Gordon, H;
Nath, S;
Trevillion, K;
Moran, P;
Pawlby, S;
Newman, L;
Howard, LM;
(2019)
Self-harm, self-harm ideation and mother-infant interactions: a prospective cohort study.
Journal of Clinical Psychiatry
(In press).
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Abstract
Objective: To investigate the association between maternal self-harm (lifetime history of self-harm and self-harm ideation during pregnancy) and mother-infant interactions in a representative cohort from southeast London. Methods: Data were drawn from a prospective cohort of 545 women attending antenatal appointments between 2014 and 2016. Women were asked about history of self-harm and current self-harm ideation during a research interview following first antenatal visit. Follow-up data on depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) were collected at 28 weeks gestation and 3 months postpartum and mother-infant relationship using the CARE-Index and Postpartum Bonding Questionnaire at 3 months postpartum. Linear regression analyses were conducted to investigate the associations between history of self-harm and (a) depressive symptoms and (b) the mother-infant relationship. Analyses were repeated with current self-harm ideation as the exposure. Results: The population prevalence of history of self-harm was 7.9% (95%CI 5.5-11.2%), and 2.3% (95%CI 1.2-4.2%) for self-harm ideation. History of self-harm was associated with baseline depressive symptoms (adjusted regression coefficient 2.23 (95%CI 0.16-4.29),p=0.035) and self-harm ideation was associated with depressive symptoms at all time-points (adjusted regression coefficients 11.53 (95%CI 10.13-12.94),p<0.001, 8.16 (95%CI 5.43-10.89),p<0.001 and 6.73 (95%CI 4.48-8.99),p<0.001 respectively. Self-harm ideation, but not history of self-harm, was associated with maternal controlling behaviors (adjusted regression coefficient 2.34 (95%CI 0.40-4.48),p=0.019) and infant compulsive behaviors (adjusted regression coefficient 2.37 (95%CI 0.36-4.38),p=0.021). Conclusion: Self-harm ideation during pregnancy is associated with elevated depressive symptoms in the perinatal period, and poorer quality mother-infant interactions. These women require effective psychological help that targets their distress, risk, and interactions with their infants.
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