Zou Linli, Wang Shu, Lai Xiaolu, Chen Jingfen, Krewski Daniel, Wen Shi Wu, Xie Ri-Hua
School of Nursing, Southern Medical University, Guangzhou, China.
School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Risk Science International, Ottawa, Ontario, Canada.
Child Abuse Negl. 2025 Mar;161:107275. doi: 10.1016/j.chiabu.2025.107275. Epub 2025 Jan 25.
Women are more prone to experience adverse childhood experiences (ACEs), placing them at higher risk of postpartum mental health disorders. However, research on ACEs, particularly their association with postpartum Post-Traumatic Stress Disorder (PTSD) in non-Western contexts, is limited.
To utilize a cumulative risk approach and latent class analysis (LCA) to operationalize ACEs among postpartum women in China and examine their association with postpartum PTSD.
In this prospective cohort study, 856 eligible participants from a tertiary hospital in Guangdong province of China between October 2022 and August 2023 completed assessments of demographic and obstetric characteristics, and ACEs within 2-3 days postpartum, followed by PTSD evaluation at 42 days postpartum. The cumulative risk approach and LCA were employed to operationalize ACEs, and their association with postpartum PTSD was assessed using log-binomial regression models, adjusting for potential confounders.
Among the participants, 80.4 % (688/856) reported ACEs, with 18.2 % experiencing four or more ACEs, a threshold above which there was a particularly higher risk of postpartum PTSD in the adjusted model (OR = 8.27, 95 % CI = 3.08-22.20). LCA identified three groups: low ACEs, household and community violence, and multiple ACEs, with women in the multiple ACEs group exhibiting the most severe postpartum PTSD symptoms in the adjusted model (OR = 4.39, 95 % CI = 1.58-12.24).
This study demonstrates that ACEs are a significant risk factor for postpartum PTSD, especially for women who have experienced four or more ACEs, or multiple ACEs, placing them at particularly high risk for developing postpartum PTSD.
女性更容易经历童年不良经历（ACEs），这使她们产后心理健康障碍的风险更高。然而，关于ACEs的研究，尤其是在非西方背景下其与产后创伤后应激障碍（PTSD）的关联，是有限的。
运用累积风险方法和潜在类别分析（LCA）来衡量中国产后女性的ACEs，并研究它们与产后PTSD的关联。
在这项前瞻性队列研究中，2022年10月至2023年8月期间，来自中国广东省一家三级医院的856名符合条件的参与者完成了人口统计学和产科特征评估，以及产后2至3天内的ACEs评估，随后在产后42天进行PTSD评估。采用累积风险方法和LCA来衡量ACEs，并使用对数二项回归模型评估它们与产后PTSD的关联，同时对潜在混杂因素进行了调整。
在参与者中，80.4%（688/856）报告有ACEs，18.2%经历了四次或更多次ACEs，在调整模型中，超过这个阈值，产后PTSD的风险特别高（OR = 8.27，95% CI = 3.08 - 22.20）。LCA识别出三组：低ACEs组、家庭和社区暴力组以及多重ACEs组，在调整模型中，多重ACEs组的女性表现出最严重的产后PTSD症状（OR = 4.39，95% CI = 1.58 - 12.24）。
本研究表明，ACEs是产后PTSD的一个重要风险因素，尤其是对于那些经历了四次或更多次ACEs或多重ACEs的女性，她们患产后PTSD的风险特别高。
