Skip to main content Accessibility help

Pre-conception self-harm, maternal mental health and mother–infant bonding problems: a 20-year prospective cohort study

  • Rohan Borschmann (a1) (a2) (a3) (a4) (a5), Emma Molyneaux (a4), Elizabeth Spry (a1) (a6), Paul Moran (a7), Louise M. Howard (a4) (a5), Jacqui A. Macdonald (a1) (a6) (a8), Stephanie J. Brown (a9) (a10), Margarita Moreno-Betancur (a8) (a11), Craig A. Olsson (a1) (a6) (a10) and George C. Patton (a1) (a10)...



Self-harm in young people is associated with later problems in social and emotional development. However, it is unknown whether self-harm in young women continues to be a marker of vulnerability on becoming a parent. This study prospectively describes the associations between pre-conception self-harm, maternal depressive symptoms and mother–infant bonding problems.


The Victorian Intergenerational Health Cohort Study (VIHCS) is a follow-up to the Victorian Adolescent Health Cohort Study (VAHCS) in Australia. Socio-demographic and health variables were assessed at 10 time-points (waves) from ages 14 to 35, including self-reported self-harm at waves 3–9. VIHCS enrolment began in 2006 (when participants were aged 28–29 years), by contacting VAHCS women every 6 months to identify pregnancies over a 7-year period. Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale during the third trimester, and 2 and 12 months postpartum. Mother–infant bonding problems were assessed with the Postpartum Bonding Questionnaire at 2 and 12 months postpartum.


Five hundred sixty-four pregnancies from 384 women were included. One in 10 women (9.7%) reported pre-conception self-harm. Women who reported self-harming in young adulthood (ages 20–29) reported higher levels of perinatal depressive symptoms and mother–infant bonding problems at all perinatal time points [perinatal depressive symptoms adjusted β = 5.40, 95% confidence interval (CI) 3.42–7.39; mother–infant bonding problems adjusted β = 7.51, 95% CI 3.09–11.92]. There was no evidence that self-harm in adolescence (ages 15–17) was associated with either perinatal outcome.


Self-harm during young adulthood may be an indicator of future vulnerability to perinatal mental health and mother–infant bonding problems.


Corresponding author

Author for correspondence: Dr Emma Molyneaux, E-mail:


Hide All

Joint first authors.



