Self-Harm, Self-Harm Ideation, and Mother-Infant Interactions: A Prospective Cohort Study

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.