Impact statement
Transitioning to motherhood can be stressful for first-time mothers, causing psychological problems such as emotional distress and dissatisfaction. Aside from being an abusive, neglectful and other traumatic experiences disrupting life outcomes, adverse childhood experiences (ACEs) are often a significant catalyst for emotional distress and dissatisfaction with motherhood. Providing support for first-time mothers in resource-limited populations requires understanding the intersection between ACEs and dissatisfaction with motherhood. This study provided empirically supported evidence that ACEs can cause emotional distress in first time mothers in low socioeconomic settings such as Nigeria. The effects of ACEs on dissatisfaction with motherhood are not independent but function through emotional distress. Moreover, early episodes of ACEs may affect mother–child emotional attachments (i.e., mothers’ emotional closeness to their children) and, in turn, contribute to first-time mothers’ dissatisfaction with motherhood. Therefore, trauma-informed interventions are essential for first-time mothers to navigate motherhood in Nigeria. Furthermore, consideration should be given to the gender of children, as mothers may feel dissatisfaction with motherhood differently depending on their children’s gender as a result of their ACEs.
Introduction
The process of becoming a mother can be challenging and introduce psychological, behavioral and developmental problems for first-time mothers. Becoming a mother involves moving from a familiar, known world to an unfamiliar, unknown world, where a mother develops a new identity, which includes navigating pregnancy, assuming a new role, bonding with the new child and learning how to be a mother (Mercer, Reference Mercer2004, Reference Mercer2006). Numerous psychosocial and health vulnerabilities prevalent during these periods include postpartum depression, preterm birth, pregnancy complications and poor infant development (Spinelli et al., Reference Spinelli, Frigerio, Montali, Fasolo, Spada and Mangili2016). In addition, socioeconomic strains, problematic emotional adjustments, caring for a child, lack of social support and insufficient health services could contribute to this challenging transition and promote dissatisfaction with motherhood (Erfina et al., Reference Erfina, Widyawati, McKenna, Reisenhofer and Ismail2019). Consequently, these cumulative and proximal disadvantages could cause new mothers to become dissatisfied with their role. Dissatisfaction with motherhood involves frustration, difficulties and overwhelming feelings of inadequacy to function as a mother (Cronin-Fisher and Parcell, Reference Cronin-Fisher and Parcell2019).
There is growing research aiming to address the complexities associated with dissatisfaction with motherhood to facilitate a safe and effective process of motherhood (e.g., Wu and MacNeill, Reference Wu and MacNeill2002; Mott et al., Reference Mott, Schiller, Richards, O’Hara and Stuart2011; De Genna et al., Reference De Genna, Cornelius, Goldschmidt and Day2015; Akbarian et al., Reference Akbarian, Kohan, Nasiri and Ehsanpour2018). However, many aspects of distal factors, such as the developmental trajectory of first-time mothers, that is, adverse childhood experiences (ACEs), remain poorly understood among mothers in under-resourced regions such as Nigeria. As a consequence of parental, caregiver, family or community members’ actions and attitudes, children under 18 are exposed to ACEs such as neglect, physical abuse, sexual abuse, psychological abuse, criminality and violence (Dube et al., Reference Dube, Felitti, Dong, Giles and Anda2003; Akintunde et al., Reference Akintunde, Isangha, Iwuagwu and Adedeji2023). Research on these complex ACEs among first-time mothers in Nigeria is rare, which warrants further study. It is also imperative that the difficulties associated with dissatisfaction with their motherhood experiences are further investigated to support global evidence, particularly in highly diverse cultures like Nigeria.
Research into ACE prevalence among women in Nigeria is limited. However, evidence indicates that about 31.2% of Nigerians have experienced two or more types of ACEs and that most of these ACEs are associated with mental health difficulties (Oladeji et al., Reference Oladeji, Makanjuola and Gureje2010). There are also similarities based on the gender experience of ACEs in Nigeria’s young population aged 10–24 (Olusimbo et al., Reference Olusimbo, Olayinka and Ayodeji2012). Nigeria’s regressing socioeconomic situation and stagnant economic growth have made it one of the world’s poverty hubs (Isangha et al., Reference Isangha, Akintunde, Cherry Hau Lin and Wai Man Choi2023a). Issues like socioeconomic and family limitations in Nigeria pose significant risks to the prevalence of ACEs. Nigeria lacks an adequate child protection framework, contributing to children’s exposure to adversity and necessitating urgent policy intervention (Isangha et al., Reference Isangha, Akintunde, Choi and Lin2023b). Recent reports from the Centers for Disease Control and Prevention suggest socioeconomic conditions catalyze ACE exposures (CDC, 2019, 2022). Socioeconomic disadvantages have been linked to both dysfunctional behavior within families (Bhatti, Reference Bhatti2011; Pereira et al., Reference Pereira, Negrão, Soares and Mesman2015) as well as violent behavior caused by frustrations (Wight et al., Reference Wight, Botticello and Aneshensel2006). The socioeconomic constraints within Nigerian families may further expose girl-children to ACEs capable of disrupting their later life experiences. Accordingly, first-time mothers from socioeconomically disadvantaged families in Nigeria may be exposed to ACEs and later experience emotional and behavioral problems chanelling dissatisfaction with motherhood.
