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Maternal adverse childhood experiences,child mental health,and the mediating effect of maternal depression: A cross-sectional,population-based study in rural,southwestern Uganda |
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| Authors: | Andrew Wooyoung Kim Amber D Rieder Christine E Cooper-Vince Bernard Kakuhikire Charles Baguma Emily N Satinsky Jessica M Perkins Allen Kiconco Elizabeth B Namara Justin D Rasmussen Scholastic Ashaba David R Bangsberg Alexander C Tsai Eve S Puffer |
| Institution: | 1. Department of Anthropology, University of California, Berkeley, California, USA;2. Duke Global Health Institute, Durham, North Carolina, USA
Contribution: ?Investigation (equal), Writing - review & editing (equal);3. Départment de Psychiatrie, Universitié de Genève, Geneva, Switzerland Contribution: Writing - review & editing (equal);4. Mbarara University of Science and Technology, Mbarara, Uganda Contribution: ?Investigation (equal), Project administration (equal), Writing - review & editing (equal);5. Mbarara University of Science and Technology, Mbarara, Uganda Contribution: ?Investigation (equal), Project administration (equal);6. Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA Department of Psychology, University of Southern California, Los Angeles, California, USA Contribution: Data curation (equal), Project administration (equal), Writing - review & editing (equal);7. Peabody College, Vanderbilt University, Nashville, Tennessee, USA Vanderbilt Institute of Global Health, Nashville, Tennessee, USA Contribution: Project administration (equal), Writing - review & editing (equal);8. Mbarara University of Science and Technology, Mbarara, Uganda Contribution: ?Investigation (equal), Writing - review & editing (equal);9. Mbarara University of Science and Technology, Mbarara, Uganda Oregon Health and Science University – Portland State University School of Public Health, Portland, Oregon, USA Contribution: ?Investigation (equal), Writing - review & editing (equal);10. Mbarara University of Science and Technology, Mbarara, Uganda Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Contribution: Funding acquisition (lead), ?Investigation (lead), Methodology (equal), Resources (lead), Supervision (equal), Writing - review & editing (lead) |
| Abstract: | ObjectivesThis study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health.MethodsData come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis.ResultsAmong 218 mother–child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership.ConclusionsMaternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families. |
| Keywords: | adverse childhood experiences child mental health depression mediation analysis Uganda |