Hide All
Borschmann, R, Becker, D, Coffey, C, Spry, E, Moreno-Betancur, M, Moran, P and Patton, G (2017) 20-year outcomes in adolescents who self-harm: a population-based cohort study. The Lancet Child & Adolescent Health 1, 195202.
Brockington, I, Fraser, C and Wilson, D (2006) The postpartum bonding questionnaire: a validation. Archives of Women's Mental Health 9, 233242.
Cox, JL, Holden, JM and Sagovsky, R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry 150, 782786.
Crone, EA and Dahl, RE (2012) Understanding adolescence as a period of social-affective engagement and goal flexibility. Nature reviews. Neuroscience 13, 636.
Donath, S (2001) The validity of the 12-item general health questionnaire in Australia: a comparison between three scoring methods. Australian and New Zealand Journal of Psychiatry 35, 231235.
Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinelli, M, Gureje, O and Rutter, C (1997) The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191197.
Herbert, A, Gilbert, R, Cottrell, D and Li, L (2017) Causes of death up to 10 years after admissions to hospitals for self-inflicted, drug-related or alcohol-related, or violent injury during adolescence: a retrospective, nationwide, cohort study. The Lancet 390, 577587.
Howard, LM, Oram, S, Galley, H, Trevillion, K and Feder, G (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Medicine 10, e1001452.
Howard, LM, Molyneaux, E, Dennis, C-L, Rochat, T, Stein, A and Milgrom, J (2014) Non-psychotic mental disorders in the perinatal period. The Lancet 384, 17751788.
Kessler, RC, Andrews, G, Mroczek, D, Ustun, B and Wittchen, HU (1998) The World Health Organization composite international diagnostic interview short-form (cidi-sf). International Journal of Methods in Psychiatric Research 7, 171185.
Kita, S, Haruna, M, Matsuzaki, M and Kamibeppu, K (2016) Associations between intimate partner violence (IPV) during pregnancy, mother-to-infant bonding failure, and postnatal depressive symptoms. Archives of Women's Mental Health 19, 623634.
Klonsky, ED (2006) The functions of deliberate self-injury: a review of the evidence. Clinical Psychology Review 27, 226239.
Lewis, G and Williams, P (1989) Clinical judgement and the standardized interview in psychiatry. Psychological Medicine 19, 971979.
Lewis, G, Pelosi, AJ, Glover, E, Wilkinson, G, Stansfeld, SA, Williams, P and Shepherd, M (1988) The development of a computerized assessment for minor psychiatric disorder. Psychological Medicine 18, 737745.
Mars, B, Heron, J, Crane, C, Hawton, K, Lewis, G, Macleod, J, Tilling, K and Gunnell, D (2014) Clinical and social outcomes of adolescent self harm: population based birth cohort study. BMJ 349, g5954.
Mcmanus, S, Meltzer, H, Brugha, T, Bebbington, P and Jenkins, R (2009) Adult psychiatric morbidity in England, 2007: results of a household survey. Available at, The NHS Information Centre for health and social care.
Mcmanus, S, Hassiotis, A, Jenkins, R, Dennis, M, Aznar, C and Appleby, L (2014) Suicidal thoughts, suicide attempts, and self-harm. In McManus, S, Bebbington, P, Jenkins, R and Brugha, T (eds), Adult Psychiatric Morbidity Survey. NHS Digital, Chapter 12, pp. 129.
Mcmanus, S, Bebbington, P, Jenkins, R and Brugha, T (2016) Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014: a Survey Carried Out for NHS Digital by NatCen Social Research and the Department of Health Sciences, University of Leicester, NHS Digital.
Moran, P, Coffey, C, Romaniuk, H, Olsson, C, Borschmann, R, Carlin, JB and Patton, G (2012) The natural history of self-harm during adolescence and young adulthood: population-based cohort study. The Lancet 379, 236243.
Moran, P, Coffey, C, Romaniuk, H, Degenhardt, L, Borschmann, R and Patton, G (2015) Substance use in adulthood following adolescent self-harm: a population-based cohort study. Acta Psychiatrica Scandinavica 131, 6168.
Morgan, C, Webb, RT, Carr, MJ, Kontopantelis, E, Green, J, Chew-Graham, CA, Kapur, N and Ashcroft, DM (2017) Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ 359, j4351.
Murray, D and Cox, JL (1990) Screening for depression during pregnancy with the Edinburgh depression scale (EDDS). Journal of Reproductive and Infant Psychology 8, 99107.
Oldershaw, A, Grima, E, Jollant, F, Richards, C, Simic, M, Taylor, L and Schmidt, U (2009) Decision making and problem solving in adolescents who deliberately self-harm. Psychological Medicine 39, 95104.
Oram, S, Khalifeh, H and Howard, LM (2017) Violence against women and mental health. The Lancet Psychiatry 4, 159170.
Patton, GC, Coffey, C, Lynskey, MT, Reid, S, Hemphill, S, Carlin, JB and Hall, W (2007) Trajectories of adolescent alcohol and cannabis use into young adulthood. Addiction 102, 607615.
Patton, GC, Romaniuk, H, Spry, E, Coffey, C, Olsson, C, Doyle, LW, Oats, J, Hearps, S, Carlin, JB and Brown, S (2015) Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. The Lancet 386, 875883.
Singleton, N, Bumpstead, R, O'BRIEN, M, Lee, A and Meltzer, H (2003) Psychiatric morbidity among adults living in private households, 2000. International Review of Psychiatry 15, 6573.
Skegg, K (2005) Self-harm. The Lancet 366, 14711483.
STATA (2017) Stata Release 15.0. Stata Corporation. 15.0 ed. Texas, USA.
Van Buuren, S and Oudshoorn, K (1999) Flexible Multivariate Imputation by MICE. Leiden: Netherlands: Organization for Applied Scientific Research; (TNO).
Wasserstein, RL and Lazar, NA (2016) The ASA's statement on p values: context, process, and purpose. The American Statistician 70, 129133.
WHO (1997) Composite International Diagnostic Interview, CIDI-Auto 2.1: Administrator's Guide and Reference. Geneva: World Health Organization.
WHO (2004) International Statistical Classification of Diseases and Related Health Problems. World Health Organization, Geneva: World Health Organization.
Woolhouse, H, Gartland, D, Hegarty, K, Donath, S and Brown, S (2012) Depressive symptoms and intimate partner violence in the 12 months after childbirth: a prospective pregnancy cohort study. BJOG: An International Journal of Obstetrics & Gynaecology 119, 315323.
Zubrick, SR, Hafekost, J, Johnson, SE, Lawrence, D, Saw, S, Sawyer, M, Ainley, J and Buckingham, WJ (2016) Self-harm: prevalence estimates from the second Australian child and adolescent survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry 50, 911921.


Type Description Title
Supplementary materials

Borschmann et al. supplementary material
Borschmann et al. supplementary material 1

 Word (112 KB)
112 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed