Childhood sexual abuse, parenting and postpartum depression—a 3-year follow-up study
Introduction
Increasing interest in outcomes of the children of the mentally ill have resulted in a number of long-term studies of children of women who have histories of depression or schizophrenia (Seifer & Dickstein, 1993). Those studies looking at the offspring of depressed women have included studies with women who have been diagnosed with depression occurring in the child’s first year of life, following these families from early infancy to look at the potential impact of the maternal depression.
Cox, Puckering, Pound, and Mills (1987) suggested the possible methods by which the depression might impact on children. They classified these as genetic, interaction of genetic and environmental influences, exposure to symptoms, alterations in parenting via changes in family structure or function and the effect of depression, and incidental and correlated factors influential or interactive with depression.
Tatano Beck’s (1995) meta-analytic review of 19, principally American, studies concluded that postpartum depression had a “medium to large effect” on mother-infant interaction in the year after delivery. She notes, however, that the larger the study and the better the design, the less effect was noticed.
A subsequent meta-analysis by the same author (Tatano Beck, 1998) examined nine studies that looked at the effect of postpartum depression on the cognitive and emotional development of children older than 1 year. She concluded it had a small but significant effect on both aspects of development.
The studies, a number of which follow the children to school age, are generally small and complicated by:
Differing measures—some cognitive, others behavioral, often with little distinction, as well as a mixture of observational techniques and self reports between studies Tatano Beck 1995, Tatano Beck 1998.
Age of child—this affects the assessor’s ability to engage, as well as the accuracy of the instruments available. At young ages, a considerable variability is possible for most instruments Tatano Beck 1995, Tatano Beck 1998.
Definition of depression—particularly what postpartum depression is, and whether the depression has been continuously present, re-emerging later, or only present later Tatano Beck 1995, Tatano Beck 1998, Coghill et al 1986, Caplan et al 1989.
Other factors—such as studies involving socioeconomically disadvantaged families (Murray & Cooper, 1997).
Findings in early childhood have varied, with some studies concluding a negative effect on behavior Caplan et al 1989, Sharp et al 1995, Lee and Gotlib 1989, others on cognitive development Coghill et al 1986, Hay and Kumar 1995. These studies differed in conclusions as to the importance of the timing of the depression, some suggesting current depression was more crucial, others depression in the first year of life. Murray and Cooper (1997) also suggested that the child’s gender was influential in the outcome.
While many of these studies looked at some of the broader factors beside the depression that may have influenced the child’s outcome, and which often go hand in hand with postpartum depression, the relative contribution of these factors has been difficult to establish (Buist, 1998a). The role of maternal sexual abuse, in particular, has not been examined in this context (Buist & Barnett, 1995).
This study reports the final phase of a 3-year follow-up study of women who had a major depressive episode postpartum. The specific focus was the impact of a maternal past history of abuse, and parenting capacity with respect to maternal and child outcome. The initial stage of the study found that an abuse history had a potentially deleterious effect, particularly on the mother-infant interaction, in women who become depressed postpartum (Buist, 1998b). This was demonstrated particularly on the Monash Mother Infant Interaction Scale (Stocky, Tonge & Nunn, 1996).
Section snippets
Method
Fifty-six women, their infants, and 29 of their partners participated in the initial phase of a 3-year study. In Phase One (Buist, 1998b), women were all admitted to an inpatient specialized psychiatric unit, with their infants under the age of 12 months; all women admitted were asked to participate, and there were no demographic or diagnostic differences between participants and nonparticipants (n = 14). The unit is located in a large, centralized, teaching obstetric hospital that services a
Results
Forty-five of the original 56 women participated in Phase Two, together with 27 partners and 39 children.
Eight women had moved and no forwarding address or number could be located. One woman who had moved interstate declined any involvement. Two others who were contacted agreed to be involved but failed to attend appointments or return questionnaires. Of these 11 women who did not participate in Phase Two in any way, 5 were from the index group and 6 were from the comparison group. The
Discussion
This study examined the effect of a sexual abuse history on the 3-year outcome of women and their children, where the woman had developed a depressive illness in the postpartum period. Partners were included where agreeable, but low numbers limit conclusions from their responses. The loss of 11 women from the original sample also limits the ability to generalize from some of the findings, but the second phase nevertheless provides a useful body of information on an as yet little explored area.
Conclusions
This study suggests that women with a history of childhood sexual abuse who develop postpartum depression may be more likely to have a more severe illness that is longer term, with increased anxiety and depression scores 3 years later.
There was no evidence that women with childhood sexual abuse histories have more impaired relationships with parents, partners, and supports. These women were observed to have more impaired mother-infant relationships postpartum and, though there was no
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