Elsevier

Child Abuse & Neglect

Volume 25, Issue 7, July 2001, Pages 909-921
Child Abuse & Neglect

Childhood sexual abuse, parenting and postpartum depression—a 3-year follow-up study

https://doi.org/10.1016/S0145-2134(01)00246-0Get rights and content

Abstract

Objective: This study is the second and final phase of a 3-year follow-up study of women who had been admitted with a major depressive episode in the postpartum period, along with their children and partners where present. The effect of a maternal sexual abuse history on the women’s well-being and child outcome compared to those women without such a history is highlighted.

Method: Forty-five of an original cohort of 56 women were seen with their child where possible, when the child was an average of 36.8 months old. Twenty-two women had no history of sexual abuse, and 23 gave a history of childhood sexual abuse. Women were assessed with respect to well-being, relationships, parenting stress and psychiatric history since recruitment. The child’s behavior and cognitive development was also assessed.

Results: Women with a history of sexual abuse rated higher depression and anxiety scores (p < .05), and had greater life stresses (p < .05). Their partners rated themselves as more comforting and their children as more disturbed (p < .05). Over time, this group had failed to improve as much as the nonabuse group on these measures. There was no difference in child cognitive scores between groups.

Conclusions: A history of sexual abuse in women who become depressed postpartum may have long term implications for the woman’s mental health, her relationship with her child, as well as the emotional development of her child. It is critical to offer women in this high-risk group supports in an attempt to minimize these difficulties and any long-term adverse effects.

Résumé

Objectif: Ceci est la deuxième et dernière phase d’une étude qui avait pour but de faire un suivi auprès de femmes admises pour un épisode postpartum sérieux de dépression. Dans la mesure du possible, conjoints et enfants faisaient aussi partie de l’étude. Les mères qui ont connu des agressions sexuelles ont été comparées à un groupe de mères non victimes, ceci au niveau des effets des ces agressions sur le bien-être de la mère et sur ses enfants.

Méthodes: Quarante-cinq femmes parmi un groupe de 56 ont été évaluées, ainsi que leur enfant lorsque ceci était possible. Les enfants avaient un âge moyen de 36.8 mois. Vingt-deux femmes n’avaient connu aucune agression sexuelle, tandis que 23 étaient des victimes d’agressions sexuelles en enfance. L’évaluation portait sur leur bien-être, leurs relations avec d’autres, le stress parental et leur anamnèse psychiatrique. Le comportement des enfants ainsi que leur développement cognitif faisaient aussi partie de l’évaluation.

Résultats: Les femmes victimes d’agressions sexuelles démontrent des taux de dépression et d’angoisse plus élevés (p <. 5) et vivent des conditions de stress plus importantes (p <. 0). Leurs conjoints se considèrent plus sécurisants envers elles. Les enfants de ces mères sont plus perturbés (p < .05). Au fil du temps, on note qu’elles font moins de progrès au niveau des troubles mentionnés ci-dessus que les mère non victimes. Par contre, on note aucune différence entre les deux groupes d’enfant au niveau des capacités cognitives.

Conclusions: Les mères victimes d’agressions sexuelles durant leur enfance et qui souffrent d’une dépression postpartum risquent de connaı̂tre des troubles mentaux et d’éprouver des difficultés dans leur relation avec leur enfant et l’enfant risque de connaı̂tre des difficultés dans son développement émotionnel. Il est important d’offrir un appui à ces mères à risque élevé afin de réduire leurs difficultés et les effets nocifs à long terme de leur maladie.

Resumen

Objetivo: Este estudio es la segunda y última fase de un estudio longitudinal de 3 años llevado a cabo con madres que han sido admitidas con un episodio de Depresión Mayor en el perı́odo postparto. Sus hijos y compañeros también estuvieron presentes. Se analizó el efecto de la historia de abuso sexual materno en la situación de los niños y en el bienestar de la madre.

Método: Cuarenta y cinco madres de una cohorte de 56 mujeres fueron vistas con sus niños, cuando el niño tenı́a una edad media de 36.8 meses. Veintidós mujeres no presentaron una historia de abuso sexual infantil, mientras que 23 sı́ la presentaron. A todas la mujeres se les evaluó su bienestar, sus relaciones, su estrés parental, y su historia psiquiátrica desde el inicio de su participación en el estudio. La conducta y el desarrollo cognitivo infantil también fueron evaluados.