In addition, global research indicates that ACEs could promote psychological problems in adulthood, necessitating further investigation of their influence on first-time mothers (Anastas et al., Reference Anastas, Payne and Ghuman2021; Shin et al., Reference Shin, Tomlinson, Nelson-Hence and Ksinan Jiskrova2022). It is also unclear whether child gender plays a role in dissatisfaction with motherhood. To fill this research gap, this study examined among first-time mothers utilizing primary healthcare services in Nigeria how ACEs may be associated with emotional distress, child emotional closeness and dissatisfaction with motherhood. Further, the study examined whether emotional distress and child emotional closeness have a sequential mediation effect on the association between ACEs and dissatisfaction with motherhood.
ACEs and dissatisfaction with motherhood
Developmental trauma theory emphasizes the lifelong effects of complex and traumatic experiences on individuals’ life outcomes (Nurius et al., Reference Nurius, Green, Logan-Greene and Borja2015). These traumatic experiences can occur in relationships and distort the formation of new ones (Yoder et al., Reference Yoder, Grady and Dillard2019). Negative developmental experiences such as ACEs may disrupt and impair many aspects of life outcomes, including role attainment and maternal competence needed to excel in a new role (Bailey et al., Reference Bailey, DeOliveira, Wolfe, Evans and Hartwick2012; Muzik et al., Reference Muzik, Ads, Bonham, Lisa Rosenblum, Broderick and Kirk2013). The process of acquiring competence and integrating maternal behavior is particularly challenging for mothers who have a history of ACEs (Ochoa et al., Reference Ochoa, Fernandez, Lee, Estrada and Prado2022). Inaddition, traumatic experiences pose challenges to developing self-identity for motherhood, making first-time mothers face difficulties adapting and approaching their new role with trepidation (Mercer, Reference Mercer2004, Reference Mercer2006). Self-efficacy theories reinforce these perspectives by emphasizing the importance of self-identity for fulfilling specific roles and responsibilities in motherhood (Coleman et al., Reference Coleman, Karraker, Coleman and Karraker2000). Mothers are expected to develop efficacy and competence in fulfilling expected obligations and performing maternal roles (Darvill et al., Reference Darvill, Skirton and Farrand2010). Traumatic childhood may hinder the development of motherhood identities among first-time mothers (Mercer, Reference Mercer2004). Thus, ACEs may adversely affect first-time mothers’ self-efficacy and increase their dissatisfaction with motherhood.
ACEs and emotional distress
Life course theory describes the risk of developing emotional and behavioral difficulties as an adult as a consequence of trauma experienced during childhood (Chapman et al., Reference Chapman, Whitfield, Felitti, Dube, Edwards and Anda2004; Akintunde et al., Reference Akintunde, Isangha, Iwuagwu and Adedeji2023). Studies have consistently demonstrated a link between ACEs and psychological problems in mothers (Chapman et al., Reference Chapman, Whitfield, Felitti, Dube, Edwards and Anda2004; Strine et al., Reference Strine, Edwards, Dube, Wagenfeld, Dhingra, Prehn, Rasmussen, McKnight-Eily and Croft2012). Scholarships on life course examines the pathways and mechanisms involved in human development, experiences and processes (Elder and Shanahan, Reference Elder and Shanahan2007; Mayer, Reference Mayer2009). These empirical arguements are based on how personal and social backgrounds, family context influences life course outcomes (Elder, Reference Elder1998; Mayer, Reference Mayer2009). For instance, early childhood experiences may influence how individuals develop relationships,adopt and adapt to new roles (Macmillan, Reference Macmillan2005). Individuals raised in dysfunctional, abusive or neglectful environments are likely to experience chronic stress as part of their transition process, resulting in emotional difficulties (McLaughlin et al., Reference McLaughlin, DeCross, Jovanovic and Tottenham2019). When ACE-affected children become parents, they may experience emotional problems (Cooke et al., Reference Cooke, Racine, Plamondon, Tough and Madigan2019; Grasso et al., Reference Grasso, Drury, Briggs-Gowan, Johnson, Ford, Lapidus, Scranton, Abreu and Covault2020).
Furthermore, problematic attachments during childhood may influence later-life attachments in relationship types, such as mother–child relationships (Moe et al., Reference Moe, Fredriksen, Kjellevold, Dahl, Markhus, Stormark, von Soest, Olafsen, Vannebo and Smith2019; Karakaş et al., Reference Karakaş, Sarı, Aksakal, Özdemir and Dağlı2021). According to attachment theories, a child’s relationship with their caregiver (i.e., parents) shapes their emotional patterns and may influence their ability to develop emotional stability later in life (Karakaş et al., Reference Karakaş, Sarı, Aksakal, Özdemir and Dağlı2021), including positive emotions as mothers. However, when these mothers’ childhood experiences are marked by adversity, positive attachments are impaired, resulting in psychological instability that may persist into motherhood (Khan and Renk, Reference Khan and Renk2019). First-time mothers may experience emotional instability due to the complex process of coping with childhood adversity, mainly if they are unable to recover from their negative childhood attachments. Consequently, mothers with ACE histories may experience emotional distress during and after becoming mothers.
