Mother‑Baby Program, Department of Psychiatry, and Redleaf Center for Family Healing, Hennepin Healthcare, Minneapolis, MN, USA.
Mother-Baby Program and Redleaf Center for Family Healing, Hennepin Healthcare, 825 S 8th Street, Suite 400, Minneapolis, MN, 55404, USA.
Matern Child Health J. 2022 Feb;26(2):289-298. doi: 10.1007/s10995-021-03345-7. Epub 2022 Jan 7.
Adverse childhood experiences (ACEs) can detrimentally impact perinatal mental health, birth outcomes, and parenting behaviors. Proximal psychosocial stressors also increase risks to perinatal health and wellbeing. Additional research on effective perinatal mental health programs is needed, especially for individuals and families with historical and concurrent adversity, and those with moderate to severe symptoms.
The Mother-Baby Day Hospital at Hennepin County Medical Center provides trauma-informed, multi-generation treatment for perinatal women. Data were collected from patients between January 2016 and September 2019. Self-reported depression, anxiety, and maternal functioning assessments were administered pre- and post-treatment. Patients completed the ACE questionnaire and indicators of current psychosocial stressors (i.e., food insecurity, housing insecurity, and social support) at intake. A series of bivariate tests and hierarchical regression models examined relationships among variables, including whether distal and proximal adversity predicted post-treatment symptoms.
159 Perinatal patients consented to research and completed the ACEs questionnaire at first admission. High proportions of patients reported 4+ ACEs and current psychosocial stressors. Effect sizes for associations between ACEs, psychosocial stressors, and self-report symptoms were small to moderate. Individuals with food or housing insecurity entered treatment with higher anxiety. In regression models, the most robust predictors of post-treatment symptoms were pre-treatment symptoms. Effects of ACEs on post-treatment depression and food insecurity on post-treatment maternal functioning approached the adjusted significance cut-off (p < .01). CONCLUSIONS FOR PRACTICE: Current psychosocial stressors and ACEs did not substantially limit post-treatment depression, anxiety, and maternal functioning outcomes. High prevalence of ACEs and psychosocial stressors highlight the need for trauma-informed, multi-generation treatments to improve maternal mental health and parenting capacity.
童年逆境（ACEs）可对围产期心理健康、生育结果和养育行为产生不利影响。近期心理社会应激源也会增加围产期健康和福祉的风险。需要进一步研究有效的围产期心理健康计划，特别是针对有历史和当前逆境的个人和家庭，以及有中度至重度症状的个人和家庭。
亨内平县医疗中心母婴日医院为围产期妇女提供创伤知情、多代治疗。数据于 2016 年 1 月至 2019 年 9 月期间从患者中收集。在治疗前后进行自我报告的抑郁、焦虑和母亲功能评估。患者在入组时完成 ACE 问卷和当前心理社会应激源指标（即，食物不安全、住房不安全和社会支持）。一系列双变量检验和层次回归模型检查了变量之间的关系，包括远端和近端逆境是否预测治疗后的症状。
159 名围产期患者同意参与研究，并在首次入院时完成 ACE 问卷。大多数患者报告了 4 个或更多 ACEs 和当前的心理社会应激源。ACEs、心理社会应激源和自我报告症状之间的关联效应大小为小到中等。有食物或住房不安全的个体在治疗开始时焦虑程度较高。在回归模型中，治疗前症状是治疗后症状的最强预测因素。ACEs 对治疗后抑郁的影响以及食物不安全对治疗后母亲功能的影响接近调整后的显著水平（p <.01）。
当前的心理社会应激源和 ACEs 并没有显著限制治疗后的抑郁、焦虑和母亲功能结局。ACEs 和心理社会应激源的高患病率突出表明需要进行创伤知情、多代治疗，以改善产妇心理健康和养育能力。
