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Effects of maternal depressive symptomatology during pregnancy and the postpartum period on infant-mother attachment
Abstract
Postnatal Depression has demonstrated long-term consequences on child cognitive and emotional development; however, the link between maternal and child pathology has not been clearly identified. We conducted a prospective study using self-rating questionnaires to clarify the association between bonding disorder and maternal mood during pregnancy and after childbirth.
A total of 389 women participated in this study and completed questionnaires. Participants were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale (MIB) four times during pregnancy and the postpartum period.
We found statistically significant weak to moderate correlations (r=0.14-0.39) between the EPDS and MIB scores at each testing period. Women who experienced low mood tended to have stronger bonding disorder. Furthermore, the effectiveness of attachment between the mother and child was closely related to the mood of the mother as measured by the EPDS.
We observed different patterns of bonding and maternal mood. Distinct subtypes regarding maternal mood and formation of mother-to-infant attachment suggests that analysis of bonding disorder should be performed considering the course of maternal depressive symptoms.
... Bonding refers to the development of an emotional connection between a parent and child (Ohoka et al., 2014), with a focus on the parental caregiving and security-promoting behaviors toward the child (Larkin, 2006). Bonding is a bidirectional process, whereby a caregiver's motivation and behaviors are influenced by the child's security-seeking behavior, cues, temperament, and other characteristics (Larkin, 2006). ...
... Furthermore, the wider influence of society and the supposed immediacy of the biological parent-child attachment may cause adoptive parents anxiety about the nature and depth of adoptive parent-child relationships (Goldberg et al., 2013). Parental stress, maternal anxiety and depression are all identified as potential disrupters to bonding and attachment development (Larkin, 2006;Ohoka et al., 2014). ...
... The participants' experiences of uncertainty, stress, and anxiety arising from the wider process, not just in the moments of separation and reunification, are crucial to consider in the context of the attachment development. Parental stress, maternal anxiety, and depression can disrupt the process of bonding and attachment development (Larkin, 2006;Ohoka et al., 2014). It is possible that the psychological impact of the concurrency process on the carers, documented in the current findings, interferes with the relationship and the attachment development. ...
... Conversely, a failure in the creation of this bond can have deleterious effects on the parent-child relationship and on the child's emotional development [43,44]. Studies on women have shown that depressive symptoms in the postpartum period (blues or depression) can hinder positive mother-to-infant bonding [45][46][47]. Likewise, several studies on paternal PPD have found a link between depressive and anxiety-related symptoms in the perinatal period and impaired infant bonding [48][49][50]. ...
... This study aimed to assess the prevalence of PPB in a sample of French-speaking fathers living in France, as well as the relationship between its intensity and sociodemographic factors, perinatal factors, and bonding quality during the first 10 days postpartum. This study contributes to filling the gap in research on fatherhood in the peri-partum period [10] and expands existing knowledge on the links between PPB and bonding in new parents [46,55,56]. ...
... The depression and decreased self-confidence domains of the Maternity Blues Questionnaire were the most related to the quality of bonding. These findings are consistent with the existing literature on mothers [45][46][47] and highlight the negative impact of PPB symptoms on the quality of father-to-infant bonding. ...
In this study we explored, in men, one of the most common postpartum syndromes in women: the postpartum blues. The aims of the study were (a) to evaluate the prevalence of postpartum blues in fathers, (b) to explore the sociodemographic and perinatal factors that may be associated with its intensity, and (c) to investigate the relationship between the intensity of blues symptoms and the quality of father-to-infant bonding. Three hundred and three French-speaking fathers living in France completed a sociodemographic and obstetrical questionnaire, the Maternity Blues Questionnaire, and the Postpartum Bonding Questionnaire. The fathers were recruited from two maternity hospitals and a Child and Maternal Health Centre within 10 days of their infant's birth, or from online forums devoted to parenting. At least 17.5% of fathers experienced postpartum blues. A high level of education was associated with a higher level of postpartum blues symptoms. Dissatisfaction with the maternity care and significant father involvement during pregnancy and delivery predicted more severe postpartum blues symptoms. Symptoms of postpartum blues were positively correlated with impairment in the father-to-infant bond. This study lends support to the existence of postpartum blues among fathers and highlights its possible consequences on early father-infant relationships.
... Previous studies in general population samples as well as in psychiatric clinical samples, have shown that bonding disturbances are related to pre-and postpartum depression (Flykt et al., 2010;Garcia-Esteve et al., 2016;Kerstis et al., 2016;Ohoka et al., 2014). Compared to nondepressed mothers, depressed mothers more often have a hostile or withdrawn relationship with the baby; they also have less vocal and visual communication with their baby (Lefkovics et al., 2014), and they are more often unresponsive (Flykt et al., 2010), pejorative (Hornstein et al., 2006) or less sensitive (Bernard et al., 2018). ...
... The intensity and the timing of the depression also make a difference. Continuous depression (i.e., during both antenatal and postpartum periods) is more detrimental for the motherbaby bond than shorter periods of depression or the lack of it altogether (Ohoka et al., 2014). Moreover, Flykt et al. (2010) reported that the effect of prenatal depression is more strongly associated with the mother's unresponsiveness than postpartum depression. ...
... Based on previous studies, our hypothesis is that negative expectations about the unborn baby (Pearce & Ayers, 2005) and psychological risk factors-such as stress (Bicking Kinsey et al., 2014;Parfitt & Ayers, 2009), anxiety (de Cock et al., 2016, depression (Flykt et al., 2010;Garcia-Esteve et al., 2016;Ohoka et al., 2014), adverse life events, and poor relationships inside the family and with other adults (Bicking Kinsey et al., 2014;Flykt et al., 2010;Kerstis et al., 2016;Ohara et al., 2017)-all increase the risk of mother-baby postpartum bonding disturbances. ...
