhood abuse, but rather, these childhood experiences have increased the risk of adulthood trauma and prior mental disorders. Women at risk for antenatal common mental disorders include those with a history of depression, domestic violence, financial difficulties, spousal substance abuse and lack of social support.
KeywordsCommon mental health problems Adverse childhood experiences Adverse experiences in adulthood Pregnancy
We thank the Primary Health Care of Reykjavik, the Capital area of Iceland, the Primary Health Care of Akureyri and the Perinatal Service of Landspitali-The National University Hospital of Iceland for their co-operation. We also thank the following research assistants, Petur I. Petursson (BS), Thorbjorg Sveinsdottir (MA) and Maria H. Nikulasdottir (MA), psychologist Petur Tyrfingsson (MA), midwife Sigridur S. Jonsdottir (MS) and nurse Sigridur B. Sigurdardottir (BS), who contributed to the study. Finally, we like to thank all the women who participated in the study.
Linda Bara Lydsdottir, Halldora Olafsdottir and Jon Fridrik Sigurdsson designed the study and wrote the protocol. Linda Bara Lydsdottir, Hjalti Einarsson and Halldora Olafsdottir contributed in acquisition of data. Linda Bara Lydsdottir, Louise Howard, Jon Fridrik Sigurdsson and Thora Steingrimsdottir contributed to the interpretation of data. Linda Bara Lydsdottir undertook the statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript. This manuscript has not been published and is not under consideration for publication elsewhere.
This work was supported by the The Icelandic Centre for Research (RANNIS) [50427021, 50427022, 50427023, 100740001]; The University of Iceland Research Fund [grant numbers not available]; The LSH-University Hospital Research Fund [grant numbers not available] and the Wyeth Research Fund [grant number not available]. These grants had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. Louise Howard is supported by the National Institute for Health Research South London and Maudsley NHS Foundation Trust specialist Biomedical Research Centre for Mental Health. All other authors declare that they have no conflicts of interest.
Compliance with ethical standards
Approval for the study was received from the Icelandic National Bioethics Committee (ref. no. 05-107-S1) and the Icelandic Data Protection Authority (ref. no. S2589). When pregnant women attended the antenatal clinics at the beginning of their pregnancy (weeks 12–16), they received information about the study from the midwives, who also invited them to participate. If the women agreed to participate they signed an informed consent. Parental consent was required for women under the age of 18. If the women were in need of psychiatric treatment, they were referred to appropriate treatment at the Mental Health Services at Landspitali–The National University Hospital of Iceland.
Conflict of interest
The authors declare that they have no conflicts of interest.
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