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

OBJECTIVE: To evaluate whether adverse childhood experiences (ACEs) and resilience assessed during routine prenatal care were associated with same-day mental health referral. METHODS: 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. RESULTS: 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). CONCLUSIONS: ACE and resilience scores were associated with prenatal mental health referral even after adjusting for existing mental health risk factors.