Abstract
The use of cocaine and other drugs during pregnancy may have serious public health consequences. The objective of this study was to determine if the use of cocaine prenatally identifies women for ongoing risk of psychological symptoms. Four hundred and two women (207 cocaine using [C], 195 non-cocaine using [NC]) were assessed for rates of clinically elevated psychological symptoms shortly after childbirth, 6.5 months and 1, 2, 4 and 6 years after using the Brief Symptom Inventory (BSI). Generalized estimating equation modeling (GEE) was used to compare psychological symptom severity, controlling for confounding factors including early childhood trauma. Results indicated that women identified as having used cocaine during pregnancy had clinically elevated psychological distress (OR = 1.76, 95%CI = 1.15–2.71, p = 0.01), psychoticism (OR = 1.97, 95%CI = 1.41–2.76, p = 0.001), interpersonal sensitivity (OR = 2.34; 95%CI = 1.65–3.34; p < 0.0001) and phobic anxiety (OR = 1.86; 95%CI = 1.24–2.79) across all assessments compared to NC women. Childhood emotional abuse was also independently associated with psychological distress. Women who use cocaine during pregnancy should be recognized as at very high risk of ongoing clinically elevated psychological symptoms and should receive early and regular assessments and intervention for mental health and substance use problems.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
APA (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
Baigent MF (2005) Understanding alcohol misuse and comorbid psychiatric disorders. Curr Opin Psychiatry 18(3):223–228
Beckwith L, Howard J, Espinosa M, Tyler R (1999) Psychopathology, mother–child interaction, and infant development: substance-abusing mothers and their offspring. Dev Psychopathol 11(4):715–725
Berger LM (2005) Income, family characteristics, and physical violence toward children. Child Abuse Neglect 29(2):107–133
Bernstein DP, Fink L (1998) Childhood trauma questionnaire: a retrospective self-report. Psychological, San Antonio, TX
Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T et al (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Neglect 27(2):169–190
Bowers MB, D’Souza N, Deepak C, Madonick S (2001) Substance abuse as a risk factor for schizophrenia and related disorders. Int J Ment Health 30(1):33–57
Burke L (2003) The impact of maternal depression on familial relationships. Int Rev Psychiatry 15(3):243–255
Costello EJ, Compton SN, Keeler G, Angold A (2003) Relationships between poverty and psychopathology: a natural experiment. JAMA 290(15):2023–2029
Crum RMA, James C (1993) Cocaine use and other suspected risk factors for obsessive–compulsive disorder: a prospective study with data from the Epidemiologic Catchment Area surveys. Drug Alcohol Depend 31(3):281–295
Derogatis LR, Melisaratos N (1983) The Brief Symptom Inventory: an introductory report. Psychol Med 13(3):595–605
Dunn LM, Dunn LM (1997) Peabody picture vocabulary test—third edition (PPVT-III). AGS, Circle Pines, MN
Eiden RD, Stevens A, Schuetze P, Dombkowski LE (2006) Conceptual model for maternal behavior among polydrug cocaine-using mothers: the role of postnatal cocaine use and maternal depression. Psychol Addict Behav 20(1):1–10
Espinosa M, Beckwith L, Howard J, Tyler R, Swanson K (2001) Maternal psychopathology and attachment in toddlers of heavy cocaine-using mothers. Infant Ment Health J 22(3):316–333
Falck RS, Wang J, Carlson RG, Eddy M, Siegal HA (2002) The prevalence and correlates of depressive symptomatology among a community sample of crack-cocaine smokers. J Psychoact Drugs 34(3):281–288
Falck RS, Wang J, Siegal HA, Carlson RG (2004) The prevalence of psychiatric disorder among a community sample of crack cocaine users: an exploratory study with practical implications. J Nerv Ment Dis 192:503–507
Hans SL (2002) Studies of prenatal exposure to drugs: focusing on parental care of children. Neurotoxicol Teratol 24:329–337
Hipwell AE, Goossens FA, Melhuish EC, Kumar R (2000) Severe maternal psychopathology and infant–mother attachment. Dev Psychopathol 12(2):157–175
Holmstrand C, Nimeus A, Traskman-Bendz L (2006) Risk factors of future suicide in suicide attempters—a comparison between suicides and matched survivors. Nord J Psychiatry 60(2):162–167
Howard J, Beckwith L, Espinosa M, Tyler R (1195) Development of Infants born to cocaine abusing women: biologic/maternal influences. Neurotoxicol Teratol 17(4):403–411
Jantzen K, Ball SA, Leventhal JM, Schottenfeld RS (1998) Type of abuse and cocaine use in pregnant women. J Subst Abuse Treat 15(4):319–323
Johanson CE, Timothy R, Schuh K, Warbasse L (1999) The effects of cocaine on mood and sleep in cocaine-dependent males. Exp Clin Psychopharmacol 7(4):338–346
Kuczkowski K (2002) Cocaine abuse in pregnancy—anesthetic implications. Int J Obstet Anesth 11(3):204–210
Ladd GTP, Nancy M (2003) Antisocial personality in treatment-seeking cocaine abusers: psychosocial functioning and HIV risk. J Subst Abuse Treat 24(4):323–330
Laqueille X (2005) Related, induced and associated psychiatric disorders to cannabis. Rev Prat 55(1):30–34
Lejoyeux M, Mourad I, Ades J (2000) Psychiatric disorders induced by drug dependence other than alcohol. Encephale 26(2):21–27
Lewis D, Moore C, Leikin J (1994) Cocaethylene in meconium specimens. J Toxicol Clin Toxicol 32(6):697–703
Liang K, Zeger S (1986) Longitudinal data analysis using general linear models. Biometrika 73(1):13–22
