Offspring of mothers who had antenatal depression and experienced maltreatment in childhood are more likely to experience child maltreatment themselves
- Correspondence to: Dr Deborah Capaldi, Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene 97401, Oregon, USA;
Implications for practice and research
Girls who experience maltreatment are at risk for long-term psychopathology, including antenatal depression and antisocial behaviour and their offspring are also at risk for maltreatment and adolescent antisocial behaviour if their mothers experienced both maltreatment and antenatal depression.
Early prevention of childhood maltreatment is necessary to prevent intergenerational transmission of psychopathology.
Screening pregnant women for a history of maltreatment, and starting prevention or treatment of depression and teaching parenting skills is indicated.
In 2010, close to 700 000 children were found to be victims of maltreatment.1 The WHO ranks major depression as one of the most common and burdensome diseases in the world.2 Similarly, conduct problems are one of the most common reasons for referrals to child mental health clinics and have the poorest prognosis, of any childhood disorder, for adult adjustment.3 Thus, when these problems occur for the same individual, whether simultaneously or at different times in development, this creates a ‘perfect storm’ with severe consequences for future adjustment.
The study recruited a sample of 125 pregnant women from South London. The women provided retrospective reports of their childhood maltreatment experiences and were considered maltreated if two or more types of maltreatment (physical abuse, sexual abuse, emotional neglect and physical neglect) were present. History of antisocial behaviour and psychiatric problems were also assessed, and depression diagnoses were obtained at 36 weeks of pregnancy. Maltreatment in offspring was assessed at 11 years, and adolescent antisocial behaviour and depression at age 16 years.
Maltreatment was associated across generations. Maternal antenatal depression was associated with the mother's prior history of depression, childhood maltreatment and antisocial behaviour, as well as predicting maltreatment of their offspring (by themselves or others) and offspring antisocial behaviour. Surprisingly, it was not predictive of depression in offspring. Maltreatment in offspring and antisocial behaviour was much higher when mothers experienced both childhood maltreatment and antenatal depression than when they had experienced only one of these conditions. A connection between maternal history of childhood maltreatment to their child's adolescent antisocial behaviour only occurred if those offspring experienced childhood maltreatment themselves.
As it becomes clear from a number of longitudinal studies examining questions across generations, problems such as psychopathology and maltreatment can cast very long shadows, not just for the individuals involved but for their children; whereas depression and antisocial behaviour are significantly likely to co-occur both in women (as in this study) and in men, the prevalence of depressive symptoms is higher in women than in men, and seems to play a stronger role in intergenerational transmission of psychopathology and family risk.
Selecting the appropriate developmental or life stage for screening individuals for risk factors and delivering effective targeted interventions are key challenges for research and practice. Pregnancy is a time when women are in contact with health services; therefore, in addition to intervening in antenatal depression, this is an excellent time to address issues affecting the baby's future health. Plant and colleagues report that in almost one-half of the cases, mothers were the maltreatment perpetrator, and teaching parenting skills during pregnancy can improve the skills of both parents. Maternal risk behaviour and harsh discipline practices influence the father's discipline practices, even controlling for other factors.4 Ideally, fathers would also be included in such parenting programmes. Kerr and colleagues5 found that, following the birth of their first biological child, men showed decreases in crime, alcohol and tobacco use relative to their peers. Thus, pregnancy is not only a time when women may be particularly receptive to interventions that will benefit their children, but also the fathers of these children, who also play a role in intergenerational transmission of risk, are receptive.