Emotional distress and dissatisfaction with motherhood
Becoming a mother is multifaceted and involves several separate yet interconnected adjustments necessary for a successful transition. Many empirical studies have documented how pregnancy periods channel emotional problems (Darvill et al., Reference Darvill, Skirton and Farrand2010; Abdollahi et al., Reference Abdollahi, Lye and Zarghami2016; Costa et al., Reference Costa, Castanheira, Moreira, Correia, Ribeiro and Graça Pereira2020; Reuveni et al., Reference Reuveni, Lauria, Monk and Werner2021). Postpartum theory supports psychological problems associated with becoming a mother, suggesting that some psychosocial and biological factors may increase the risk of developing emotional difficulties during pregnancy and following childbirth (Stewart and Vigod, Reference Stewart and Vigod2019). The process of becoming a mother is made more challenging by factors such as sleep deprivation, stress, hormone changes and the recovery processes associated with childbirth (Mott et al., Reference Mott, Schiller, Richards, O’Hara and Stuart2011). Unresolved emotional problems may exacerbate incompetence and dissatisfaction with motherhood.
Three aspects of becoming a mother reflect the experiences of first-time mothers: adult experiences, child experiences and emotional closeness to their child. In contrast to “emotional closeness” to a child, which reflects a more positive attitude toward becoming a mother, the experiences of first-time mothers with their child and as adults reflect problematic or negative experiences, that is, dissatisfaction. Social expectations may compound the emotional burden and transitional process associated with motherhood (Schmidt et al., Reference Schmidt, Décieux, Zartler and Schnor2023). Specifically, social expectations raise concerns regarding unrealistic social demands, judgment and pressure to perform in a role, contributing to feelings of inadequacy and incompetence (Correll and Ridgeway, Reference Correll, Ridgeway and Delamater2006). Moreover, societal norms and expectations may not correspond with individual circumstances and preferences, leading to pressure to excel as mothers, which can make fulfilling multiple roles overwhelming and exhausting. In response to these pressures, some mothers may develop mental imbalances where they doubt their ability to be mothers. Thus, emotional distress may negate the process of becoming a mother.
Indirect pathways from ACEs to dissatisfaction with motherhood
First-time mothers’ emotional distress may act as a bridge between ACEs and their dissatisfaction with motherhood based on the formation of psychopathologies. According to cumulative trauma theories, multiple typologies of negative childhood incidences may lead to future cognitive impairments and deficits in executive function, that is, motherhood roles (Martin et al., Reference Martin, DePrince, Cromer and Freyd2013). There is a risk that first-time mothers may experience emotional distress as a result of ACEs, which may lead to life-long maladaptive emotions (Garofalo et al., Reference Garofalo, Booth-LaForce, Nurius, Thompson, Calhoun, Shimomaeda and Lengua2023). When accumulated trauma results in maladaptive emotions (Leite Ongilio et al., Reference Leite Ongilio, Gaspardo and Linhares2022), it can contribute to dissatisfaction with maternal roles due to the inability to effectively manage motherhood emotional demands.
Studies investigating the pathway from ACEs to dissatisfaction with motherhood are limited and mainly focus on Western contexts (Cronin-Fisher and Parcell, Reference Cronin-Fisher and Parcell2019; Goebel et al., Reference Goebel, Stuhrmann, Barkmann, Schulte-Markwort and Mudra2020). In response to ACEs, first-time mothers may experience difficulty transitioning from these experiences and develop serious mental health issues. The presence of ACEs is associated with a higher risk of perinatal mental health problems (Alvarez-Segura et al., Reference Alvarez-Segura, Garcia-Esteve, Torres, Plaza, Imaz, Hermida-Barros, San and Burtchen2014), and these issues may persist into motherhood periods when not addressed. Moreover, ACEs can influence individuals’ sensitivity to stressful situations, impair emotional regulation and adversely affect first-time mothers (Trinidad, Reference Trinidad2021; Rassart et al., Reference Rassart, Paradis, Bergeron and Godbout2022). First-time mothers may experience mental problems associated with ACEs, impairing their perceptions of their competence and readiness for motherhood.
However, adversity response perspectives suggest that individuals may respond differently to adversity based on their level of emotional resources (Pomerantz and Rudolph, Reference Pomerantz and Rudolph2003; Muldoon et al., Reference Muldoon, Haslam, Haslam, Cruwys, Kearns and Jetten2019). These perspectives are reflected in trauma and coping scholarship, suggesting that people who have experienced adversity may adopt unhealthy coping mechanisms by overcompensating emotional burden from childhood manifesting as emotional distress and subsequently affect relational responses (Bloom, Reference Bloom1999; Nurius et al., Reference Nurius, Green, Logan-Greene and Borja2015). Alternatively, individuals may learn and adopt effective coping strategies to deal with the emotional consequences of childhood experiences (Jenzer et al., Reference Jenzer, Meisel, Blayney, Colder and Read2020). The ability to successfully manage childhood trauma could contribute to the development of a healthy relationship between mother and child i.e, child emotional closeness (Hampton-Anderson et al., Reference Hampton-Anderson, Carter, Fani, Gillespie, Henry, Holmes, Lamis, LoParo, Maples-Keller, Powers, Sonu and Kaslow2021), which may help protective psychosocial resources to help alleviate the dissatisfaction associated with motherhood for first-time mothers. Some first-time mothers could develop an emotional connection with their child, positively influencing their transitioning process. Nevertheless, these perspectives have not yet been empirically supported among first-time mothers in Nigeria. This study examined the indirect pathways from ACEs to dissatisfaction with motherhood through emotional distress and child emotional closeness using data from first-time mothers in Nigeria.
Current study
The study contributes to the understanding of how ACEs directly relate to emotional distress and dissatisfaction with motherhood among first-time mothers. Further, the study examined indirect pathways from ACEs to dissatisfaction with motherhood through emotional distress and child emotional closeness. The study also examined whether there are any differences in outcomes based on the gender of children of first-time mothers to provide population-specific interventions.
