Self-harm, self-harm ideation and mother-infant interactions: a prospective cohort study

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Objective: To investigate the association between maternal self-harm (lifetime history of self-harm and self-harm ideation during pregnancy) and mother-infant interactions in a representative cohort from southeast London. Methods: Data were drawn from a prospective cohort of 545 women attending antenatal appointments between 2014 and 2016. Women were asked about history of self-harm and current self-harm ideation during a research interview following first antenatal visit. Follow-up data on depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) were collected at 28 weeks' gestation and 3 months postpartum, and data on mother-infant relationship using the CARE-Index and Postpartum Bonding Questionnaire were collected at 3 months postpartum. Linear regression analyses were conducted to investigate the associations between history of self-harm and (a) depressive symptoms and (b) the mother-infant relationship. Analyses were repeated with current self-harm ideation as the exposure. Results: The population prevalence of history of self-harm was 7.9% (95% CI 5.5%-11.2%) and of current self-harm ideation was 2.3% (95% CI, 1.2%-4.2%). History of self-harm was associated with baseline depressive symptoms (adjusted regression coefficient = 2.23 [95% CI, 0.16-4.29], P = .035), and self-harm ideation was associated with depressive symptoms at all time points (adjusted regression coefficients = 11.53 [95% CI, 10.13-12.94], P < .001 at baseline; 8.16 [95% CI, 5.43-10.89], P < .001 at midpregnancy; and 6.73 [95% CI, 4.48-8.99], P < .001 postpartum). Self-harm ideation, but not history of self-harm, was associated with maternal controlling behaviors (adjusted regression coefficient = 2.34 [95% CI, 0.40-4.48], P = .019) and infant compulsive behaviors (adjusted regression coefficient = 2.37 [95% CI, 0.36-4.38], P = .021). Conclusions: Self-harm ideation during pregnancy is associated with elevated depressive symptoms in the perinatal period and with poorer quality mother-infant interactions. These women require effective psychological help that targets their distress, risk, and interactions with their infants.

Original languageEnglish
Article number18m12708
JournalJournal of Clinical Psychiatry
Issue number5
Early online date10 Sept 2019
Publication statusPublished - Sept 2019


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