The effect of adverse childhood experiences on depression prevalence in adolescent girls and young women over time: a secondary analysis of HPTN 068 trial data

Background: There is a high burden of adverse childhood experiences (ACEs) and depression in adolescent girls and young women (AGYW) in low- and middle-income countries (LMICs). Quantifying the impact of specific ACEs is critical to develop effective interventions to improve adolescent mental health. Methods: We used data on 2533 AGYW enrolled in the HPTN 068 study followed over five timepoints from 2011 to 2019. We measured six self-reported ACEs at baseline: double orphanhood, low guardian care, food insecurity, physical intimate partner violence (IPV), sexual violence, and school violence. We measured depression with the 20-item Centers for Epidemiologic Studies Depression scale. Using a marginal structural model to account for confounding and missing outcomes, we estimated the effect of each ACE on depression prevalence during follow-up. Results: Depression prevalence was highest at Year 1 [31.9% (30.0%, 33.8%)]. Multiple ACEs had a lasting significant effect on depression, including food insecurity [Year 5 prevalence difference (PD): 7.7% (3.1%, 12.3%)], physical IPV [Year 5 PD: 8.3% (1.6%, 14.9%)], joint physical IPV and sexual violence [Year 5 PD: 14.4% (3.6%, 25.3%), and school violence [Year 5 PD: 6.4% (0.5%, 12.3%)]. By Year 7, depression prevalence was lower [8.8% (7.8%, 9.8%)], and no ACE had a statistically significant effect. Discussion: ACEs have lasting effects on depression. A tailored approach to prevent ACEs and support AGYW who have experienced ACEs with appropriate depression and trauma informed interventions is warranted.