Impact of adverse childhood experiences on women’s psychosocial and HIV-related outcomes and early child development in their offspring

ABSTRACT

Adverse childhood experiences (ACEs) may have a critical influence on adult outcomes and subsequent offspring development, but few data have explored the effects of ACEs in low-resource settings where the burdens of childhood adversity and HIV are high. Among mothers living with HIV in Cape Town, we examined the effects of ACEs on maternal psychosocial and HIV-related outcomes, as well as early child development in their offspring aged 36–60 months. The World Health Organization’s Adverse Childhood Experiences International Questionnaire was used to measure maternal reports of ACEs, and the Ages & Stages Questionnaire to screen for developmental delays in their offspring. Among 353 women (median age: 32 years), 84% reported ≥1 ACEs. Increased report of ACEs was strongly associated with depressive symptoms, hazardous alcohol use, intimate partner violence and self-reported suboptimal adherence to antiretroviral therapy. These associations were driven by more severe childhood experiences, including abuse, neglect and exposure to collective violence. Among 255 women who reported on their child’s development, maternal ACEs were associated with poorer socioemotional development. These data suggest that childhood adversity has long-term effects on maternal outcomes as well as their children’s socioemotional development and point to ACEs that might be targeted for screening and intervention.

KEYWORDS:

• adverse childhood experiences
• mental health
• HIV
• early child development
• South Africa

Acknowledgements

The authors would like to thank the women who participated in this study, as well as the study staff, for their support of this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), grant numbers 1R01HD074558 and 1R01HD080465. Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation. Dr. Mellins is supported by a grant from the National Institute of Mental Health (NIMH) to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).