Avendano Sara, Tafflet Muriel, Galéra Cedric, Davidovic Laetitia, Heude Barbara, van der Waerden Judith
Social Epidemiology, Mental Health and Addiction Team (ESSMA), Pierre Louis Institute of Epidemiology and Public Health, INSERM, Sorbonne University, Paris 75012, France.
Obstetric, Perinatal, Paediatric Life Course Epidemiology (OPPaLE), Center for Research in Epidemiology and Statistics, INSERM, INRAE, Paris Cité University and Sorbonne University Paris Nord, Paris 75004, France.
Depress Anxiety. 2025 May 6;2025:1295206. doi: 10.1155/da/1295206. eCollection 2025.
Adverse childhood experiences (ACEs) may negatively affect prenatal mental health. However, the use of a cumulative ACEs score may obscure the identification of which specific types of adversity are most strongly associated with unfavorable mental health outcomes. This study aims to evaluate the association between ACEs and prenatal symptoms of depression and anxiety using a cumulative score, a person-centered approach, and the dimensional model of adversity and psychopathology (DMAP). Data were collected from 1887 pregnant women in the French Etude des Déterminants du développement et de la santé de l'ENfant (EDEN) cohort. To operationalize our exposure, we calculated a cumulative ACE score, threat and deprivation scores, and conducted latent class analysis (LCA). Depressive and anxious symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the State-Trait Anxiety Inventory state subscale (STAI-S) questionnaires, using cutoffs of 16 and 38 indicating high symptoms. Participants were categorized into four outcome groups: (1) no symptoms, (2) high depressive symptoms only, (3) high anxious symptoms only, and (4) comorbid high symptoms. Multinomial regressions were performed. LCA identified three ACE classes: low-risk, family discordance, and multidimensional adversity. Women reporting two or more ACEs had higher odds of depressive and comorbid symptoms, compared to those with zero ACEs. Compared to the low-risk class, women in the family discordance class had increased odds of high depressive symptoms (adjusted odds ratios [aOR] 95% confidence interval [CI] = 1.80 [1.33, 2.56]) and comorbid high symptoms (aOR [95% CI] = 2.04 [1.43, 2.89]). Threat experiences were significantly linked to high depressive symptoms (aOR [95% CI] = 1.48 [1.22, 1.79]) and comorbid high symptoms (aOR [95% CI] = 1.53 [1.25, 1.87]). Using the DMAP and LCA approaches, we found that ACEs related to the familial environment and relationships during childhood were most strongly associated with prenatal high depressive and comorbid symptoms. This highlights the importance of operationalizing ACEs beyond a cumulative score to better capture their role in the development of prenatal mental health difficulties.
童年不良经历（ACEs）可能会对产前心理健康产生负面影响。然而，使用累积ACEs评分可能会掩盖对哪些特定类型的逆境与不良心理健康结果关联最为紧密的识别。本研究旨在使用累积评分、以人为中心的方法以及逆境与精神病理学维度模型（DMAP）来评估ACEs与产前抑郁和焦虑症状之间的关联。数据收集自法国儿童发育与健康决定因素研究（EDEN）队列中的1887名孕妇。为了对我们的暴露因素进行操作化，我们计算了累积ACE评分、威胁和剥夺评分，并进行了潜在类别分析（LCA）。使用流行病学研究中心抑郁量表（CES-D）和状态-特质焦虑量表状态分量表（STAI-S）问卷评估抑郁和焦虑症状，分别采用16分和38分的临界值来表示高症状。参与者被分为四个结果组：（1）无症状，（2）仅高抑郁症状，（3）仅高焦虑症状，（4）高症状合并存在。进行了多项回归分析。LCA识别出三种ACE类别：低风险、家庭不和谐和多维度逆境。与无ACEs的女性相比，报告有两种或更多ACEs的女性出现抑郁和合并症状的几率更高。与低风险类别相比，家庭不和谐类别中的女性出现高抑郁症状（调整后的优势比[aOR] 95%置信区间[CI] = 1.80 [1.33, 2.56]）和高症状合并存在（aOR [95% CI] = 2.04 [1.43, 2.89]）的几率增加。威胁经历与高抑郁症状（aOR [95% CI] = 1.48 [1.22, 1.79]）和高症状合并存在（aOR [95% CI] = 1.53 [1.25, 1.87]）显著相关。使用DMAP和LCA方法，我们发现童年时期与家庭环境和人际关系相关的ACEs与产前高抑郁和合并症状关联最为紧密。这凸显了超越累积评分对ACEs进行操作化以更好地捕捉其在产前心理健康困难发展中作用的重要性。
