ArticleBMJ open2022
Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Exposure to community violence and biomarkers of allostatic load: A systematic review and meta-analysis.Psychological bulletin · 2025Pooled it
- Comparing childhood, chronic, and recent adversity on internalizing symptoms and hypothalamic-pituitary-adrenal axis functioning.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2026Article
- Alcohol intake patterns, stress exposures and oral health in treatment seeking individuals with alcohol use disorder.Frontiers in oral health · 2026Article
- Effect of work schedule flexibility as a moderator in the relationship between job stress and wellbeing in pharmacy practice.Scientific reports · 2025Article
- Suicide and Self-Harming Among Young Women: A Qualitative Exploratory Study in Southern Punjab, Pakistan.Healthcare (Basel, Switzerland) · 2025Article
- Childhood trauma is associated with perceived stress and hair cortisol levels characterized by the BDNF Val66Met genotype and sex.Frontiers in psychiatry · 2025Article
- Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2022Article
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Authors and funding
9 authors at 6 institutions in 3 countries.
Funding
Abstract
objectivesAdverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan.
designThis study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum.
settingAll participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers.
participantsData were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol. PRIMARY AND SECONDARY OUTCOMES MEASURES: ACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables.
resultsAll models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production.
conclusionsAll four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.
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