There is extensive discussion in traditional gender theories regarding the role that gender plays in decision-making and behavior across cultures and nationalities, particularly in Africa (Olatunji, Reference Olatunji2013; Olonade et al., Reference Olonade, Oyibode, Idowu, George, Iwelumor, Ozoya, Egharevba and Adetunde2021). Patriarchal norms and gender roles perpetuated by patriarchal institutions favor male children (Sylvia, Reference Sylvia1989; Church et al., Reference Church, Ibitoye, Chettri and Casterline2023; Ibrahim et al., Reference Ibrahim, Ahmad, Opowoye, Omole, Umar, Usman, Gobir and Sufiyah2023). A high priority is given to continuing a family lineage through male children in Nigeria (Church et al., Reference Church, Ibitoye, Chettri and Casterline2023). Women have traditionally been assigned the role of household and caregiving (Ibrahim et al., Reference Ibrahim, Ahmad, Opowoye, Omole, Umar, Usman, Gobir and Sufiyah2023), while men have traditionally been assigned the role of breadwinner (Mensah, Reference Mensah2023). Consequently, it is believed that having a male child will ensure the family’s economic stability and support, especially if the male child is expected to care for their aging parents and sustain family lineage.
Additionally, filial piety and male dominance perspectives emphasize the importance of sons fulfilling their filial responsibilities, including caring for their aging parents (Yeh and Bedford, Reference Yeh and Bedford2003). It is common for families to view their son as a symbol of honor, prestige and reputation. The fulfillment of filial duties by sons is also considered positive for the family and its status within society. First-time mothers may be better prepared to approach motherhood if they expect their firstborn to be male (Chappell and Kusch, Reference Chappell and Kusch2007). Due to these expectations, emotional connections may develop, which may help buffer the effects of ACEs on motherhood. Therefore, the model examined whether there are differences in outcomes based on child gender.
Methods
Study design, population and data collection
This study adopted a cross-sectional research design to recruit first-time mothers attending primary healthcare centers across two states in Nigeria (i.e., Oyo and Akwa Ibom). First-time mothers utilize primary healthcare centers for prenatal and postnatal consultations and treatments. Trained research assistants implemented the research survey between July 1 and August 30, 2022. Data were collected during scheduled immunization in partnership with the primary healthcare centers. The survey personnel partnered with primary healthcare center workers to administer the questionnaires during scheduled immunization and wellness visits. All research participants were invited for voluntary participation and further screened for eligibility. A total of 445 first-time mothers were recruited to participate in the survey. To be eligible for participation, mothers must be first-time mothers, have visited the primary healthcare centers for wellness and immunization consultation for a child, and be the child’s biological mother.
Measures
Outcome variables
Dissatisfaction with motherhood: The measure of dissatisfaction with motherhood was developed by Matthey (Reference Matthey2011) from the Becoming a Mother scale, which includes 13 items. However, 11 items from these questions examined negative child experiences and adult experiences. The child and adult experiences were captured negatively to indicate adverse experiences of dissatisfaction with motherhood. The adult experiences include six items questions such as “I have felt isolated/lonely”, “I have felt bored”, “I have felt unsupported”, I have missed the life I had before I became pregnant……” which were fitted on a five-point Likert Scales (1. Strongly Disagree – 5. Strongly Agree). Child experiences question include five items that address feelings toward a child, such as “I have felt guilty”, I have felt nervous or uneasy around my baby, I am not as good as other mothers, I have found it hard to cope with my baby” also fitted on a five-point Likert scale (1. Strongly Disagree – 5. Strongly Agree). Both adult and child experiences were explicitly captured as problematic processes reflecting “dissatisfaction with motherhood.” Adults and child experiences were scored independently and fitted into the structural model as latent variables. Information on the reliability and validity is detailed in Tables 4 and 5.
Child emotional closeness: Child emotional closeness reflects mothers’ emotional connection with the child, showing a positive motherhood experience (Matthey, Reference Matthey2011). First-time mothers’ child emotional closeness was captured on a two-item, five-point Likert scale (1. Strongly Disagree – 5. Strongly Agree) to reflect a positive aspect of becoming a mother. These two questions were asked thus, “I have felt confident about looking after my baby” and “I have felt close to my baby. Information relating to the reliability and validity of the measuring instruments are shown in Tables 4 and 5.
Predictors
ACEs: First-time mothers’ ACEs comprise questions relating to mothers’ historical experiences of adversity. Questions that were asked mothers focused on their experiences before they were 18 years old. The internationally revised inventory guided the validated ACE scale (Finkelhor et al., Reference Finkelhor, Shattuck, Turner and Hamby2015). This study adopted 13-item adversity questions probed on past incidences of emotional neglect, sexual violation, violent treatment, an intergenerational manifestation of mental illness, family member substance abuse and other indicators. Item 14 was omitted from the analysis due to non-response among the participants (item 14 addressed issues around government financial support for low-income families). A higher score value is an indication of an adverse experience. These questions were dichotomous, with 0 = No and 1 = Yes. ACEs were treated as an observed variable by scoring the item questions, which showed good reliability (0.75). Information relating to the reliability and validity of the measuring instruments are shown in Tables 4 and 5.
