The relationship between childhood trauma, socioeconomic status, and maternal depression among pregnant women in a South African birth cohort study. (June 2021)

• Record Type: Journal Article
• Authors: Mal-Sarkar, Tatini; Keyes, Katherine; Koen, Nastassja; Barnett, Whitney; Myer, Landon; Rutherford, Caroline; Zar, Heather J.; Stein, Dan J.; Lund, Crick
• Is Part Of: SSM - population health. Volume 14(2021)
• Publication Date: 2021-06
• Subjects: Depression -- Trauma -- Poverty -- Epidemiology -- Birth cohort; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; 362.105
• DOI: 10.1016/j.ssmph.2021.100770
• Languages: English
• ISSNs: 2352-8273

Abstract

Abstract: Background: Maternal depression is an important cause of morbidity and mortality. Experiences of childhood trauma contribute to maternal depression, potentially causing adult socio-economic disparities in mental health. We investigate whether adult socioeconomic status (SES) mediates the relationship between childhood trauma and antenatal depression. Methods: We analyzed data from two sociodemographically distinct peri-urban sites in the Western Cape, South Africa in a birth cohort study, the Drakenstein Child Health Study: Mbekweni (N = 510) and TC Newman (N = 413). Data were collected from pregnant women between 28 and 32 weeks' gestation. Results: Associations between trauma and depressive symptoms differed by site ( χ 2 =2163.6, df = 1419, p < 0.01); direct effects of trauma on depression were 0.24 mean increased symptoms in Mbekweni (p < 0.01) and 0.47 in TC Newman (p < 0.01). Trauma was differentially associated with SES (Mbekweni: −0.10, p = 0.07; TC Newman: −0.05, p = 0.37) and SES with depression (Mbekweni: −0.18, p < 0.01; TC Newman: −0.02, p = 0.62) across both sites. Indirect effects of trauma on depression through SES were 0.018 (95% C.I. −0.002-0.039) in Mbekweni and 0.001 (95% C.I. −0.004-0.006) in TC Newman, suggesting mediation was not supported. SES was a stronger indicator of depression risk in relatively poorer Mbekweni. Conclusion: Neighborhood-level effects and poverty are potentially important modifiers, and points of intervention, for maternal mental health outcomes. Highlights: Childhood trauma and low socioeconomic status (SES) independently predict antenatal depression among a cohort of expecting women. The relationship between childhood trauma, SES, and antenatal depression differed by clinical site. These differential relationships may have been due to neighborhood effects on social determinants of mental health.