A recent study conducted by Kaiser Permanente sheds light on the correlation between adverse childhood experiences (ACEs) and resilience levels with the likelihood of developing depression or anxiety during pregnancy. Published in Obstetrics & Gynecology, the analysis reveals that pregnant individuals with a history of ACEs or low resilience are more susceptible to new diagnoses of depression or anxiety during pregnancy.
ACEs encompass potentially traumatic events occurring during childhood, such as abuse, neglect, parental divorce, substance use, or incarceration. Resilience, on the other hand, refers to one’s capacity to endure and rebound from adversity.
Lead author Dr. Carey Watson, an ob-gyn at The Permanente Medical Group, expressed surprise at the study’s findings, stating, “These results are much more striking than we expected.” Identifying at-risk patients early on could facilitate timely intervention, potentially preventing mental health disorders not only for the patient but also mitigating potential adverse childhood experiences for their newborn or other children in the family.
Senior author Dr. Kelly Young-Wolff, a research scientist with the Kaiser Permanente Division of Research, emphasized the significance of the study, highlighting that the participants did not have depressive or anxiety disorders before pregnancy. ACEs and low resilience may serve as critical factors contributing to the onset of these conditions during pregnancy, she noted.
The study, the largest of its kind, examined 13,852 patients who underwent screening for both ACEs and resilience during prenatal care between October 2021 and March 2023. Kaiser Permanente Northern California has been routinely administering screening questionnaires for ACEs and resilience to prenatal care patients since 2021.
Among the findings, 17% of patients received a new depression diagnosis during prenatal care, with 9.8% presenting new depression symptoms and 8.9% experiencing newly identified anxiety.
The analysis revealed that patients with four or more ACEs were three times more likely to develop depression compared to those with no ACEs. Additionally, individuals with low resilience had twice the likelihood of depression compared to those with high resilience. When ACEs and low resilience were combined, the odds of depression were 6.4 times greater than those with no ACEs and high resilience. Similar patterns were observed for anxiety.
Dr. Watson highlighted pregnancy as a period of heightened emotional vulnerability, acknowledging the significant impact of past experiences on mood during this stage of life.
Depression and anxiety during pregnancy pose risks to both maternal health during pregnancy and postpartum. Identifying individuals at risk early on is crucial, as perinatal mood disorders are a leading cause of medical complications during pregnancy and can have long-term mental and physical health implications for both the patient and their family.
Dr. Young-Wolff mentioned that the study team is actively seeking federal funding to expand their research on ACEs and resilience during pregnancy to include additional health outcomes.
The study was funded by The Permanente Medical Group Delivery Science and Applied Research Program, with additional contributions from co-authors Dr. Abigail Eaton, Dr. Cynthia Campbell, Dr. Stacey Alexeeff, Dr. Lyndsay Avalos from the Division of Research, and Dr. Kathryn K. Ridout from The Permanente Medical Group.
