Karmel W Choi1, Kathleen J Sikkema2, Bavi Vythilingum3, Lut Geerts4, Sheila C Faure5, Melissa H Watt6, Annerine Roos5, Dan J Stein7. 1. Department of Psychology & Neuroscience, Duke University, Durham, NC, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: kwchoi@mgh.harvard.edu. 2. Department of Psychology & Neuroscience, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 3. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 4. Department of Obstetrics and Gynecology, Stellenbosch University, South Africa. 5. MRC Research Unit on Anxiety and Stress Disorders, Stellenbosch University, Cape Town, South Africa. 6. Duke Global Health Institute, Duke University, Durham, NC, USA. 7. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Research Unit on Anxiety and Stress Disorders, Stellenbosch University, Cape Town, South Africa.
Abstract
BACKGROUND: Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. METHODS: A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. RESULTS: Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. LIMITATIONS: Limitations included modest sample size, self-report measures, and unmeasured potential confounders. CONCLUSIONS: Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa.
BACKGROUND:Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. METHODS: A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. RESULTS:Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. LIMITATIONS: Limitations included modest sample size, self-report measures, and unmeasured potential confounders. CONCLUSIONS: Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa.
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