Mediating variables
Emotional Distress: Emotional distress examined multiple facets of psychological problems in first-time mothers, such as somatization, depression and anxiety. These subscales of emotional distress were captured from brief symptom inventory 18 (BSI-18) (Franke et al., Reference Franke, Jaeger, Glaesmer, Barkmann, Petrowski and Braehler2017; Li et al., Reference Li, Wang, Shou, Zhong, Ren, Zhang and Yang2018). Depression subscale includes six items measured on a five-point Likert scale from 1 (not at all) to 5 (very much) to questions examining feeling no interest in things, feeling blue, feeling worthless, feeling hopeless about the future and suicidal thoughts. Somatization subscale measured psychopathological symptoms containing six items on a five-point Likert scale from 1 (not at all) to 5 (very much), examining symptoms such as nausea, pains in chest, trouble breathing, numbness and feeling weak. Anxiety subscale six items on a five-point Likert scale from 1 (not at all) to 5 (very much) that ask questions relating to “feeling fearful”, “spells of panic”, “suddenly scared” and “feeling tensed”. The reliability and validity of the emotional distress are shown in Tables 4 and 5.
Control variables
First-time mothers’ sociodemographic variables, such as age, income and child’s age, were controlled for in the analysis based on the ability to attain desire factor loading to maximize the output of the path analysis. Details of the control variables are shown in Table 4.
Analysis plan
Descriptive analysis of the study population was performed using SPSS ver. 25. Partial least-square (PLS) method of structural equation modeling (SEM) was applied to evaluate the interrelationships among variables and paths (Hair Jr et al., Reference Hair, Matthews, Matthews and Sarstedt2017). Indicators such as Cronbach alpha (α), average variance explained (AVE), variance inflated factors (VIFs) and composite reliability (dos Santos and Cirillo, Reference dos Santos and Cirillo2023; Furr and Bacharach, Reference Furr and Bacharach2014; Hair Jr et al., Reference Hair, Matthews, Matthews and Sarstedt2017), were used to determine whether all instruments were valid and reliable. Table 4 contains information on composite reliability, factor loadings and AVE. Factor loading analysis evaluates the reliability of the corresponding construct for each item (Van Voorhees et al., Reference Van Voorhees, Wagner, Beckham, Bradford, Neal, Penk and Elbogen2018). Based on the recommendation, factor loadings should be accepted if ≥0.5 and loadings less than 0.5 were deleted (Hu and Bentler, Reference Hu and Bentler1999; Dash and Paul, Reference Dash and Paul2021). Further, the ratio between between-trait and within-trait correlations was examined (Hair et al., Reference Hair, Ringle and Sarstedt2013), to test the discriminant validity and the heterotrait-monotrait (HTMT) ratio. The HTMT for each construct is lower than 0.90, indicating the predictors have no multicollinearity. The constructs were generally robust and reliable due to the absence of VIFs greater than five, as shown in Table 5, which indicates the variables are discriminatory (Hsieh et al., Reference Hsieh, Lavori, Cohen and Feussner2003; Marcoulides and Raykov, Reference Marcoulides and Raykov2019). Multigroup analysis was conducted based on child gender by analyzing invariance between male and female children of first-time mothers. Multigroup analyses (MGA) allow examination of whether pre-defined data groups differ significantly in their group-specific parameter estimates (e.g., outer weights, outer loadings and path coefficients) (Chin, Reference Chin1998; Vinzi et al., Reference Vinzi, Chin, Henseler and Wang2010). Smart PLS 4.0 was used to analyze the measurements and structural model. Further, a bootstrapping approach was employed to examine the indirect pathways by resampling the data using 5,000 random samples to assess the statistical significance of indirect effects (Dziak et al., Reference Dziak, Lanza and Tan2014; Abu-Bader and Jones, Reference Abu-Bader and Jones2021).
Result
Sociodemographic and sociodemographic attributes of mother–child dyads (n = 445) are reported in Table 1. The age of children reported in years ranges between ≤1 and 5, with 58% males and 42% females.
Table 1. Descriptive statistics
ACEs by items and prevalence
Table 2 provides information on the prevalence of ACEs in the population of first-time mothers by number of exposures. The findings show that 16.2% had no history of ACEs. However, 42.9% had experienced one to three typologies of ACEs. In addition, 40.9% of the population had experienced ≥4 types of ACEs.
Table 2. ACEs prevalence by number of exposures
Figure 1 provides information on item response based on ACEs among the recruited population. The lowers forms of ACEs are those relating to the experiences of criminality in the family (item 10).
Figure 1. Adverse childhood experiences (ACEs) by items.
The psychometric properties of the variables are presented in Table 3 based on the gender of the children and the total population. Results indicate that the constructs are not significantly different by child gender.
Table 3. Psychometric properties based on child gender
Factor loadings, composite reliability, VIF and average variance extracted
The factor loadings, composite reliability, VIF (multicollinearity analysis) and average variance extracted are reported in Table 4. The factor loadings range from 0.593 to 0.939 and are within the threshold for accepting that the items reflect the variables intended to be measured. The Cronbach alpha estimation was also robust for accepting the reliability of the variables. Composite reliability of the latent variables was ensured through the value of rho_c, as shown in Table 4. None of the average variance extracted is less than the 0.5 thresholds except for the sociodemographic attributes controlled for in the SEM. The analysis verifying the absence of multicollinearity (VIF) indicated that the variables did not violate associated assumptions. Consequently, all criteria were met to compute the structural equation models to examine the hypothesis presented in the study.
Table 4. Factor loadings, composite reliability, VIF and average variance extracted
Abbreviations: AVE, average variance extracted; CR, composite reliability; VIF, variance inflated factors.
