The Predictive Role of Childhood Maltreatment for Long-Term HPA Axis Regulation, Chronic Stress and Postpartum Depression

Background: Childhood maltreatment increases the risk for mental disorders, including postpartum depression (PPD). Outside the peripartum period, attenuated long-term hypothalamus-pituitary-adrenal (HPA) axis regulation and perceived chronic stress are discussed as potential mechanisms underlying the adverse effects of childhood maltreatment. Hair cortisol concentration (HCC) enables the detection of long-term changes in HPA axis regulation. This study aimed to examine the mediating role of HCC linking childhood maltreatment with symptoms of PPD.Methods: We measured childhood maltreatment, symptoms of PPD and chronic stress via online questionnaires in N = 111 individuals 12 months after childbirth. Current and past major depressive episodes were assessed with the Structured Clinical Interview for DSM-5. To determine HCC of month 09 – 12 postpartum, participants provided self-collected hair samples. Mediated regression models examined the role of HCC and chronic stress for the relation between childhood maltreatment and PPD symptoms.Results: Childhood maltreatment predicted higher levels of PPD symptoms and chronic stress, and was associated with higher rates of a current depressive episode but not with HCC. Perceived chronic stress mediated the relationship of childhood maltreatment with symptoms of PPD. Interpretation: Individuals with a history of childhood maltreatment are highly vulnerable for adverse mental health outcomes in the postpartum period. Perceived chronic stress may be an important underlying pathway, while neuroendocrinological mechanisms between CM and PPD remain poorly understood. Longitudinal studies are needed to improve our understanding of pathways of CM and PPD, enabling the development of targeted prevention and intervention strategies.