Adverse childhood experiences, intimate partner violence, and postpartum depressive symptoms in a pregnancy cohort in Central Vietnam.

Adverse Childhood Experiences (ACEs), intimate partner violence (IPV), and maternal depression are prevalent globally. IPV mediates the association between ACEs and depressive symptoms. However, the effects of ACEs and IPV on postpartum depressive symptoms have primarily been examined using cross-sectional designs. This cohort study explored pathways linking ACEs, IPV during pregnancy (p-IPV), and postpartum IPV (IPV-12) with depressive symptoms at 6 and 12 months postpartum. This prospective cohort study recruited 942 pregnant women in their last trimester in Da Nang, Vietnam, and followed them up to 12 months postpartum. ACEs were assessed using the Adverse Childhood Experiences Questionnaire at baseline. IPV was measured using the Revised Conflict Tactics Scale during pregnancy (p-IPV) and 12 months postpartum (IPV-12). Postpartum depressive symptoms (PPDS) was assessed using the Patient Health Questionnaire-9 at 6 (PPDS-6) and 12 (PPDS-12) months postpartum. Mediation analysis using the Karlson-Holm-Breen method was performed to examine direct and indirect path coefficients. Loss to follow-up was 20.0% at 6 months (n = 753) and 15.3% at 12 months (n = 638). Mediation analysis indicated that ACEs influenced PPDS-12 (total path coefficient = 0.536). p-IPV, PPDS-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 PPDS-6 (7.77%) and p-IPV (5.93%). IPV types (psychological, physical, sexual) demonstrated significant mediating roles. Exposure to IPV is critical for the ACE-PPDS relationship. IPV exposure at 12 months postpartum may strongly mediate the cumulative relationship between adversity and violence exposure. Community-based ACE and IPV screening is recommended to identify risk for higher depressive symptoms in postpartum women.