Brief Report: Pathways From Childhood Abuse History to Adulthood Mental Health Among Women Living With HIV in Canada: Longitudinal Cohort Findings

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INTRODUCTION: Experiencing childhood abuse elevates risks for long-term mental health challenges (MHC); this complex relationship is underexplored among women with HIV. Informed by the 'chains of risk' life-course approach, we examined pathways from childhood abuse to mental health among women with HIV. METHODS: Using longitudinal data from the Canadian HIV Women's Sexual & Reproductive Health Cohort Study [CHIWOS], we examined associations between childhood abuse history (sexual, physical, verbal) and current poverty (income, food insecurity, housing insecurity) at time 1 (T1, August 2013-May 2015), substance use and past 3-month violence at time 2 (T2, June 2015-January 2017), and MHC (depression, PTSD, mental functioning) at time 3 (T3, February 2017-December 2018). We conducted path analysis to examine direct and indirect effects from childhood abuse to adult MHC via poverty, substance abuse, and violence. FINDINGS: Most (68%) participants with reported data (n=1,315) experienced childhood abuse. Childhood abuse was associated with adulthood poverty, violence, substance use, and MHC. T1 poverty was associated with T2 substance use and violence, and T3 MHC. Violence was associated with T3 MHC. The total standardized effect of childhood abuse on T3 MHC was 0.27 ( p <0.001). Half of this effect was indirect (β=0.13, p <0.001), with poverty accounting for 43% of the total indirect effect (β=0.06, p =0.003). CONCLUSIONS: Among women with HIV in Canada, childhood abuse was associated with poorer adulthood mental health; this association was mediated by poverty, violence, and substance use in adulthood. Findings emphasize the need for life-course approaches in women-centred violence and trauma-aware HIV care.

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