The mother's bond to her baby starts to develop during pregnancy, and it is related to the baby's attachment. We study how the mother's prenatal expectations of her unborn baby, the mother's adult relationships, and postnatal psycho‐social factors (stress, depression, and anxiety) are related to the risk of bonding disturbance. The study comprised 1398 mothers and their unborn babies assessed both during pregnancy and when the babies were 3 months old (47.7% girls). The mother's risk of bonding disturbance was investigated using Brockington's Postpartum Bonding Questionnaire. According to the results, 71 (5.1%) of all the mothers in the study had a risk of a bonding disturbance. In a final adjusted logistic regression model, the most important risk factors were the mother's inability to form positive expectations about relationships with the baby during the third trimester of pregnancy (AOR = 7.78, p ≤ .001), maternal postnatal stress (AOR = 4.95, p ≤ .001) and maternal postnatal depression (AOR = 3.46, p ≤ .01). The results challenge healthcare professionals to screen pregnant mothers to identify at‐risk groups for post‐partum bonding disturbances. Intervention programs to prevent the development of bonding disturbances, and thus their possible serious consequences for children's development, should be considered.
... Looking further at the postpartum period, research has found that depression is also a significant predictor of bonding postpartum (Dubber et al., 2014;Goecke et al., 2012;Ohoka et al., 2014;Quattlebaum & O'Connor, 2012;Sabuncuoğlu & Berkem, 2006). Depressed versus nondepressed mothers showed less vocal and visual communications, less bodily interactions and less smiling with their infants at 3-months postpartum (Righetti-Veltema, Conne-Perreard, Bousquet, & Manzano, 2002). ...
... There is some limited prospective research that considers mental health, particularly stress and anxiety, across the antenatal and postnatal period and its relationship to bonding. Depression has been associated with poor mother-fetal bonding during pregnancy (Alhusen et al., 2012;Goecke et al., 2012;Lindgren, 2001;McFarland et al., 2011;Ossa et al., 2012) and bonding postpartum (Damato, 2004;Goecke et al., 2012;Ohoka et al., 2014). Women with low quality fetal bonding tend to report higher levels of anxiety and depression (Hart & McMahon, 2006). ...
... A prospective study of 389 women found a significant weak to moderate correlation (r=0.14 to 0.39) between the EPDS and Mother-to-Infant Bonding Scale scores during pregnancy and the postpartum period (Ohoka et al., 2014). This study extended on that work by using the MAAS and MPAS while also considering other predictor variables including substance use and other mental health factors (stress and anxiety). ...
Background
Mother-infant relationship quality in the first year of life has important implications for offspring development through the life course. The emotional bond that a mother feels towards her baby is critical to offspring social, emotional and cognitive development (Bornstein, 2014). Likewise, the capacity for a mother and her infant to share an emotional connection and enjoy a mutually fulfilling and healthy relationship, otherwise known as emotional availability (EA), is critical to establishing positive parent-child relationships (Biringen & Easterbrooks, 2012). Despite an emerging literature on the importance of bonding and EA, little is known about the predictors of the mother’s felt bond to her offspring across pregnancy and the postnatal period as well as emotional availability at infant age 12-months. Even less is known about the predictors of the relationship between partners and their infants. There are a range of factors theorised to promote bonding and EA in infancy including healthy parent-infant bonding during pregnancy and parent wellbeing (i.e., good mental health and low-risk substance use); yet these factors have not been comprehensively assessed in both mothers and their partners across the first year of life.
Aims
Four empirical studies sought to examine: (1) maternal bonding to offspring across the pregnancy and postnatal period, and to examine a broad range of sociodemographic and psychosocial predictors of the maternal-offspring bond; (2) the extent to which mother-fetal bonding, substance use and mental health through pregnancy predicted postnatal mother-infant bonding at 8-weeks; (3) the extent to which postnatal bonding, maternal mental ill-health and substance use at infant age 8-weeks predicted mother-infant bonding and mother EA at 12-months of age; and, (4) the role of mother and partner bonding, mental health and substance use at 8-weeks post-birth on mother and partner-infant EA at 12-months infant age, accounting for the correlated dyadic influence.
Methods
Using a sample of pregnant women participating in an Australian pregnancy cohort study of perinatal health and development, participants completed maternal and paternal bonding, mental health and substance use questionnaires at each trimester (one, two and three), 8-weeks and 12-months postnatal. Data was collected on a range of sociodemographic and psychosocial factors. The EA Scales were used to code the quality of interactions between mother-infant and partner-infant dyads during a 20-minute free play observational video recorded at 12-months infant age.
Results
Maternal-fetal bonding increased in quality and intensity across the pregnancy period with a plateauing of bonding representations towards the end of pregnancy. Bonding between late pregnancy and the early postnatal period remained relatively stable. Maternal-fetal bonding was the strongest predictor of maternal bonding in the postnatal period, both at 8-weeks and 12-months. Mental health and substance use also predicted both maternal and paternal relationship quality, as indicated by bonding and EA measures. Tobacco use for both mothers and partners was negatively associated with EA at 12-months.
Conclusion
The results of this thesis show that early bonding to the fetus was not only important in laying the foundation for mother-infant bonding in the early postnatal period, but also later in the postnatal period. Moreover, both maternal mental ill-health and substance use appeared to play a small yet significant role in predicting later bonding. However, it was notable that substance use occurred only infrequently in the sample and that substance abuse/dependence were not reported in this sample.
These results highlight the importance of supporting the development of a healthy bond between a mother and her fetus during pregnancy and in the early postnatal period. The results also suggest that interventions could be targeted towards parents struggling with symptoms of depression and/or substance use during pregnancy and postnatal. Interventions aimed at emotional regulation and EA promotion for young parents with a history of depression and substance use might also be helpful in strengthening the mother/partner-child relationship. There is a need for further longitudinal research continuing into the toddler and preschool years, including continued assessment of partners and the important role they play. Targeted interventions aimed at enhancing bonding have the potential to strengthen parent-infant relationships through the first year of life.
... In terms of psychological factors, higher self-reported depression and anxiety symptoms were associated with poorer mother-infant bonding. This aligns with previous research which highlights that maternal depressive symptomatology during the antenatal and postnatal periods can adversely affect the development of mother-infant bonding [40]. Importantly, women with GDM are at a 2-4 fold increased risk of developing depression in the perinatal period [11], and women who experience continuous depressive symptoms are at a higher risk for bonding disorders, which can lead to long-term implications for both maternal and infant health [41]. ...
... As the interplay between maternal mental health and bonding is complex, depressive symptoms may not only arise from bonding difficulties but may also perpetuate them and there may be a cyclical pattern of distress [40,42]. Given the differences we observed in women's depression, anxiety, and eating disorder scores between the antenatal and postnatal periods, it is important for future studies to compare these psychological factors across perinatal periods for women with GDM. ...
Objective
To explore the impact of psychological and social factors on mother‐infant bonding in women with gestational diabetes mellitus (GDM) living in the United Kingdom.
Design
A cross‐sectional online survey study conducted between November 2022 and January 2023 administered to women who self‐reported current or past (within the previous 1 year) GDM.
Methods
The survey comprised demographic and validated self‐report measures for depression, anxiety, eating disorders, perceived social support, pregnancy and birth experience, and breastfeeding. Mother‐infant bonding was measures using the Maternal Antenatal Attachment Scale for women who were currently pregnant with GDM (antenatal) and the Maternal Postnatal Attachment Scale for women with past GDM (postnatal).
Results
N = 149 women (n = 37 antenatal, and n = 112 postnatal) completed the survey. Higher anxiety and depression symptoms and managing GDM using metformin and insulin were associated with poorer mother‐infant bonding for women in both antenatal and postnatal periods. Higher social support was associated with higher mother‐infant bonding scores in women in both the antenatal and postnatal period.
Conclusion
The experience of GDM may be amplifying the known risk factors for impaired mother‐infant bonding. Targeted psychological support for women with GDM may be necessary to ensure that their emotional well‐being is addressed as part of comprehensive perinatal care.
... Individuals with relationship difficulties may experience increased stress that may affect the quality of the mother-infant bond [16]. The mother-infant bond is also adversely affected by mothers' depressive symptoms during pregnancy and after birth and by the symptoms of post-traumatic stress disorder [28][29][30][31]. ...
... The mood and anxiety of the mother closely affect the effectiveness of the attachment between the mother and the child [16,31,41,42]. ...
... Peripartum depression (PPD), which occurs in up to 19% of women, is defined as depression in late pregnancy to 1 year postpartum, 1,2 and can have negative effects on mothers and infants. 3,4 Chronic medical conditions, including neurological disorders, can be associated with increased odds for PPD (e.g. 1.45fold increase reported for neurological conditions). ...
... Untreated PPD could have substantial negative effects not only on the mother, but on the mother and infant dyad (such as altered maternal-infant bonding) and on the infant's childhood development and mental health comorbidities. 3,4 This is especially important in MS, where parental history of mental health comorbidities have previously been shown to negatively impact child development even if parental MS itself did not. 12 In general in MS, untreated depression also negatively affects quality of life and MS self-management. ...
Background
Peripartum depression (PPD) is underexplored in multiple sclerosis (MS).
Objective
To evaluate prevalence of and risk factors for PPD in women with MS.
Methods
Retrospective single-center analysis of women with MS with a live birth. Prevalence of PPD was estimated with logistic regression with generalized estimating equations (GEE). GEE evaluated predictors of PPD (e.g. age, marital status, parity, pre-pregnancy depression/anxiety, antidepressant discontinuation, sleep disturbance, breastfeeding, relapses, gadolinium-enhancing lesions, and disability). Factors significant in univariable analyses were included in multivariable analysis.
Results
We identified 143 live births in 111 women (mean age 33.1 ± 4.7 years). PPD was found in 18/143 pregnancies (12.6%, 95% CI = 7.3–17.8). Factors associated with PPD included older age (OR 1.16, 95% CI = 1.03–1.32 for 1-year increase), primiparity (OR 4.02, CI = 1.14–14.23), pre-pregnancy depression (OR 3.70, CI = 1.27–10.01), sleep disturbance (OR 3.23, CI = 1.17–8.91), and breastfeeding difficulty (OR 3.58, CI = 1.27–10.08). Maternal age (OR 1.17, CI = 1.02–1.34), primiparity (OR 8.10, CI = 1.38–47.40), and pre-pregnancy depression (OR 3.89, CI = 1.04–14.60) remained significant in multivariable analyses. Relapses, MRI activity, and disability were not associated with PPD.
Conclusion
The prevalence of PPD in MS appeared similar to the general population, but was likely underestimated due to lack of screening. PPD can affect MS self-management and offspring development, and prospective studies are needed.
... Post-partum depression (PPD) is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as a major depressive episode occurring within 4 weeks to 3-6 months postpartum. 1 Ten to 15% of mothers develop this disorder during the first 6 months after childbirth. 2 PPD affects child development by impairing mother-infant bonding and increasing the risk of developmental disorders in infants. [3][4][5] Because a poor mother-infant relationship increases the risk of psychological illness in the infants, 6,7 it is important to identify risk factors for PPD to prevent such deficits in the mother-infant relationship. ...
... 3,[34][35][36]45 In addition, maternal psychiatric disorders affect child development and the mother-infant relationship. [3][4][5] In our study, oxytocin concentration was associated with the presence of specific medical histories. However, it may be that oxytocin concentration could be used to predict the nature of mother-infant relationships. ...
Background:
Oxytocin has a key role in mother-infant bonding, maternal care, social interaction, and stress-related psychiatric disorders. However, the factors determining oxytocin concentrations during and after pregnancy such as medical history related to nursing or parental behavior are unknown. To elucidate these, we analyzed the relationships between oxytocin concentrations during and after pregnancy, and medical history assessed in the Japan Environment and Children's Study (JECS).
