The roles of resilience and childhood trauma history: Main and moderating effects on postpartum maternal mental health and functioning

Abstract

Objective Recently postpartum women participated to investigate main and moderating influences of resilience and childhood history of maltreatment on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), parental sense of mastery, and family functioning. Method At 4-months postpartum, 214 mothers (145 with a history of childhood abuse or neglect) completed interviews assessing mental health symptoms, positive functioning, resilience and trauma history. Multiple and moderated linear regression with the Connor- Davidson Resilience Scale (CD-RISC) and Childhood Trauma Questionnaires (CTQ) were conducted to assess for main and moderating effects. Results Resilience, childhood trauma severity, and their interaction predicted postpartum PTSD and MDD. In mothers without childhood maltreatment, PTSD was absent irrespective of CD-RISC scores. However, for those with the highest quartile of CTQ severity, 8% of those with highest resilience in contrast with 58% of those with lowest CD-RISC scores met PTSD diagnostic criteria. Similar, in those with highest resilience, no mothers met criteria for postpartum MDD, irrespective of childhood trauma, while for those with lowest quartile of resilience, 25% with lowest CTQ severity and 68% of those with highest CTQ severity were depressed. The CD-RISC, but not the CTQ, was predictive of postpartum sense of competence. The CD-RISC and the CTQ were predictive of postpartum family functioning, though no moderating influence of resilience on childhood trauma was found. Conclusions Resilience is associated with reduced psychopathology and improved wellbeing in all mothers. It further serves as a buffer against psychiatric symptoms following childhood trauma. Such findings may assist in identification of those at greatest risk of adverse functioning postpartum, utilization of resilience-enhancing intervention may benefit perinatal wellness, and reduce intergenerational transmission of risk.

Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories

“…Specifically, a study examining two populations found lower resilience, as assessed by the Connor-Davidson Resilience Scale (CD-RISC; Connor and Davidson, 2003), predicting suicide attempts in those with CM histories (Roy et al, 2011). A recent investigation by Sexton et al (2015) in postpartum women showed that resilience, CM severity, and their interaction were associated with PTSD and MDD postpartum. Given the associations between CM, shame, resilience and psychiatric functioning, continued efforts to understand relationships between these factors and postpartum SI are warranted.…”

“…During the postpartum period, women reflect on their own childhoods, thus triggering prior memories and experiences that result in emotional (psychopathology) as well as behavioral (parenting) disruptions (Lyons-Ruth & Block, 1996; Wright, Fopma-Loy, & Oberle, 2012). The frequency and severity of CM are known to predict increased psychopathology in adult postpartum populations (Choi and Sikkema, 2015; Grekin and O’Hara, 2014; Leigh and Milgrom, 2008; Muzik et al, 2013; Sexton et al, 2015). Sit et al’s (2015) investigation established a relationship between CM and SI in mothers with postpartum depressive disorder (PPD).…”

“…One of the best-validated theories concerning suicidal behavior is Joiner’s Interpersonal Theory of Suicide (IPTS; Joiner, 2005; Van Orden et al, 2010), which posits that social connectedness and support can buffer susceptibility to SI and depression (Esposito & Clum, 2002; Kleiman & Liu, 2013; Xie et al, 2009). Specific to postpartum women, family and peer support are associated with reduced risk for mood and anxiety disorders as well as SI after childbirth (Leahy-Warren et al, 2012; Killian, 2013; Norhayati et al, 2015; Robertson et al, 2004; Sexton et al, 2015). Some literature has shown that individuals who are married also demonstrate reduced risk for suicidal behavior (Kposowa, 2000; Smith et al, 1988).…”

Family Social Support Modifies the Relationships Between Childhood Maltreatment Severity, Economic Adversity and Postpartum Depressive Symptoms

“…There is extensive literature supporting a link between childhood maltreatment (CM) exposure and adverse mental health outcomes in adulthood. In particular, major depressive disorder (MDD), Posttraumatic Stress Disorder, anxiety, interpersonal aggression, and suicide attempts are frequently noted sequelae in adults reporting abuse and neglect in early development (Hamilton, Micol-Foster, & Muzik 2015; Harford & Grant 2014; Kaplow & Widom 2007; Sexton, Hamilton, McGinnis, Rosenblum, & Muzik 2015). Compounding these threats to public health, a history of CM increases risk of recurrent depressive episodes throughout the lifespan and is associated with more treatment refractory responses to evidence based interventions for postpartum depressive symptoms (PDS) (Cort et al 2012; Nanni, Uher, & Danese 2012).…”

“…A recent systematic review confirmed robust relationships between CM and perinatal mood disorders (Choi & Sikkema 2015; Buist & Janson, 2001). Further, studies have identified associations between CM, maternal psychopathology, and mother-infant bonding and child development, thus increasing the probability of intergenerational transmission of risk (e.g., Martinez-Torteya et al 2014; Muzik et al 2013; Sexton et al 2015). …”