ABSTRACT:
INTRODUCTION Adverse Childhood Experiences (ACEs), Intimate partner violence (IPV), and Postpartum depression (PPD) represent notable concerns given their high prevalence and consequences globally. Notably, IPV partially and fully mediated the association of ACEs with depressive symptoms. This study used longitudinal data to explore the pathways linking ACEs, IPV during pregnancy (p-IPV), and postpartum IPV (IPV-12) with PPD at 6 and 12 months postpartum in central Vietnam. METHODS A prospective cohort study was conducted, recruiting 942 women in their last trimester of pregnancy in Da Nang, Vietnam, and following them up to 12 months postpartum. ACEs were assessed using the 10-item Adverse Childhood Experiences Questionnaire (ACE-Q) at baseline. IPV (psychological, physical, sexual) was measured using the Revised Conflict Tactics Scales (CTS2) during pregnancy (p-IPV) and at 12 months postpartum (IPV-12). PPD was assessed using the Patient Health Questionnaire-9 (PHQ-9) at 6 months (PPD-6) and 12 months (PPD-12) postpartum. Mediation analysis using the Karlson-Holm-Breen (KHB) method was performed to examine direct and indirect effects. RESULTS Loss to follow-up was 20.0% at 6 months (n=753) and another 15.3% at 12 months (n=638). Mediation analysis indicated that ACEs influenced PPD-12 (Total Effect = 0.536) and that p-IPV, PPD-6, and IPV-12 fully mediated this relationship, accounting for 85.44% of the total effect. IPV-12 was the strongest mediator (71.74%), followed by PPD-6 (7.77%) and p-IPV (5.93%). Types of IPV (psychological, physical, sexual) also demonstrated significant mediating roles. CONCLUSION This study suggests the critical role of exposure to IPV in the relationship between ACEs and PPD. Exposure to IPV at 12 months postpartum may act as a particularly potent mediator in the cumulative relationship of exposures to adversity and violence. Community-based screening for ACEs and IPV is recommended as an integral component of PPD prevention and treatment.