The HTMT ratio in Table 5 examined the ratio of between-trait correlation, which requires that all correlations should be less than 0.90 before accepting that there is distinctiveness across all the variables examined.
Table 5. Discriminant validity – eterotrait-monotrait (HTMT) ratio – matrix
The hypothesis was tested, and the result is shown in the path analysis in Table 6 and Figure 2. ACEs are positive predictors of dissatisfaction with motherhood (
$ \beta $
= 0.092; p < 0.01) and emotional distress (
$ \beta $
= 0.367; p < 0.001). In addition, there is an inverse association between ACEs and child emotional closeness (
$ \beta $
= − 0.335; p < 0.001). First-time mothers’ emotional distress is a positive predictor of dissatisfaction with motherhood (
$ \beta $
= 0.728; p < 0.001). Child emotional closeness has an inverse association with dissatisfaction with motherhood (
$ \beta $
= − 0.132; p < 0.001). First-time mothers’ socioeconomic attributes are negatively associated with child emotional closeness (
$ \beta $
= −0.287; p < 0.001). Based on the model, the explanatory power of the model in explaining the emotional distress = 13.5%, child emotional closeness = 19% and dissatisfaction with motherhood = 63.8%.
Table 6. Path analysis
Note: *p < 0.05, **p < 0.01, ***p < 0.001.
Abbreviations: SD, standard deviation; SES, socioeconomic status.
Figure 2. Path analysis.
Table 7 presents the result of the indirect path analysis on how ACEs can indirectly influence dissatisfaction with motherhood through emotional distress and emotional closeness. As an extension, the result highlights if there is a serial effect of emotional distress and child emotional closeness in the association between ACEs and dissatisfaction with motherhood, that is, (i) the indirect pathway from ACEs to dissatisfaction with motherhood through child emotional closeness is significant (
$ \beta $
= 0.044; 95% CI (0.025, 0.066); p < 0.001); (ii) the indirect pathway from ACEs to dissatisfaction with motherhood through emotional distress is significant (
$ \beta $
= 0.267; 95% CI (0.213, 0.323); p < 0.001). However, (iii) the serial pathway from ACEs to dissatisfaction with motherhood through emotional distress and child emotional closeness is insignificant (
$ \beta $
= 0.000; 95% CI (−0.005, 0.003); p = 0.428).
Table 7. Indirect path analysis
Note: *p < 0.05, **p < 0.01, ***p < 0.001.
Child gender outcomes
According to the child gender analysis in Table 8, ACEs are significant predictors of dissatisfaction with motherhood among first-time mothers of girls (
$ \beta $
= 0.159; p < 0.01). However, this association is not significant for first-time mothers of boys. The findings further should show some notable differences in effect size between males and females. There is an inverse relationship between ACEs and child emotional closeness for girl children (
$ \beta $
= − 0.272; p < 0.001) and male children (
$ \beta $
= − 0.391; p < 0.001). Similarly, ACEs are positive predictors for mothers of male (
$ \beta $
= 0.352; p < 0.001) and female children (
$ \beta $
= 0.396; p < 0.001). Child emotional closeness has an inverse effect on dissatisfaction with motherhood of girls (
$ \beta $
= − 0.194; p < 0.001) and boy children (
$ \beta $
= − 0.095; p < 0.01). The distinct difference in child gender analysis is the effects of ACEs on dissatisfaction with motherhood based on child gender.
Table 8. Child gender outcome
Note: *p < 0.05, **p < 0.01, ***p < 0.001.
Discussion
This study examined how ACEs may be associated with emotional distress, child emotional closeness and dissatisfaction with motherhood among first-time mothers utilizing primary healthcare services in Nigeria. The study also examined the serial mediation effects of emotional distress and emotional closeness on ACEs and dissatisfaction with motherhood. Extending empirical evidence on the association of ACEs, emotional distress and motherhood dissatisfaction among first-time mothers in Nigeria is imperative to support the transition to motherhood in the region. Given that there is no clear evidence of gender prevalence and specific adverse later-life outcomes of first-time mothers in Nigeria, this study becomes timely and relevant to support first-time mothers (Olusimbo et al., Reference Olusimbo, Olayinka and Ayodeji2012). Existing studies of ACEs in Nigeria highlight their fatalistic mental health effects among different subpopulations but failed to examine these issues among first-time mothers (Oladeji et al., Reference Oladeji, Makanjuola and Gureje2010; Olusimbo et al., Reference Olusimbo, Olayinka and Ayodeji2012). Moreover, the socioeconomic limitations of Nigeria highlight vital problems that must be addressed to provide tailored support to young women to support their process of becoming mothers (CDC, 2019, 2022; Isangha et al., Reference Isangha, Akintunde, Cherry Hau Lin and Wai Man Choi2023a).
