Adverse childhood experiences, resilience, and mental health referral following routine prenatal screening in Northern California.

Abstract

To evaluate whether adverse childhood experiences (ACEs) and resilience assessed during routine prenatal care were associated with same-day mental health referral. We conducted a retrospective cohort study of 52,527 pregnant individuals aged ≥18 years in Kaiser Permanente Northern California whose pregnancies began between January 1, 2022, and June 1, 2024, lasted ≥20 weeks, and included ACEs screening. All data were accessed via the electronic health record (EHR). ACEs were categorized as zero, one, two-three, or ≥ four; Road to Resilience scores as low (<15) or normal/high (≥15). The primary outcome was same-day EHR-documented referral; sensitivity analyses assessed referral within 14 days. Modified Poisson regression estimated adjusted prevalence ratios (aPRs) and confidence intervals (CIs), controlling for patient, clinician, and facility characteristics. Overall, 1.4% received same-day referral. Same-day referral increased with one ACE (aPR = 1.45, 95% CI:1.14,1.84), two-three ACEs (aPR = 2.08, 95% CI:1.67,2.59), and ≥ four ACEs (aPR = 3.39, 95% CI:2.78,4.13; p-trend<0.0001). Low resilience was also associated with referral (aPR = 2.28, 95% CI:1.93,2.68). ACE and resilience scores were associated with prenatal mental health referral even after adjusting for existing mental health risk factors.