Browsing by Subject "Postpartum depression"

Childhood maltreatment is a potent and common form of early trauma that not only produces negative outcomes for individuals during their lifetime, but may also have consequences for the next generation. Mothers who have experienced childhood maltreatment are more likely to have children also exposed to maltreatment, a phenomenon known as the intergenerational transmission of maltreatment. The perinatal period, the earliest point of intersection between generations, may offer an opportunity to interrupt such transmission. This dissertation leveraged two longitudinal studies in diverse global settings to examine how childhood maltreatment influences maternal mental health during the postpartum period, in turn impacting children’s risk for maltreatment exposure and related outcomes. In Study 1, a UK-based longitudinal cohort of 1,116 mothers and their twin children (E-Risk) was used to: (1) explore maternal childhood maltreatment as a risk factor for postpartum depression; (2) test the bridging role of postpartum depression between maternal childhood maltreatment and long-term child outcomes, specifically child exposure to maltreatment, internalizing symptoms, and externalizing symptoms; and (3) examine the intergenerational effects of specific maltreatment subtypes. Structural equation modeling revealed that maternal childhood maltreatment predicted postpartum depression, which in turn predicted child maltreatment exposure between 5 and 12 years and subsequent child internalizing and externalizing symptoms at 12 years. Indirect effects through postpartum depression were significant, robust across twin zygosity and child gender, and persisted after controlling for maternal covariates – though appeared to be carried by later maternal depression when included. In particular, emotional abuse emerged as a significant predictor of this pathway above and beyond other subtypes. In Study 2, similar aims were examined in a sample of 150 South African mothers followed through pregnancy and into the first postpartum year, with more proximal outcomes including maternal-infant bonding, infant development, and infant growth. Again, maternal childhood maltreatment predicted postpartum depression through 6 months, which then predicted child outcomes at 1 year. Indirect effects through postpartum depression were significant and persisted for maternal-infant bonding and infant physical growth after controlling for maternal and child covariates and accounting for antenatal distress. In particular, emotional neglect was a significant predictor of this pathway above and beyond other subtypes. Alterations in maternal emotion processing emerged as a potential explanatory mechanism. Together, findings from this dissertation underscore how postpartum depression may play a role in perpetuating negative outcomes across generations and in different global settings. Identifying and treating postpartum depression, as well as preventing its occurrence/recurrence, may help interrupt the intergenerational transmission of maltreatment and its sequelae.

Background: Previous studies in Sri Lanka showed a high prevalence- 30% of postpartum depression (PPD). PPD screening using the Edinburgh Postnatal Depression Scales (EPDS) was included in postnatal care in 2012. This study aimed to estimate the prevalence of PPD in 2017 in two medical offices of health (MOH) areas, identify the association between risk factors and presence of postpartum depression, understand current practice, challenges, and suggestions of PPD screening in Sri Lanka.

Methods: The study consists of a population-based quantitative study and a qualitative study. PPD outcomes were assessed by mothers’ responses to the EPDS. Potential factors were extracted from routine paper-based medical records. The association was examined at unadjusted level first, and at adjusted level using multivariate linear regression and multivariate logistic regression models. Individual in-depth interviews were conducted among public health midwives. Framework approach was adopted to analyze the transcripts.

Results: The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. PPD was associated with earlier screening time, mothers’ delivery age > 35, >= 4 living children, and mothers’ illness. Mothers who attended prenatal sessions and whose partners were employed were less likely to report potential PPD. Other risk factors of PPD noted from interviews include socio-economic factors, interpersonal relationship, mother’s disease history, delivery method, and baby’s illness. The challenges of screening PPD included social stigma, mother’s difficulty of understanding EPDS and lack of privacy at home.

Conclusions: Mothers exposed to various socio-economic, interpersonal, and other risk factors deserve special attention. Family-based interventions, further cultural validation of EPDS, development of risk-assessing instrument could be introduced for future practice. Future research on other risk factors for PPD with larger sample size should be conducted, and qualitative research could engage other stakeholders in maternal mental health care to assess the accessibility, capacity, and quality of PPD care.