Postpartum Depression in the Intergenerational Transmission of Child Maltreatment: Longitudinal Evidence from Global Settings

Sikkema, Kathleen J

Choi, Karmel Wong

2018-03-20T17:52:36Z

2019-08-29T08:17:11Z

2017

Psychology and Neuroscience

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.

https://hdl.handle.net/10161/16215

Clinical psychology

Developmental psychology

Epidemiology

Childhood trauma

Child maltreatment

Global mental health

Intergenerational transmission

Perinatal mental health

Postpartum depression

Postpartum Depression in the Intergenerational Transmission of Child Maltreatment: Longitudinal Evidence from Global Settings

Dissertation

Updated with superseding copy at author's request and with approval by Graduate School administration 2019-12-11. The biographical statement on page 168 was edited to remove personal information about the author.

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