Combined effect of adverse childhood experiences and young age on self-harm ideation among postpartum women in Japan

Abstract

BackgroundSuicide among postpartum women is a new and emerging issue in developed countries. However, little is known about the combined effect of risk factors on self-harm ideation, although various risk factors have been found. The aim of this study is to examine the combined effect of maternal adverse childhood experiences and maternal age on self-harm ideation among postpartum women. MethodsThe study comprised a cross-sectional study of 8074 mothers participating in a 3-month health checkup between September 2013 and August 2014 in City A, Prefecture A, Japan. Main outcome was self-harm ideation assessed using the Edinburgh Postnatal Depression Scale (EPDS), item 10. Possible risk factors were maternal adverse childhood experiences (ACEs), maternal characteristics, relationship with husband/partner (e.g., feelings when pregnancy was confirmed), household characteristics, child characteristics (e.g., age, sex, birth weight), and postpartum characteristics, and postpartum depression status other than self-harm ideation. ResultsPostpartum women with 3 or more ACEs and younger age (<25 years old) were 10.3 times more likely than those with no ACEs and older age to have self-harm ideation (95%CI = 5.3–20.2). This combined effect was also found in first-time mothers (OR = 7.6, 95%CI = 3.2–17.9). LimitationsStudy limitations are excluding an item on sexual abuse which is one of the ACEs, recall bias and information bias. ConclusionsPostpartum women with 3 or more ACEs and who were younger than 25 years old were at a high risk for self-harm ideation. Providing prevention strategies aimed at mothers with multiple risk factors, especially younger age and ACEs, is warranted.