Deconstructing the Effects of Interpersonal Violence, Childhood Trauma, and Loss On Perinatal Depression in Adolescent Mothers

Background and Purpose: Childhood trauma history, intimate partner violence (IPV), and perinatal depression (PND) have been linked to outcomes including low infant birth weight, impaired maternal bonding, and adverse infant biological and neurodevelopmental outcomes.  Considerable research supports relationships between childhood maltreatment, IPV, and perinatal depression in adolescent and adult women. However, considerably less is known about the specific types of IPV, childhood trauma subtypes, childhood loss, and the developmental course of both antenatal and postpartum depression. This prospective longitudinal study addresses this gap in the literature by deconstructing IPV, childhood maltreatment, and early trauma experience to examine specific relationships between these risk factors and PND in adolescent mothers.

Methods: A diverse sample of 224 adolescents aged 14-20 years  was recruited during routine prenatal visits at a public health clinic. Measures of depression, childhood trauma history, and IPV were administered prenatally and postpartum. Bivariate analyses examined the prevalence of PND, childhood maltreatment, IPV, and childhood loss. A mediation model of trauma subtypes, IPV subtypes, antenatal depression (AND), and postpartum depression (PPD) was tested using path analysis. Relationships between maltreatment subtypes, childhood loss, IPV subtypes, and PND are 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 trauma, with over 75% reporting IPV, specifically. Of the IPV victimization reported, 12.4% reported sexual IPV, 49.3% reported physical IPV, and 72.7% reported psychological IPV. Nearly 30% of the subjects reported losing a primary caregiver and 28.4% report a history of child maltreatment. Emotional neglect was the most common form of child maltreatment (16.9%), followed by sexual abuse (10.7%), and physical abuse (8.42%). Our final model (χ² (3)=3.972, p=0.265) indicates childhood sexual abuse (0.204, p<0.01), childhood loss (0.199, p<0.01), and sexual IPV (0.139, p=0.060) were all significantly related (or approaching significance) to PPD, partially mediated by AND (0.321, p<0.000). Physical IPV and physical childhood abuse were not significantly related to PND outcome.

Conclusions and Implications: Results suggest that interpersonal trauma, and sexual trauma in particular may be the most substantial risk factor for PND. Further, childhood loss of a caregiver or close family member appears to also be a significant risk for the onset of both AND and PPD in adolescent mothers. When IPV was parsed into subtypes, only the sexual subtype held a significant relationship to PND. The trauma survey used in this study did not allow for more in-depth review of traumatic grief as a mediator of the childhood loss variable and PND. However, future research should focus on examining childhood loss and traumatic grief, as well as more specifically defining IPV as a risk factor. Professionals addressing the needs of this population could consider childhood loss and sexual trauma specifically 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 to enhance mother and baby resilience.