Postpartum Depression and Anxiety: An Examination of Adverse Childhood Experiences, Discrimination, Material Hardship, and Social Support

Perinatal mental health (PMH) conditions are the most common complications of pregnancy and the first postpartum year. Adverse childhood experiences (ACEs) are increasingly recognized as important contributors to PMH, particularly postpartum depression and anxiety (PPD/A). This study examines a broad range of ACEs—including parental mental illness and substance use, incarceration, death, divorce, discrimination, economic hardship, and forced migration—to assess their influence on PPD/A. Using a modified explanatory sequential mixed-methods design, phase I included an online survey of racially, ethnically, and socioeconomically diverse U.S. women (n = 306) who delivered a live infant in the past year. Hierarchical regression showed that while ACEs initially predicted PPD/A, this association was no longer significant when social support, material hardship, and discrimination were added to the model. These current life circumstances emerged as stronger direct predictors of PPD/A than ACEs. In phase II, purposive and stratified sampling identified participants with ACE scores ≥ 4 for interviews (n = 22). Qualitative findings identified social support, financial security, work flexibility and choice, and time for self-care as central protective factors in adjustment to motherhood when these resources aligned with mothers’ individual needs and values. Results can inform clinical counseling, ACEs screening, and policies to strengthen PMH support.