Methods:
We then selected the pregnant women with a medical history of anxiety disorder and endometriosis as cases and pregnant women without medical history as controls adjusting the cohort for age and parity for a nested case-control study, after which 162 women remained for analysis. We evaluated 162 pregnant women from JECS using answers provided in a questionnaire and by measuring plasma oxytocin concentration by ELISA during the first (T1) and second (T2) trimesters of pregnancy, and after childbirth (T3).
Results:
Oxytocin concentration increased in a time dependent manner, consistent with previous reports. There were weak negative correlations between oxytocin concentration at T1 and the mother's age and height, but no correlation with other factors. The mean oxytocin concentrations of pregnant women with a history of an anxiety disorder (n = 7) and endometriosis (n = 13) were significantly lower than those of pregnant women with no such history at T2 and T3.
Conclusion:
These results suggest that oxytocin concentrations during and after pregnancy were affected by a past history of anxiety disorder and endometriosis. This is the first study of the relationship between oxytocin concentration and endometriosis. To elucidate the molecular mechanisms, further study is needed.
... 24 PPF is also strongly correlated with postpartum depression, 25 which is associated with weaker mother-infant bonding. 26 This review has limitations, primarily due to the paucity of literature on PPF. Furthermore, the lack of standardized measures for assessing PPF also hinders comparisons with the well-documented metrics used in MS fatigue studies. ...
Postpartum fatigue (PPF) is a common issue affecting mothers, characterized by reduced capacity for physical and mental activity in the weeks to months following delivery. While often attributed to the demands of infant care, severe or atypical PPF can signal an underlying medical condition, such as multiple sclerosis (MS). In this narrative review, guidance is provided to clinicians on recognizing signs of severe or atypical PPF, differentiating it from MS-associated fatigue. Patients’ qualitative descriptions of fatigue, its intensity, and specific triggers can be particularly informative, as MS fatigue is severe, recurrent, often refractory to rest, and/or exacerbated by high temperatures. By identifying such cases early, healthcare providers can support timely diagnosis and intervention, ultimately improving outcomes for women who may be at risk for MS.
... In the literature (Table 1), there are very few studies that have investigated the personality variable in women with high-risk pregnancies [14], while studies on the presence of depression and prenatal attachment as two variables capable of determining psychoevolutionary outcomes in the postpartum period are much more widespread [15][16][17][18][19]. Table 1. ...
Background: The observational study investigates how personality factors influence depression , prenatal attachment, and fear of COVID-19 in women with high-risk pregnancies. Methods: Women experiencing a high-risk pregnancy between the 20th and 24th weeks of gestation (N = 84) were selected. The Personality Inventory (PI), Beck Depression Inventory (BDI), Prenatal Attachment Inventory (PAI), and Fear of COVID (FCV-19S) were used for data collection. Results: Agreeableness was significantly negatively correlated with fear of COVID-19 (r = −0.33, p = 0.002) and positively correlated with prenatal attachment (r = 0.28, p = 0.008). Conscientiousness was negatively correlated with prenatal attachment (r = 0.34, p = 0.001). Depression was positively correlated with fear of COVID-19 (r = 0.27, p = 0.013). Linear regressions showed that agreeableness negatively predicted fear of COVID-19 (β = −0.34, p = 0.002) and positively predicted prenatal attachment (β = 0.27, p = 0.008). Conscientiousness negatively influenced prenatal attachment (β = −0.35, p = 0.001). Conclusions: This study explores personality traits in high-risk pregnancies, a variable underexplored in this clinical population. High-risk pregnancies may lead to adverse outcomes for both mother and child.
... Similarly, another key factor that needs to be considered when observing mother-infant interaction is maternal mental health. Critically, a line of research focusing on the impact of maternal mental health on mother-infant interactions shows how these interactions are affected in clinical as well as sub-clinical samples [15][16][17][18]. For example, Cohn et al. [19] reported that depressed mothers have longer latencies in terms of maternal responsivity towards the infant, indicating a lack of synchrony during interactions. ...
This longitudinal study investigated the associations between mother-infant interaction characteristics at 9 months of age, maternal mental health, infant temperament in the first year postpartum, and child behaviour at 3 years of age. The infants (N = 54, 22 females) mainly had White British ethnic backgrounds (85.7%). Results showed that i) mother-infant dyadic affective mutuality positively correlated with infant falling reactivity, suggesting that better infant regulatory skills are associated with the dyad’s ability to share and understand each other’s emotions; and ii) maternal respect for infant autonomy predicted fewer child peer problems at 3 years of age, suggesting that maternal respect for the validity of the infant’s individuality promotes better social and emotional development in early childhood.
... In recent academic studies, the interest in prenatal attachment has been increasing gradually because it affects the whole life, although it starts during pregnancy. There are many studies in the literature investigating the effect of attachment levels on both mother and fetus (Dubber et al., 2015;Ohoka et al., 2014;Ranson & Urichuk, 2008;YEŞİLÇINAR et al., 2021). Studies have reported that low prenatal attachment is associated with preterm birth, low birth weight, early termination of breastfeeding in the postpartum period (Alhusen et al., 2012), increased levels of postpartum depression and anxiety in the mother (Dubber et al., 2015), and deterioration in the mother-infant relationship (Della ÖZ Amaç: Term gebelik ve miad aşımı gebelik döneminde olan gebelerin obstetrik ve sosyodemografik özelliklerinin yanı sıra anksiyete ve bağlanma düzeylerini karşılaştırması. ...
Introduction and Aim: To compare anxiety and attachment levels besides obstetric and sociodemographic characteristics between late term and non-late term pregnant. Methods: This cross-sectional descriptive study was conducted on 49 pregnant women who were over 41 weeks of pregnancy as late-term pregnancy group and 67 pregnant women who were 37-41 weeks of pregnancy were included in the study as control group. Data were collected using demographic and obstetrics data form, Pregnancy-Related Anxiety Questionnaire-Revised-2, and prenatal attachment scale. Results: The prenatal attachment scale median score of late term pregnant women was 68 (39-81) and the anxiety scale median score was 28 (13-55). The median score of the prenatal attachment scale for may not affect the non-late term pregnant women was 64 (30-84), and the median score of the anxiety scale was 26 (11-43). There was no statistically significant difference between the two groups in terms of scale scores (p>0.05). Conclusions: It was found that prenatal attachment and anxiety levels were not affected by the late term state of pregnant women in this study. In the presence of other conditions that positively
affect attachment, although late term pregnancy is risky , it did not have an effect on attachment and anxiety .
