Impacts of chronic suicidal ideation on parenting and child development: A longitudinal mother-child cohort study in Pakistan.

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.