Parenting among women with and without SITB histories: A call for transdiagnostic perinatal health care

• In Event: Self-Injurious Thoughts and Behaviors in Understudied Samples Across the Lifespan: Implications for Transdiagnostic Interventions

Abstract

Introduction: Suicide is a leading cause of death among new mothers (Mangla et al., 2019), yet research on self-injurious thoughts and behaviors (SITBs) sorely neglects perinatal populations. Furthermore, as many as 20% of women who endorse recent SITBs do not meet diagnostic criteria for postpartum depression (PPD), rendering them less likely to receive adequate mental health care (Wisner et al., 2013). Given the undoubted influences of maternal mental health on parenting and child developmental outcomes, transdiagnostic research on this topic is critical. The present study addressed this need by examining associations between women’s experiences with SITBs, emotion dysregulation, and mindfulness and their parenting stress and behaviors at 7 months postpartum. We tested for these associations above and beyond PPD symptoms.

Method: English- and Spanish-speaking pregnant women (Mage = 28.64, SD = 4.83 years) were recruited along a uniform distribution of the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). This strategy afforded a more transdiagnostic sample with a wider range of emotion dysregulation. During 3rd trimester, women completed self-report measures, including the Mindful Attention and Awareness Scale (MAAS; Brown & Ryan, 2003). Women were classified as having a SITB history if they reported ever experiencing SITBs in their lifetime. Approximately 7 months postpartum, they completed the Parenting Stress Index (PSI-SF; Abidin, 1990) and a 15-minute lab-based play interaction with their infants. We used the Observational Record of the Caregiving Environment (NICHD Early Childcare Research Network, 1996) to code parenting behaviors along scales of sensitivity, intrusiveness, detachment, and positive regard.

Results: Of 131 women who participated in 7-month postpartum tasks, 42 (32.1%) reported SITB histories. These women (versus those without SITB histories) were more likely to endorse psychotropic medication use during pregnancy, higher emotion dysregulation and more depressive symptoms during pregnancy and postpartum, more borderline personality traits and experiences with childhood maltreatment, and lower mindfulness. Hierarchical linear regression analyses revealed that, above and beyond PPD, lower mindfulness during pregnancy predicted more parenting stress at 7 months postpartum. In addition, emotion dysregulation at 7 months postpartum interacted with SITB history to predict parenting stress, such that higher emotion dysregulation associated with more stress among those with no SITB histories; this relation was nonsignificant among those with SITB histories. Women with SITB histories demonstrated more intrusive behaviors during the mother-infant play interaction, and SITB history, emotion dysregulation, and mindfulness did not predict maternal sensitivity, detachment, or positive regard.

Discussion: In our sample of new mothers, PPD did not associate significantly with parenting measures. SITB history predicted more intrusive behaviors, which aligns with research on parenting among mothers with borderline personality disorder (e.g., Eyden et al., 2016). However, among these women with SITB histories, emotion dysregulation did not associate with self-reported parenting stress. This finding is unexpected and may inform methodological considerations (e.g., self-report vs. observational coding) when working with women who endorse emotion dysregulation and SITBs. Overall, these findings underscore the need for transdiagnostic perinatal health care, and such prevention and intervention implications will be discussed.

Authors

• Parisa R. Kaliush, University of Utah
  Presenting Author

• Jennifer Lauren Isenhour, University of Utah
  Non-Presenting Author

• Mindy A. Brown, Brigham Young University
  Non-Presenting Author

• Robert Vlisides-Henry, University of Utah
  Non-Presenting Author

• Mengyu (Miranda) Gao, Faculty of Psychology, Beijing Normal University, China
  Non-Presenting Author

• Lee Raby, University of Utah
  Non-Presenting Author

• Liz Conradt, Duke University
  Non-Presenting Author

• Sheila E Crowell, University of Utah
  Non-Presenting Author