... In recent academic studies, the interest in prenatal attachment has been increasing gradually because it affects the whole life, although it starts during pregnancy. There are many studies in the literature investigating the effect of attachment levels on both mother and fetus (Dubber et al., 2015;Ohoka et al., 2014;Ranson & Urichuk, 2008;YEŞİLÇINAR et al., 2021). Studies have reported that low prenatal attachment is associated with preterm birth, low birth weight, early termination of breastfeeding in the postpartum period (Alhusen et al., 2012), increased levels of postpartum depression and anxiety in the mother (Dubber et al., 2015), and deterioration in the mother-infant relationship (Della ÖZ Amaç: Term gebelik ve miad aşımı gebelik döneminde olan gebelerin obstetrik ve sosyodemografik özelliklerinin yanı sıra anksiyete ve bağlanma düzeylerini karşılaştırması. ...
Introduction and Aim: To compare anxiety and attachment levels besides obstetric and sociodemographic characteristics between late term and non-late term pregnants. Methods: This cross-sectional descriptive study was conducted on 49 pregnant women who were over 41 weeks of pregnancy as late-term pregnancy group and 67 pregnant women who were 37-41 weeks of pregnancy were included in the study as control group. Data were collected using demographic and obstetrics data form, Pregnancy-Related Anxiety Questionnaire-Revised-2, and prenatal attachment scale. Results: The prenatal attachment scale median score of late term pregnant women was 68 (39-81) and the anxiety scale median score was 28 (13-55). The median score of the prenatal attachment scale for may not affect the non-late term pregnant women was 64 (30-84), and the median score of the anxiety scale was 26 (11-43). There was no statistically significant difference between the two groups in terms of scale scores (p>0.05). Conclusions: It was found that prenatal attachment and anxiety levels were not affected by the late term state of pregnant women in our study. In the presence of other conditions that positively affect attachment, although late term pregnancy is risky, it did not have an effect on attachment and anxiety.
... Bonding, is the process of developing an attachment and tie between newborn and mother (Ohoka et al., 2014). According to Bowlby (1982), attachment is defined as "a strong disposition to seek proximity to and contact with a specific figure and to do so in certain situations, notably when frightened, tired or ill". ...
... The mental health of participants was assessed using the Kessler Psychological Distress Scale (K6) [17] at mid-pregnancy (start of the study) and immediately after giving birth (i.e., within 5 days after giving birth), as well as at 1 month after giving birth, using the EPDS and the MIBS [18,19]. In addition, maternal blood was collected in early pregnancy (around gestational week 12), mid-pregnancy (around gestational week 28), late pregnancy (around gestational week 36), and the day after giving birth, while cord blood and colostrum (milk produced within 5 days after giving birth) were collected for fatty acid composition analysis. ...
We investigated the postpartum mental health of women who had consumed perilla oil or fish oil containing various omega-3 fatty acids for 12 weeks starting in mid-pregnancy. The association between fatty acids in maternal erythrocytes and mental health risk factors was also examined. Healthy Japanese primiparas in mid-pregnancy (gestational weeks 18–25) were randomly divided into two groups and consumed approximately 2.0 g/day of omega-3 fatty acids in either perilla oil (the ALA dose was 2.4 g/day) or fish oil (the EPA + DHA dose was 1.7 g/day) for 12 weeks. Maternal mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS) as the primary measure and the Mother-to-Infant Bonding Scale (MIBS) as the secondary measure. Data from an observational study were used as a historical control. Maternal blood, cord blood, and colostrum samples were collected for fatty acid composition analysis. In addition, completers of the observational studies were enrolled in a case–control study, wherein logistic regression analysis was performed to examine the association between maternal fatty acids and EPDS score. The proportion of participants with a high EPDS score (³9) was significantly lower in the perilla oil group (12.0%, p = 0.044) but not in the fish oil group (22.3%, p = 0.882) compared with the historical control (21.6%), while the proportions between the former groups also tended to be lower (p = 0.059). No marked effect of omega-3 fatty acid intake was observed from the MIBS results. In the case–control study of the historical control, high levels of α-linolenic acid in maternal erythrocytes were associated with an EPDS score of < 9 (odds ratio of 0.23, 95% confidence interval: 0.06, 0.84, p = 0.018 for trend). The results of this study suggest that consumption of α-linolenic acid during pregnancy may stabilize postpartum mental health.
... Studies have consistently linked maternal depressive symptoms to impaired mother-to-infant bonding postpartum [9][10][11][12][13][14]. Indeed, research indicates that even subclinical depressive symptoms can negatively affect the developing maternal-infant bond during the first months postpartum [15,16]. ...
A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman’s correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother’s MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.
... Depressive symptoms during the antenatal period emerged as a significant predictor of both postnatal maternal attachment and postnatal maternal competence. Previous studies have documented that depression during pregnancy especially during the last trimester negatively influences the development of maternal attachment and competence during the early postnatal period (Shorey et al. 2015;Choi et al. 2010;Goecke et al. 2012;Ohoka 2014;Rossen et al. 2016;Zheng et al. 2018). Some studies have shown strong association between antenatal depression and unrealistic expectations about one's maternal role during the transition to motherhood which in turn influences the formation of confident maternal identity (Craig and Howard 2009;Davey et al. 2011). ...