This study findings suggests that first-time mothers’ ACEs are associated with dissatisfaction with motherhood. According to previous research, women who have experienced negative developmental experiences may experience disruptions in their self-identity, self-efficacy and competence as mothers, as well as doubts concerning their ability to fulfill their role as new mothers (Bailey et al., Reference Bailey, DeOliveira, Wolfe, Evans and Hartwick2012; Muzik et al., Reference Muzik, Ads, Bonham, Lisa Rosenblum, Broderick and Kirk2013). Evidence from this study supports those from Germany that mothers who receive less recalled care from their own mothers are more likely to report being dissatisfied with motherhood (Goebel et al., Reference Goebel, Stuhrmann, Barkmann, Schulte-Markwort and Mudra2020). Further findings in this study suggest that first-time mothers’ ACEs are inversely associated with emotional closeness to their children. This finding indicates that first-time mothers’ early traumatic events may prevent them from having meaningful emotional connection with their children. Further, a positive association was observed between first-time mothers’ ACEs and emotional distress. Based on existing evidence, mothers with ACE histories might experience emotional dysfunction as adults and mothers (Costa et al., Reference Costa, Castanheira, Moreira, Correia, Ribeiro and Graça Pereira2020). Moreover, this finding is similar among mothers with low socioeconomic backgrounds in the United States (Garofalo et al., Reference Garofalo, Booth-LaForce, Nurius, Thompson, Calhoun, Shimomaeda and Lengua2023). On a more positive note, this study finds that mothers who are emotionally connected to their children are less likely to be dissatisfied with motherhood.
The study indicates that emotional distress is a significant factor in dissatisfaction with motherhood among first-time mothers. This finding is consistent with research evidence showing that psychological burdens could make the motherhood process more challenging, resulting in feelings of incompetence (Mott et al., Reference Mott, Schiller, Richards, O’Hara and Stuart2011; Schmied et al., Reference Schmied, Johnson, Naidoo, Austin, Matthey, Kemp, Mills, Meade and Yeo2013). Nevertheless, according to the study findings, the direct path from emotional distress to child emotional closeness among these first-time mothers is not significant, suggesting that mental burden does not significantly affect the emotional connection between these first-time mothers and their children. Moreover, first-time mothers who experienced greater emotional closeness to their children were less likely to be dissatisfied with motherhood. First-time mothers’ emotional closeness to their children was negatively affected by ACEs. According to these findings, socioeconomic limitations may adversely affect first-time mothers’ emotional closeness to their children.
Through emotional distress mechanisms, ACEs are indirectly linked to dissatisfaction with motherhood. Based on these findings, the study confirmed that first-time mothers’ ACEs significantly contributed to emotional distress, which in turn contributed to increased dissatisfaction with motherhood among first-time mothers. Several factors can cause psychological deficits during motherhood, including cumulative trauma from childhood (Martin et al., Reference Martin, DePrince, Cromer and Freyd2013). Some first-time mothers may experience adverse mental responses to ACEs, resulting in problems developing competence for their new maternal role (Pomerantz and Rudolph, Reference Pomerantz and Rudolph2003; Muldoon et al., Reference Muldoon, Haslam, Haslam, Cruwys, Kearns and Jetten2019). The evidence indicates that trauma and coping perspectives are reinforced, suggesting individuals who have been subjected to adversity may adopt unhealthy coping mechanisms that manifest in emotional distress and adversely affect their ability to build motherhood competences (Bloom, Reference Bloom1999).
An indirect relationship was found between first-time mother ACEs and dissatisfaction with motherhood, mediated by child emotional connection, which channeled the dampening effect of ACEs on dissatisfaction with motherhood. This evidence supports the understanding that despite the positive attributes of the emotional closeness of first-time mothers to their children, this closeness may not be protective to cushion the negative effect of childhood adversity and subsequently lead to dissatisfaction with motherhood. This study reinforces the detrimental impact of ACEs on mother–child bonding and emotional connection.
In addition, there was no support for a serial mediating effect of first-time mothers’ emotional distress and child emotional closeness on ACEs and dissatisfaction with motherhood. First-time mothers’ emotional closeness to their children did not cushion the emotional distress caused by ACEs, which in turn did not influence dissatisfaction with motherhood. Research interventions are needed to examine other psychosocial factors that may cause a chain effect to eliminate dissatisfaction with motherhood among first-time mothers. Given this evidence, the model explained 13.5% of the variance in first-time mothers’ emotional distress and 19% in emotional closeness. Approximately 63.8% of the variance in dissatisfaction with motherhood of first-time mothers was explained in this study, which indicated that support for these groups of mothers should pay attention to these indicators.
Based on the study assumptions that child gender may influence the effects of ACEs on the study outcomes, only one path differs significantly in the outcome based on child gender. There is a significant difference in the path from first-time mothers’ ACEs to dissatisfaction with motherhood between male and female children. According to the study, ACEs are a significant predictor of dissatisfaction with motherhood for first-time mothers of female children. Conversely, there was no association between first-time mothers of male children’s ACEs and dissatisfaction with motherhood. The evidence demonstrates the importance of gender in first-time mothers’ behavior in Nigeria, which reinforces perspectives on patriarchal institutions and a preference for male children (Sylvia, Reference Sylvia1989; Olatunji, Reference Olatunji2013). Therefore, having a male child indicates that first-time mothers may not experience dissatisfaction with motherhood regardless of their ACEs history. This evidence supports filial piety perspectives emphasizing male-child preference based on family responsibility in the future (Yeh and Bedford, Reference Yeh and Bedford2003). The motivation that a male child would bring honor to the mother and family may explain why mothers’ ACEs may not be associated with dissatisfaction with motherhood (Chappell and Kusch, Reference Chappell and Kusch2007). Accordingly, this evidence emphasizes the disadvantages of girl children in Nigeria since their mothers are more likely to suffer from dissatisfaction with motherhood resulting from ACEs and create a negative cycle of adversity.
