The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi

Steven P. Masiano, Xiaoying Yu, Tapiwa Tembo, Elizabeth Wetzel, Mtisunge Mphande, Innocent Khama, Angella Mkandawire, Mike Chitani, Olive Liwimbi, Michael Udedi, Alick Mazenga, Phoebe Nyasulu, Elaine Abrams, Saeed Ahmed, Maria H. Kim

Research output: Contribution to journalArticlepeer-review


Introduction: Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi—an HIV endemic resource-limited setting. Methods: This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. Results: The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms—even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. Limitations: Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. Conclusions: ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.

Original languageEnglish (US)
Pages (from-to)159-168
Number of pages10
JournalJournal of Affective Disorders
StatePublished - Sep 1 2022


  • ACE-IQ
  • Adverse childhood experiences
  • Mental health
  • Pregnant women living with HIV
  • Prevalence
  • Resource-limited settings

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi'. Together they form a unique fingerprint.

Cite this