The aim of this study is to examine the influence of antenatal factors such as anxiety, depression, perceived stress, marital satisfaction, maternal antenatal attachment, and social support on postnatal maternal attachment and competence in women who received assisted reproductive treatment. A prospective longitudinal cohort design was adopted with two groups—50 women who received assisted reproductive treatment and 50 women who had natural conception. Both the groups were assessed using self-report measures over three time points: T1, 7th month of pregnancy; T2, 2 weeks postpartum; and T3, 3 months postpartum. A final sample of 44 women who had assisted conception and 47 women who had natural conception completed assessments across all three time points. Descriptive, bivariate analyses, and stepwise multiple linear regression analyses were carried out. In the assisted conception group, maternal antenatal attachment, depression, and marital satisfaction significantly predicted postnatal maternal-infant attachment. Perceived social support, depression, and duration of marriage significantly predicted postnatal maternal competence. In the naturally conceived group, maternal antenatal attachment and social support significantly predicted postnatal maternal-infant attachment; perceived stress significantly predicted postnatal maternal competence. Antenatal depressive symptoms and relational factors significantly influenced postnatal maternal attachment and competence highlighting the need for screening and targeted psychological interventions during pregnancy.
... Furthermore, untreated mental disorders in the mothers can affect the mother-child-bonding [14]. The study of Ohoka et al. showed that the mother-to-infant-bonding is less pronounced in women who suffer from depression during pregnancy, furthermore, that bonding decreased after delivery, and then went up at 1 month postpartum [15]. The negative effects on children's development caused by low mother-child bonding are well known [16]. ...
Background
Pregnancy and the postpartum period are times when women are at increased risk for depression and mental problems. This may also negatively affect the foetus. Thus, there is a need for interventions with low-threshold access and care. Telemedicine interventions are a promising approach to address these issues. This systematic literature review examined the efficacy of telemedicine interventions for pregnant women and/or new mothers to address mental health-related outcomes. The primary objective was to analyse whether telemedicine interventions can reduce mental health problems in pregnant women and new mothers. The secondary aim was to clarify the impact of type of interventions, their frequency and their targets.
Methods
Inclusion criteria: randomized controlled trials, with participants being pregnant women and/or new mothers (with infants up to twelve months), involving telemedicine interventions of any kind (e.g. websites, apps, chats, telephone), and addressing any mental health-related outcomes like depression, postnatal depression, anxiety, stress and others. Search terms were pregnant women, new mothers, telemedicine, RCT (randomised controlled trials), mental stress as well as numerous synonyms including medical subject headings. The literature search was conducted within the databases PubMed, Cochrane Library, Web of Science and PsycINFO. Screening, inclusion of records and data extraction were performed by two researchers according to the PRISMA guidelines, using the online tool CADIMA.
Results
Forty four articles were included. A majority (62%) reported significantly improved mental health-related outcomes for participants receiving telemedicine interventions compared to control. In particular (internet-delivered) Cognitive Behavioural Therapy was successful for depression and stress, and peer support improved outcomes for postnatal depression and anxiety. Interventions with preventive approaches and interventions aimed at symptom reduction were largely successful. For the most part there was no significant improvement in the symptoms of anxiety.
Conclusion
Telemedicine interventions evaluated within RCTs were mostly successful. However, they need to be designed to specifically target a certain mental health issue because there is no one-size-fits-all approach. Further research should focus on which specific interventions are appropriate for which mental health outcomes in terms of intervention delivery modes, content, target approaches, etc. Further investigation is needed, in particular with regard to anxiety.
... The postpartum period is characterized by the vulnerability of primiparous women to stress. Postpartum stress not only impairs the health of primiparous women but also reduces their self-esteem, impedes adaptation to the role of mother, and impairs maternal bond with the baby [2]. Common stressors of the postpartum period include breastfeeding problems, sleep deprivation, fatigue, responsibility for caring for the baby, hormonal changes, and lack of social support [3]. ...
Abstract Background Primiparous women experience various challenges if not provided with social support in the early postpartum period. Support in form of postpartum education programs is needed to improve mental well-being in primiparous women. The aim of this study was to determine the effect of a postnatal supportive education program for husbands on the perceived social support (primary outcome), and stress and maternal self-efficacy (secondary outcome) of their primiparous wives. Methods This randomized clinical trial was performed on pregnant women referring to healthcare centers for routine care from September to November 2021 in Kermanshah, Iran. One hundred pregnant women were randomly divided in to intervention and control groups. Four 45–90 min online training sessions were held weekly for the husbands of the intervention group. The primiparous women completed the Postpartum Partner Support Scale, Perceived Stress Scale, and Postpartum Parental Expectations Survey before (third day after delivery, immediately and one month after completing the intervention. Data were analyzed using Fisher's exact test, Chi-square test, independent t-test, and repeated measures analysis of variance in SPSS version 24, and p 0.05), the mean scores of perceived social support (P = 0.11), maternal self-efficacy (p = 0.37) and perceived stress (p = 0.19) were not statistically significant. However, in the intervention group compared to the control group the mean scores of perceived social support (79.42 ± 7.17 vs. 37.26 ± 7.99, P
... Life-enhancing bonding is what provides the human beings with information that will keep them free from mental pathologies like schizophrenia, mania, or depression (Ohoka et al. 2014;Meltzer-Brody 2011), maybe even post-partum depression (Taylor, Atkins, Kumar, Adams, & Glover 2005), or from physical pathologies. ...
Bonding is more than a lifelong process. It is a process that begins long before conception. In a broader context, this process begins with the dawn of the cosmos itself. Bonding is the linking process that bridges the prenatal and postnatal stages and prepares the child to connect securely and meaningfully with the world and life on earth. This article highlights aspects of bonding in the pre-conception and conception periods, as well as in pregnancy and birth, so that connections can be made to pre-, gestational, then peri-, and postnatal growth. A list of bonding support issues accompanies the consideration of parent and child development within the psychocultural, spatial, and temporal environments so that taking responsibility for personal health and growth at different stages becomes possible. In summary, bonding is about strengthening the life-enhancing polarity over the life-diminishing polarity.