Despite the significance and empirical contribution of this study, there are limitations to the study. When adopting the findings of this study, we draw readers’ attention to the fact that data were collected among mothers attending PHCs in Nigeria, and caution should be applied to interpretation. The sample size used in this study is relatively small. We suggest that future studies consider conducting a nationwide survey among first-time mothers that could guarantee a large sample size. Additionally, a cross-sectional design may prevent interpretations of the results as causal factors. Future research should, therefore, recruit first-time mothers in Nigeria for a longitudinal analysis. However, the study extends empirical evidence on the influences of ACEs on becoming a mother among first-time mothers in a developing region like Nigeria and the mechanisms that channel dissatisfaction with motherhood by considering child gender in the analysis. In addition, while the Cronbach α value of 0.60 is considered acceptable (Ursachi et al., Reference Ursachi, Horodnic and Zait2015), caution must be applied when interpreting the influence of emotional closeness in the study findings.
Research and theoretical implications
This study has significant empirical and theoretical significance in understanding the associations of ACEs, emotional distress and dissatisfaction with motherhood among first-time mothers in Nigeria. Developmental and life course trajectories significantly influence first-time mothers’ psychological health and motherhood satisfaction. Additionally, first-time mothers must embrace their identity as mothers to promote self-efficacy to fulfill their motherhood responsibilities. Similarly, mothers who develop negative attachment styles as a result of ACEs may experience psychological problems later in life. Most importantly, first-time mothers who have experienced ACEs require urgent mental health support and services to cushion emotional distress during motherhood.
In addition, the motherhood process of first-time mothers may be impacted by ACEs and emotional distress together. First-time mothers suffering from ACEs, for example, must also deal with postpartum emotional difficulties and societal expectations that may their readiness to become mothers. Attempting to conform to societal standards of motherhood can put significant pressure on these first-time mothers, draining them mentally. A combination of these factors may lead to a deficit in motherhood capabilities. Consequently, cumulative disadvantages may result in emotional distress that could lead to dissatisfaction with motherhood. Moreover, these negative factors, such as ACEs, can negatively affect mother’s child’s emotional closeness, ultimately leading to dissatisfaction with motherhood satisfaction.
ACEs have a direct effect on the dissatisfaction with motherhood of mothers who have girl children. This group should receive tailored support to address these issues. Mothers should be enlightened about this possibility and ensure that they raise their girl child from a trauma-informed perspective. First-time mothers should be screened for ACEs and emotional distress in primary healthcare settings throughout Nigeria as part of parenting education. Finally, based on the findings of this study, it is imperative to examine the unique effects of specific traumas, such as those relating to emotional abuse/neglect. In addition, future studies should consider examining the influences of ACEs, like sexual trauma, in the process of becoming a mother that could promote dissatisfaction with motherhood.
Conclusion
In this study, ACEs are associated with dissatisfaction with motherhood and emotional distress, and emotional distress predicts dissatisfaction with motherhood. Dissatisfaction with motherhood is indirectly associated with first-time mothers’ ACEs through their emotional distress. In addition, the effects of ACEs on dissatisfaction with motherhood for first-time mothers ACEs could not be cushioned by child emotional closeness to the child. The study found no serial impact of emotional distress and child emotional closeness in the association between ACEs and dissatisfaction with motherhood. As indicated by the results by child gender, ACEs are only associated with dissatisfaction with motherhood among first-time mothers of female children. As part of reducing dissatisfaction with motherhood, particularly ACEs and emotional dysfunction, first-time mothers require person-centered and trauma-informed support.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.15.
Data availability statement
Data will be made available upon request from the corresponding authors.
Author contribution
T.Y.A. conceptualized the study; T.Y.A. and S.O.I. collected the data; T.Y.A. conducted data analysis; C.S. and S.O.I. contributed to data curation and visualization; T.Y.A., S.C. and S.O.I. contributed to writing, and editing of the manuscript; T.Y.A., C.S., Q.D. and S.O.I. contributed to the reviewing and editing of the manuscript.
Financial support
The authors received no internal or external funding support for this research.
Competing interest
The authors declare there is no competing interest in respect of this research and publication.
Ethical consideration
The research adhered strictly to the Helsinki declaration on conducting human research. Additionally, the Department of Planning, Research, and Statistics of the Oyo State’s Ministry of Health granted ethical approval to implement the survey (Ref. No. AD 13/479/44611B). We further received approval from various heads of PHCs in the communities to conduct the study, while informed consent was obtained from the research participants who filled out the consent form of the questionnaire administered as criteria to participate.
Open access
Comments
Editor in Chief
Global Mental Health
Dear Editor,
We are submitting a manuscript that extend empirical evidence on how ACEs disrupt becoming a mother among first time mothers attending primirary healthcare centers in Nigeria. The article is titled “Adverse childhood experiences, emotional distress and dissatisfaction with motherhood among first-time mothers: Mediations and child differences” for consideration and publication in Global Mental Health. This study is grounded on several theoretical perspectives that reflects on how first-time mothers may experiences dissatisfactions with motherhood because of negative childhood experiences channeled through emotional distress. This study fits into the scope of your journal because it address the far-reaching effects adverse childhood experiences which are traumatic stress and emotional distress (reflecting later life adversity) in distrupting the executive functions of mothers (becoming a mother). In particular, the study captures the experiences of marginalized and hard to reach population of mothers attending primary healthcare centers in Nigeria local communities.We hope the methodological approach, analysis, and findings meet the minimum requirement for publication in your journal.
Best Regards
The Authors