(PS11-17) Associations Between Childhood Trauma History, Emotion Dysregulation, and Suicidal Thoughts and Behaviors During Pregnancy

Background: Suicide is a leading cause of maternal morbidity, and rates of suicidal thoughts and behaviors (STBs) during the perinatal period have increased in the U.S. over the last decade (Admon et al., 2021). Childhood trauma history is an established risk factor for STBs during the perinatal period (Jasthi et al., 2022). Transdiagnostic variables such as emotion dysregulation (ED) are implicated in the association between childhood trauma history and STBs in adulthood. For instance, in non-perinatal populations, the association of childhood trauma history with STBs is stronger at higher levels of ED (Mohammadzadeh et al., 2019). Currently, there is a lack of clarity in the strength of the association between childhood trauma history and STBs in the context of elevated ED during the perinatal transition. The current study hypothesized that women with experiences of childhood trauma history will report higher STB severity during pregnancy when also endorsing elevated ED.  

Methods: Participants included 141 individuals in the 3^rd trimester of pregnancy enrolled with a range of STB histories. Participants completed an online survey and virtual clinical interview during the third trimester as part of an on-going longitudinal study. To assess STB severity, the maximum value from the Columbia Suicide Severity Rating Scale “total score” (0-9) was used, with endorsement of 0 indicating no STBs, a lower score (1-5) indicating endorsement of suicidal ideation, and higher scores (6-9) indicating endorsement of suicidal behavior (Posner et al., 2011). Zero-inflated negative binomial regression models were used to accommodate the over-dispersion of STB response data. Models examined the moderating role of ED (DERS; Gratz & Roemer, 2004) on the relation of childhood trauma history (ACES; Felitti et al., 1998) with STB severity.  

Results: The sample was over-recruited for STBs with 31% (n = 44) reporting suicidal ideation and 3.5% (n = 5) reporting suicidal behavior during pregnancy. Compared to community norms, the sample was elevated for childhood trauma history (M= 3.14) and ED (M = 85.62), especially for those endorsing STBs during pregnancy (n = 49, mACES = 4.1; mDERS = 97.6). The moderating role of ED was not significant (β = -0.003, p = 0.19), though both childhood trauma history (β = 0.14, p < 0.05) and ED (β = 0.04, p < 0.01) were significantly associated with STB severity. Specifically, STB severity increased by 15.3% for every 1-unit increase in childhood trauma history (holding ED constant) (IRR = 1.15) and increased by 3.7% for every 1-unit increase above the mean in ED (holding childhood trauma history constant) (IRR = 1.037). 

Discussion: Women with childhood trauma history and elevated ED more frequently endorse STBs during pregnancy. Counter to hypotheses, ED was an independent predictor of STB severity and did not significantly moderate the association of childhood trauma history with STB severity. These findings highlight the need to further understand time-course patterns of STB development during the perinatal transition. Future research investigating STB trajectories from pregnancy to postpartum may elucidate the role of ED and other clinically relevant moderators of the childhood trauma history risk pathway for STBs.