... However, their sample did not include NICU mothers. 25,26 It is well documented that maternal mental health can affect the early mother-infant relationship 27,28 and that maternal mood can limit the development of bonding. 22 One of the strengths of our study was that depressive symptoms and bonding were assessed in 2 diverse groups (NICU and non-NICU mothers), which enabled differences between these groups to be highlighted and thus provide a broader explanation of this research topic. ...
Objectives
Maternal perinatal depression has been associated with impaired mother-infant bonding. The adverse effect of this impaired bonding has been reported. This study aimed to investigate and compare the posnatal depressive symptoms and the mother-infant bonding in a Neonatal Intensive Care Unit (NICU) and of mothers with healthy newborns respectively. Secondly, was to explore the association between depressive symptomatology and bonding in both groups.
Methods
In this case study, mothers in the early pospartum period who gave birth in the same perinatal center of Greece were recruited to participate. The cases consisted of 88 mothers of neonates who were hospitalized in the NICU and controls were 100 mothers of full-term healthy neonates. For the collection of the data questionnaires including demographics and perinatal variables were used. For the bonding and posnatal assessment, the Mother to Infant Bonding Scale, the Postpartum Bonding Questionnaire, and the Hospital Anxiety and Depression Scale were used.
Results
There was a significant difference between the mean of bonding scores of NICU mothers and the control group (t = −2.696, P = 0.008). NICU mothers presented lower scores in bonding with the newborn compared to the control group and presented higher depression scores compared to those of controls (χ² = 28.588, P = 0.000). The depression scores were correlated with bonding scores in both groups.
Discussion
A NICU admission has an impact on bonding and in some way interacts with maternal pospartum mental health, therefore more research is needed.
Conclusions
NICU mothers have been presented as more vulnerable than mothers of healthy infants since they expressed a lower mother-infant bonding and higher depression scores. The support of these vulnerable mothers and the facilitation of mother-infant bonding by the NICU staff is of utmost importance.
... Societal expectations for breastfeeding mothers may play an important role in understanding mothers' feelings of guilt and failure related to early weaning, identifying breastfeeding as the "gold standard" of nutrition, and a picture of optimal mothering (Kestler-Peleg et al., 2015). Evidently, maternal bonding disorder can lead to impaired maternal-newborn attachment (Ohoka et al., 2014). The impaired bond could significantly affect a child's developmental milestone, hindering their basic needs and attention. ...
Background: At the time that the mother and baby transit from breastfeeding to weaning, maternal-fetal attachment becomes a crucial basis for maintaining their emotional relationship. Conceptualization is needed to better understand the phenomenon of maternal-infant attachment during the weaning process.
Objective: The purpose of this paper is to explore and identify the essence of the term maternal-infant attachment during weaning and to arrive at an operational definition of the concept.
Method: Concept analysis following Walker and Avant.
Results: The attributes of maternal-infant attachment during the weaning process include (1) consistent and properly timed, (2) dynamic transactional interaction, and (3) secured adjustment. Maternal-infant attachment during the weaning process is brought by maternal sensitivity, closeness and proximity seeking, gentle and positive weaning, and breastfeeding experiences, which later turn into favorable emotion regulation, maturity, self-efficacy, secured bond, less intrusive interaction, resilience, and child’s behavioral and development.
Conclusion: This concept analysis provides new insight into maternal-infant attachment during the weaning process that guides the nursing practice. Also, the findings can help develop or improve the models, theories, and instruments collected for maintaining maternal-fetal attachment during the weaning process.
... Other studies demonstrated that not only PPD but also depressive symptoms are related to impaired mother-infant bonding (Moehler et al., 2006;Edhborg et al., 2011;Hairston et al., 2011;Tietz et al., 2014;Dubber et al., 2015;Garcia-Esteve et al., 2016;Kasamatsu et al., 2020;Nakić Radoš et al., 2020). According to some studies addressing multiple risk factors, both the history of depression Badr et al., 2018) and depression in pregnancy (Ohoka et al., 2014;Daglar and Nur, 2018) along with PPD, have been associated with impaired mother-infant bonding. Similarly, in one study, clinically defined maternal depressive disorder during pregnancy is shown to negatively impact maternal-fetal bonding (McFarland et al., 2011), suggesting that the basis for poor mother-infant bonding in PPD may have roots in pregnancy (Lefkovics et al., 2014). ...
Introduction
History of depression symptoms, including before and during pregnancy, has been identified as an important risk factor for postpartum depression (PPD) symptoms. This condition has also been associated with diverse implications, namely, on the quality of mother–infant bonding. Moreover, the role of self-criticism on PPD has been recently found in several studies. However, the link between these factors has not been explored yet. Furthermore, anxiety symptoms in postpartum has been less studied.
Methods
This study analyzed whether the history of depression symptoms predicted mother–infant bonding, via self-criticism and PPD symptoms. The same model was repeated with a history of anxiety and postpartum anxiety symptoms. A total of 550 mothers of infants <24 months old participated in this cross-sectional study and answered an online survey.
Results
Through a parallel–serial mediation model, the results show that in a first step, self-criticism dimensions of inadequate-self, hated-self, and reassuring-self, and in a second step, PPD symptoms, mediate the relationship between the history of depression symptoms and mother–infant bonding. However, the relationship between the history of anxiety symptoms and bonding is not mediated by all the considered chain of mediators, being only mediated by one of the self-criticism dimensions, inadequate self.
Conclusions
The current study confirmed the association of history of both depression and anxiety with mother–infant bonding. While in the case of history of anxiety symptoms, the relation was only mediated by inadequate self-dimension of self-criticism, in the case of history of depression symptoms, the relation was mediated by self-criticism and postpartum depressive symptoms. The buffering effect of reassuring-self on bonding and negative affect was also evidenced. Psychological and preventive interventions should address this evidence to target interventions for mother–infant bonding problems in accordance with previous and actual current maternal risk factors.
