The Relationships Between Childhood Trauma, Adolescent Motherhood, and Perinatal Depression: Results From a Prospective Epidemiological Study

Background and Purpose: Childhood trauma history and perinatal depression (PND) have been linked to negative mother and child outcomes including low birth weight, impaired maternal bonding, and increased risk of child abuse and neglect. There is vast support of a link between childhood trauma and pregnancy as an outcome. However, considerably less is known about the relationship between childhood trauma, PND, and adolescent perceptions of their pregnancy and themselves. Existing literature for this population includes primarily small, cross-sectional samples, and provides little examination of diverse trauma types. This prospective longitudinal study addresses this gap in the literature through examination of the relationships between childhood trauma, trauma type, and PND in adolescent mothers.

Methods: A sample of 250 adolescents aged 14-20 years old was recruited during prenatal visits at a public health clinic. A survey assessing a variety of factors including depression, childhood trauma history, perceived stress, self-efficacy, social adjustment, and social support was administered prenatally and postpartum. Multivariate logistic regression analyses examined the prevalence of PND and childhood trauma history, and trauma as a predictor of PND. Relationships between sexual abuse, physical abuse, interpersonal violence, emotional abuse and PND are explored and examined as individual risk factors.

Results: Our sample included a diverse group of adolescent mothers (55.3% Latina, 28.7% Black, 16% White). Nearly 82% of subjects reported some form of childhood trauma, with 61.2% reporting interpersonal violence (IPV), specifically. There was a high incidence of psychological abuse (41.30%), followed by sexual abuse (10.34%), and physical abuse (8.42%). PND is significantly associated with trauma history (R=18.29; p<0.00), and perceived stress (R=81.85; p<0.00) and social adjustment (R=87.30, p<0.00) and support (R=39.19; p<0.00). Trauma is significantly associated with social adjustment (R=164.77, p<0.01) and social support (R=164.77, p<0.05). In both significant multiple logistic regression models predicting antenatal and postpartum depression, trauma was a significant predictor. The strongest trauma predictor of PND was a history of IPV (R=101.13, p<0.00).

Conclusions and Implications: Trauma is a significant factor in adolescent PND, with IPV posing particular risk. Screening at multiple time points during pregnancy and postpartum may be important to fully identify those with PPD and obtain a clearer picture of the role of trauma in this problem. Results suggest brief trauma and IPV measures may help prenatally screen pregnant adolescents for PND risk factors. Health clinics may better serve young mothers by educating staff on identifying and managing past and present IPV experience and risk as part of prenatal and postpartum plans. Professionals addressing the needs of this population could consider social support and overall social adjustment as other potential targets for practice and policy change. Overall, the high prevalence of trauma exposure in this population suggests that any intervention for adolescent mothers include a trauma component.