Hagaman Ashley, Frost Allison, Sanborn Kate, Zhou Yunji, Gallis John, Turner Elizabeth, Sikander Siham, Rahman Atif, Bates Lisa M, Saeed Gul, Mumtaz Sidra, Bibi Amina, Mallik Abid, Maselko Joanna
Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA; Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA; Carolina Population Center, University of North Carolina Chapel Hill, USA.
Soc Sci Med. 2025 Aug 4;383:118463. doi: 10.1016/j.socscimed.2025.118463.
Suicidal ideations (SI) among mothers are prominent and may denote risk for both the mother and her offspring. Suicide in low- and middle-income countries is understudied and undertheorized, with limited suicide prevention programs targeting local risk constellations. Theories related to the intergenerational transmission of maternal depression may not capture specific exposures or mechanisms conveyed through suicidal exposures over time. Using five waves of data from the longitudinal Bachpan Cohort study of mother-child dyads in Pakistan (n = 1154), we document distinct maternal SI trajectories and examine the associations of longitudinal patterns of maternal SI (chronic, episodic, new) on harsh (physical and non-physical) and negotiation parenting and child's socioemotional and receptive language and fine motor development at 3 years of child age. Outcomes were analyzed parametrically through linear mixed effects models weighted by the estimated generalized overlap weights. All models controlled for longitudinal trajectories of clinical depression and intimate partner violence, maternal educational attainment, age, and parity. One in four mothers exhibited some pattern of SI (chronic, episodic in pregnancy, or isolated recent episodes) between pregnancy and 3 years postpartum. Mothers in the chronic SI trajectory reported more physical 1.04 (0.3, 2.3) and non-physical 1.4 (-0.1, 2.6) harsh punishment behaviors compared to the no suicidal ideation group. The association between SI trajectories and socioemotional outcomes was statistically imprecise, with socioemotional scores slightly higher, 2.5 (-3.1, 12.8) and 2.9 (-3.0, 12.4)among children whose mothers were in the chronic and isolated recent episode trajectories respectively. Chronic and isolated recent episode mothers' children had significantly lower fine motor development -2.5 (-3.3, -0.3)and -2.7 (-3.5, -0.1. Chronic SI mothers' children had marginally lower receptive language scores -1.2 (-1.7, 0.4). Identifying these impacts over time during early child rearing informs improved etiologic understanding of intergenerational transmission and illuminates temporal patterning to determine critical windows of exposure and intervention.
母亲的自杀意念（SI）很突出，可能对母亲及其后代都构成风险。低收入和中等收入国家的自杀问题研究不足且理论阐释不够，针对当地风险因素的自杀预防项目有限。与母亲抑郁的代际传播相关的理论可能无法涵盖随着时间推移通过自杀暴露所传达的特定暴露因素或机制。利用来自巴基斯坦母子二元组纵向巴赫潘队列研究的五波数据（n = 1154），我们记录了不同的母亲自杀意念轨迹，并研究了母亲自杀意念的纵向模式（慢性、发作性、新发）与孩子3岁时严厉（身体和非身体）及协商式养育方式以及孩子的社会情感、接受性语言和精细运动发展之间的关联。通过由估计的广义重叠权重加权的线性混合效应模型对结果进行参数分析。所有模型都控制了临床抑郁和亲密伴侣暴力的纵向轨迹、母亲的教育程度、年龄和生育次数。四分之一的母亲在怀孕至产后3年期间表现出某种自杀意念模式（慢性、孕期发作性或近期孤立发作）。与无自杀意念组相比，处于慢性自杀意念轨迹的母亲报告了更多的身体惩罚行为1.04（0.3，2.3）和非身体惩罚行为1.4（-0.1，2.6）。自杀意念轨迹与社会情感结果之间的关联在统计学上不精确，母亲处于慢性和近期孤立发作轨迹的孩子的社会情感得分分别略高，为2.5（-3.1，12.8）和2.9（-3.0，12.4）。处于慢性和近期孤立发作轨迹的母亲的孩子的精细运动发展明显较低，分别为-2.5（-3.3，-0.3）和-2.7（-3.5，-0.1）。处于慢性自杀意念轨迹的母亲的孩子的接受性语言得分略低，为-1.2（-1.7，0.4）识别早期育儿过程中随时间推移的这些影响有助于增进对代际传播的病因理解，并阐明时间模式以确定关键的暴露和干预窗口。