Resultados: Las mujeres con una historia de abuso sexual presentaron puntuaciones más altas en depresión y ansiedad (p < .05) y tuvieron una mayor cantidad de acontecimientos estresantes de vida (p < .05). Sus compañeros se puntuaron a sı́ mismos como más reconfortantes y sus niños fueron evaluados como más problemáticos (p < .05). Con el paso del tiempo, este grupo mejoró menos en estas medidas que el grupo de no-abuso. No hubo diferencia entre grupos en las puntuaciones cognitivas de los niños.

Conclusiones: Una historia de abuso sexual en mujeres que presentan depresión postparto puede tener implicaciones a largo plazo para la salud mental de las madres, para la relación con su hijo/a al igual que para el desarrollo emocional de su hijo/a. Es de crı́tica importancia el ofrecer a estas mujeres en este grupo de alto riesgo un intento de minimizar estas dificultades y evitar cualquier efecto adverso a largo plazo.

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

References (27)

  • J Martin et al.

    Asking about child sexual abusemethodological implications of a two stage study

    Child Abuse & Neglect

    (1993)
  • R Abidin

    Parenting Stress Index manual

    (1983)
  • T.M Achenbach et al.

    Manual for the child behavior checklist and revised child behavior profile

    (1983)
  • American Psychiatric Association (1987). Diagnostic statistical manual DSMIIIR. Washington, DC:...
  • A.T Beck et al.

    An inventory for measuring depression

    Archives General Psychiatry

    (1961)
  • A Buist

    Childhood abuse, postpartum depression and parenting difficultiesa literature review of associations

    Australian and New Zealand Journal of Psychiatry

    (1998)
  • A Buist

    Childhood abuse, postpartum depression and parenting difficulties

    Australian and New Zealand Journal of Psychiatry

    (1998)
  • A Buist et al.

    Childhood sexual abuse—a risk factor for postpartum depression

    Australian and New Zealand Journal of Psychiatry

    (1995)
  • H.L Caplan et al.

    Maternal depression and the emotional development of the child

    British Journal of Psychiatry

    (1989)
  • S.R Coghill et al.

    Impact of maternal depression in cognitive development of young children

    British Medical Journal

    (1986)
  • S Coopersmith

    Self esteem inventory

    (1981)
  • A Cox et al.

    The impact of maternal depression in young children

    Journal of Child Psychology and Psychiatry

    (1987)
  • Gibaud-Wallston, J. (1977). Self esteem and situational stress factors related to sense of competence in new parents....
  • Cited by (83)

    • Prenatal sleep quality and mental health symptoms across the perinatal period: A longitudinal study of high-risk women

      2019, Journal of Psychosomatic Research
      Citation Excerpt :

      History of depression [22] and PTSD from sexual trauma or childhood maltreatment are linked to increased risk for perinatal symptom exacerbation [38,45]. The psychological demand of pregnancy may increase risk for depression by hampering women's coping abilities and eliciting memories of childhood adversity [7]. Prenatal care visits (e.g., vaginal examinations) and labor can also foster feelings of fear and powerlessness, triggering PTSS and depression symptoms [44].

    • Childhood maltreatment, postnatal distress and the protective role of social support

      2017, Child Abuse and Neglect
      Citation Excerpt :

      Analyses without extraordinarily high CTQ sum scores (≥70) did not change the pattern of results. In line with our hypothesis and with prior studies reporting an elevated risk for postpartum depression (for a review see Choi & Sikkema, 2015), anxiety (Buist & Janson, 2001; Choi & Sikkema, 2015), and increased levels of stress (Vranceanu et al., 2007) in individuals with a history of childhood maltreatment, we observed a significant, albeit small conditional effect of maltreatment load on postnatal distress (i.e., symptoms of stress, depression and anxiety), after controlling for the recent experience of an emotionally stressful event and level of education. Importantly, the association of maltreatment load and postnatal distress was, as a trend, moderated by social support indicating a protective effect of support in accordance with the stress buffering hypothesis by Cohen and Wills (1985) in the present findings.

    View all citing articles on Scopus
    View full text