Combinations of Adverse Childhood Events and Risk of Postpartum Depression Among Mothers Enrolled in a Home Visiting Program




Nichole Nidey, Katherine Bowers, Robert T. Ammerman, Anita N. Shah, Kieran J. Phelan, Margaret J. Clark, Judith B. Van Ginkel, and Alonzo T. Folger

Brief Type

Journal Publication


  • Other Models


Purpose: The purpose of this study was to examine how combinations of adverse childhood events (ACEs) contribute to the risk of postpartum depression and the mediating role of prenatal social support. Methods: The Adverse Childhood Experiences Scale Questionnaire and the Edinburgh Postnatal Depression Scale Questionnaire were used to measure the study's exposure and outcome. Among a cohort of 419 mothers enrolled in a home visiting (HV) program, latent class analyses were used to identify classes of ACEs exposure. General linear models assessed the risk of postpartum depression, and prenatal social support was examined as a mediator. Results: Four distinct classes of ACE exposure were identified. On the Edinburgh Postnatal Depression scale, mothers who were classified in Classes 1e3 scored higher by 2.6e4.4 points compared with women in Class 0. ACE class was found to be indirectly associated with postpartum depression scores through prenatal social support. Conclusions: Identifying combinations of ACEs in an HV program has the potential to improve the characterization of ACEs among low-income perinatal women in the United States. Elucidating how these combinations contribute to the risk of postpartum depression has the potential to identify women at increased risk, which can help HV programs prioritize prevention efforts. (author abstract)

Data Collection Methods

  • Program administrative record reviews
  • Standardized assessment tools



For More Information

Nidey, N., Bowers, K., Ammerman, R. T., Shah, A. N., Phelan, K. J., Clark, M. J., Van Grinkel,, J. B., & Folger, A. T. (2020). Combinations of adverse childhood events and risk of postpartum depression among mothers enrolled in a home visiting program. Annals of Epidemiology52, 26-34. https://doi.org/10.1016/j.annepidem.2020.09.015
Author Contact Information:
Alonzo T. Folger


  • Participant Characteristics