Global Health
Adverse childhood experiences, socioeconomic position and mental health in middle- income countries: analyses of Brazilian and Filipino birth cohorts Lucy Barrass* Lucy Barrass Lucy Riglin Theresa Maria Redaniel Nanette R Lee Duleeka Knipe Laura Howe Alicia Matijasevich
Adverse childhood experiences (ACEs) are associated with poorer mental health. However, most evidence comes from high-income settings, despite most children residing in low- and middle- income countries, where the burden of mental disorders is also highest. We aimed to explore the association between ACEs and mental health, and whether associations were modified by socioeconomic position (SEP), in two middle-income countries. We hypothesized that the effects of ACEs would be exacerbated in those with socioeconomic disadvantage.
We used data from the Pelotas 2004 birth cohort (Brazil) and the Cebu Longitudinal Health and Nutrition Survey (CLHNS) (Philippines). Self-reported ACEs were measured prospectively up to age 15 years (Pelotas) and retrospectively recalled at age 35 (CLHNS). ACEs were explored individually, cumulatively and using the dimensional approach to adversity and psychopathology (DMAP). Mental health outcomes were measured at age 18 (depression in both cohorts, anxiety in Pelotas). Logistic regression was used to explore associations between ACEs and outcomes and we assessed the modifying effect of maternal education.
Analysing data from 1620 and 1217 participants from Pelotas and CLHNS respectively, we found strong evidence of associations between experiencing physical and emotional abuse, emotional neglect, witnessing domestic violence, higher cumulative scores or threat ACEs and having depression in both cohorts. All individual, cumualtive and DMAP categorisations of ACEs were associated with anxiety, with odds ranging from 1.36 for parental separation (95%CI: 1.06,1.75) to 4.90 for 4+ ACEs (95%CI: 3.21,7.48), except parental death (OR: 0.91 95%CI: 0.57,1.44). We found inconsistent evidence that SEP modifies associations.
Consistent with HIC evidence, ACEs are linked to depression and anxiety in LMICs, suggesting a need for population-level prevention interventions and support for those exposed to ACEs to promote good mental health.