Light KC, Grewen KM, Amico JA, Boccia M, Brownley KA, Johns JM (2004) Deficits in plasma oxytocin responses and increased negative affect, stress, and blood pressure in mothers with cocaine exposure during pregnancy. Addict Behav 29(8):1541–1564
Marques PR, Pokorni JL, Long T, Teti LO (2007) Maternal depression and cognitive features of 9-year-old children prenatally-exposed to cocaine. Am J Drug Alcohol Abuse 33(1):45–61
Minnes S, Singer LT, Farkas K (2000) Psychological distress, violence and infant placement in cocaine using postpartum women. Paper presented at the College for Problems on Drug Dependence, San Juan, Puerto Rico
Minnes S, Singer LT, Arendt R, Satayathum S (2005) Effects of prenatal cocaine/polydrug use on maternal–infant feeding interactions during the first year of life. J Dev Behav Pediatr 26(3):194–200
Minnes S, Singer LT, Humphrey-Wall R, Satayathum MS (2008) Psychosocial and behavioral factors related to infant placement of post-partum cocaine-using women. Child Abuse Neglect (in press)
Nemeroff CB (2004) Neurobiological consequences of childhood trauma. J Clin Psychiatry 65(Suppl 1):18–28
Nixon RD, Resick PA, Nishith P (2004) An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. J Affect Disord 82(2):315–320
Ostrea EJ, Brady M, Parks P, Asensio D, Naluz A (1989) Drug screening of meconium in infants of drug-dependent mothers: an alternative to urine testing. J Pediatr 115(3):474–477
Raphael B, Wooding S, Stevens G, Connor J (2005) Comorbidity: cannabis and complexity. J Psychiatr Pract 11(3):161–176
Ross-Durow PL, Boyd CJ (2000) Sexual abuse, depression, and eating disorders in African American women who smoke cocaine. J Subst Abuse Treat 81(1):79–81
Sheinkopf SJ, Lester BM, LaGasse LL, Seifer R, Bauer CR, Shankaran S et al (2006) Interactions between maternal characteristics and neonatal behavior in the prediction of parenting stress and perception of infant temperament. J Pediatr Psychol 31(1):27–40
Singer LT, Arendt RE, Minnes S, Farkas K, Yamashita T, Kliegman R (1995) Increased psychological distress in post-partum, cocaine-using mothers. J Subst Abuse 7(2):165–174
Singer LT, Davillier M, Preuss L, Szekely L, Hawkins S, Yamashita T et al (1996) Feeding interations in infants with very low birth weight and bronchopulmonary dysplasia. J Dev Behav Pediatr 17(2):69–76
Singer LT, Arendt R, Farkas K, Minnes S, Huang J, Yamashita T (1997) The relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome. Dev Psychopathol 9(3):473–489
Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J (1999) Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA 281(9):799–805
Singer LT, Arendt R, Minnes S, Farkas K, Salvator A, Kirchner HL et al (2002a) Cognitive and motor outcomes of cocaine-exposed infants. JAMA 287(15):1952–1960
Singer LT, Salvator A, Arendt R, Minnes S, Farkas K, Kliegman R (2002b) Effects of cocaine/polydrug exposure and maternal psychological distress on infant birth outcomes. Neurotoxicol Teratol 24(2):127–135
Singer LT, Minnes S, Arendt R, Farkas K, Short E, Lewis B et al (2004) The home environment and cognitive outcomes of cocaine exposed, preschool children. JAMA 291:2448–2456
Streissguth AP (1986) The behavioral teratology of alcohol: performance, behavioral, and intellectual deficits in prenatally exposed children. In: West JR (ed) Alcohol and brain development. Oxford University Press, New York, pp 3–44
Strickland TL, James R, Myers H, Lawson W, Bean X, Mapps J (1993) Psychological characteristics related to cocaine use during pregnancy: a postpartum assessment. J Natl Med Assoc 85(10):755–760
Stuart GL, Moore TM, Gordon KC, Ramsey SE, Kahler CW (2006) Psychopathology in women arrested for domestic violence. J Interpers Violence 21(3):376–389
Watson R, Bakos L, Compton P, Gawin F (1992) Cocaine use and withdrawal: the effect on sleep and mood. Am J Drug Alcohol Abuse 8(1):21–28
Wechsler D (1989) Wechsler adult intelligence scale—revised. Psychological, San Antonio, TX
Woods NS, Eyler FD, Behnke M, Conlon M (1993) Cocaine use during pregnancy: maternal depressive symptoms and infant neurobehavior over the first month. Infant Behav Dev 16:83–98
Zammit S, Allebeck P, David AS, Dalman C, Hemmingsson T, Lundberg I et al (2004) A longitudinal study of premorbid IQ score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Arch Gen Psychiatry 61(4):354–360
Zeger S, Liang K (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130
Zuckerman B, Amaro H, Bauchner H, Cabral H (1989) Depressive symptoms during pregnancy: relationship to poor health behaviors. Am J Obstet Gynecol 160:1107–1111
Acknowledgements
The authors would like to acknowledge the efforts of Paul Weishampel, Addie Lang, Nicole Nall and Selena Cook who have interacted with subjects on a daily basis and carefully collected and processed data, our social worker Laurie Ellison who has maintained a high rate of subject retention and our families who continue to be active participants in this study. This study was supported through grant R01 07957 from the National Institute on Drug Abuse.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Minnes, S., Singer, L.T., Kirchner, H.L. et al. The association of prenatal cocaine use and childhood trauma with psychological symptoms over 6 years. Arch Womens Ment Health 11, 181–192 (2008). https://doi.org/10.1007/s00737-008-0011-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-008-0011-z