The relationship between childhood trauma, socioeconomic status, and maternal depression among pregnant women in a South African birth cohort study.

ABSTRACT

BACKGROUND: Maternal depression is an important cause of morbidity and mortality. Experiences of childhood trauma contribute to maternal depression, potentially causing adult socio-economic disparities in mental health. We investigate whether adult socioeconomic status (SES) mediates the relationship between childhood trauma and antenatal depression. METHODS: We analyzed data from two sociodemographically distinct peri-urban sites in the Western Cape, South Africa in a birth cohort study, the Drakenstein Child Health Study Mbekweni (N = 510) and TC Newman (N = 413). Data were collected from pregnant women between 28 and 32 weeks' gestation. RESULTS: Associations between trauma and depressive symptoms differed by site ( χ 2 =2163.6, df = 1419, p < 0.01); direct effects of trauma on depression were 0.24 mean increased symptoms in Mbekweni (p < 0.01) and 0.47 in TC Newman (p < 0.01). Trauma was differentially associated with SES (Mbekweni -0.10, p = 0.07; TC Newman -0.05, p = 0.37) and SES with depression (Mbekweni -0.18, p < 0.01; TC Newman -0.02, p = 0.62) across both sites. Indirect effects of trauma on depression through SES were 0.018 (95% C.I. -0.002-0.039) in Mbekweni and 0.001 (95% C.I. -0.004-0.006) in TC Newman, suggesting mediation was not supported. SES was a stronger indicator of depression risk in relatively poorer Mbekweni. CONCLUSION: Neighborhood-level effects and poverty are potentially important modifiers, and points of intervention, for maternal mental health outcomes.