A study of the associations among adverse childhood experiences, intimate partner violence, and prenatal mental health in expectant Chinese couples

Abstract

For the past two decades, studies have found adverse childhood experiences (ACEs) and intimate partner violence (IPV) to be associated with negative effects on physical and mental health status, including depressive symptoms during pregnancy. Prenatal depressive symptoms have adverse effects on pregnant women, their intimate partners and the foetus. However, most extant studies on ACEs were mainly conducted in Western countries; hence, this lack of research about the health of ACEs survivors who also experienced IPV in Chinese population, including their mental health during pregnancy, warrants further investigation.

The aim of the current study was to gain a better understanding of the relationships among ACEs, IPV and prenatal mental health status in Chinese expectant couples. The findings of the current study may provide necessary information to health care providers to ensuring the prenatal mental health of Chinese expectant couples who were ACEs and IPV survivors. From June 2, 2016 to July 13, 2016, a cross-sectional survey was conducted among Chinese pregnant women and their intimate partners in a public teaching hospital in Hong Kong. Questionnaires eliciting demographics, ACEs, IPV victimisation, prenatal depressive symptoms, anxiety, stress and health-related life quality were implemented in the survey. Correlation and regression analysis assessed the relationship between the ACEs history of pregnant women and their intimate partners with the IPV victimisation of pregnant women, as well as explored the factors associated with maternal prenatal depressive symptoms. Mediation analysis identified whether IPV victimisation mediated the effects of ACEs on prenatal mental health in Chinese pregnant women. The current study recruited 407 participants, including 314 Chinese pregnant women and 93 intimate partners. Around three-quarters (72%) of the participants reported at least one ACE while 20.1% reported equal or more than 4 ACEs. About one-fifth (17%) of the participants demonstrated different levels of prenatal depressive symptoms, with EPDS scores larger than 10, 14.8% and 4.9% of the participants reported moderate or above levels of anxiety and stress. IPV victimisation was measured among women, and 56 (17.83%) stated having experienced or were currently experiencing IPV. Women’s ACEs history was significantly and positively related with maternal IPV victimisation while men’s ACEs history was not. Maternal IPV victimisation and maternal stress were associated with maternal depressive symptoms. In addition, IPV victimisation mediated the effects of ACEs on prenatal depressive symptoms, anxiety and stress in pregnant women. However, pregnant women’s prenatal mental health status was not associated with their intimate partners’ mental health status. Based on the findings of the current study, women who were ACEs survivors and who also experienced IPV deserve more attention during prenatal period in relation to their mental health. Therefore, healthcare providers may address maternal depressive symptoms early by measuring ACEs and IPV in early gestation and provide timely intervention.