... The risk of postpartum depression is four times higher in women dissatisfied with their body image compared to those who are satisfied (Silveira et al. 2015;Riquin et al. 2019). Postpartum depression is associated with negative long-term consequences on a child's cognitive and emotional development (Ohoka et al. 2014). Furthermore, weight gain, as it occurs in pregnancy, can prompt individuals to start using compensatory weight control behaviors, which are often the first symptoms to emerge as people show the onset of an eating disorder (Stice et al. 2021). ...
The normal physical changes associated with pregnancy may increase the risk of body dissatisfaction, which is associated with negative mental health outcomes including depression and disordered eating. The purpose of this study was to explore body image and eating concerns among a sample of participants in pregnancy and postpartum and to assess interest and suggestions for a relevant intervention. This was a cross-sectional survey study requiring 10–15 min to complete. Individuals were eligible to participate in the study if they were pregnant or within 1 year postpartum, between the ages of 18 and 45, able to read and write in English, and provided online informed consent. The survey included measures and open-text questions to explore body image, eating behaviors, and related concerns in the perinatal period and to inform the development of an intervention. There were 161 participants, and over 50% were dissatisfied with their body image; 52% were among pregnant participants and 56.2% of postpartum participants. Approximately 80% reported that they would have appreciated the opportunity to participate in a program focused on body acceptance or expectations of body changes in pregnancy and postpartum. We identified intervention preferences as well as commonly reported themes regarding experiences of body image and eating concerns in pregnancy and postpartum. Body dissatisfaction and eating concerns are prevalent issues in pregnancy and postpartum, and our findings underscore an opportunity to tailor an intervention relevant to body image and disordered eating for the perinatal population.
... Postpartum depression (PPD) is a widespread emotional disorder with powerful short-and long-term effects on mothers' and infants' cognitive and emotional development (Ohoka et al., 2014). Symptoms include sadness and hopelessness, uncontrollable crying, suicidal ideation, and mothers' obsessive thoughts of harming their own infants (Kamperman, et al., 2017). ...
Objective
To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel.
Methods
We conducted a non-randomized controlled trial at two women’s health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26–38 weeks of pregnancy (Time 1) and one 2–4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic.
Results
The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003).
Conclusions
In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women’s clinics during pregnancy.
Clinical Trial Registry
ClinicalTrials.gov NCT02862444.
... 3 Studies have shown that women with unwanted pregnancies fail to make an emotional relationship and maternal-fetal attachment. 4 The initial relationship between mother and fetus before delivery is described as the maternalfetal attachment. A mother who becomes attached to her fetus during pregnancy is ready to establish a pleasurable relationship with the newborn after delivery. ...
Background: The present study aims to investigate the effect of progressive muscle relaxation intervention with imagery-based relaxation technique on the mental health and maternal-fetal attachment in women with a first unwanted pregnancy. Methods: From all the pregnant women referred to the clinics of Semnan city, 60 individuals were purposefully selected and randomly divided into two groups of experimental and control. The mothers of the experimental group received the corresponding intervention, while the control group was only provided with normal care. Before and after the intervention, the general health and maternal-fetal attachment questionnaires were filled by the individuals. Results: The results of the multivariate analysis of covariance indicated that a relaxation intervention period can significantly improve the mental health and maternal-fetal attachment as well. Conclusions: According to the present results, it can be concluded that the current intervention can be used as a low-cost and non-pharmacological method to improve the psychological issues and arrive at a higher maternal-fetal attachment during the pregnancy.
... Infant and maternal mortality rates in Japan are the lowest in the world. In contrast, it has been reported that 9.8% of women experience postpartum depression [1], which contributes to increased prevalence of child abuse and suicide in mothers [2], and disorders in the formation of mother-infant attachment [3]. Furthermore, an antepartum depressive state could be related to a postpartum one [4,5]. ...
... De acuerdo con los resultados del presente estudio, los estudios previos han demostrado que las puntuaciones sobre depresión y vínculo guardaban una correlación positiva. Sin embargo, su muestra no incluyó madres de la UCIN 25,26 . Está bien documentado que la salud mental de la madre puede afectar a la relación temprana madre-hijo 27,28 , así como que el estado anímico de la madre puede limitar el desarrollo del vínculo 22 . ...
Resumen
Objetivos
Se ha asociado la depresión perinatal de la madre a un vínculo madre-hijo deficiente. Se ha reportado el efecto adverso de la deficiencia de dicho vínculo. El objetivo de este estudio fue investigar y comparar los síntomas depresivos posnatales y el vínculo madre-hijo en una Unidad de Cuidados Intensivos Neonatales (UCIN), y las madres con neonatos sanos, respectivamente. Y, en segundo lugar, explorar la asociación entre la sintomatología depresiva y los vínculos en ambos grupos.
Métodos
En este estudio de casos se seleccionó a madres que se encontraban en el periodo posparto temprano, que habían dado a luz en el mismo centro perinatal de Grecia. Los casos consistieron en 88 madres de neonatos que fueron hospitalizados en la UCIN y 100 controles, consistentes en madres de neonatos sanos a término. Para la recopilación de los datos se utilizaron cuestionarios que incluían datos demográficos y variables perinatales. Para la evaluación del vínculo y la situación posnatal, se utilizaron la Mother to Infant Bonding Scale, el Postpartum Bonding Questionnaire y la Hospital Anxiety and Depression Scale.
Resultados
Existió una diferencia significativa entre las puntuaciones sobre el vínculo de las madres de la UCIN y el grupo control (t = –2,696, p = 0,008). Las madres de la UCIN presentaron menores puntuaciones en términos de vínculo con los neonatos, en comparación con el grupo control, y presentaron puntuaciones más altas de depresión en comparación con los controles (χ² = 28,588, p = 0,000). Las puntuaciones sobre depresión guardaron relación con las puntuaciones sobre vínculos en ambos grupos.
Discusión
El ingreso en la UCIN tiene un impacto sobre el vínculo e interactúa de alguna manera con la salud mental posparto de la madre. Por ello se hace necesaria más investigación.
Conclusiones
Las madres de la UCIN se han mostrado más vulnerables que las madres de bebés sanos, ya que han expresado un menor vínculo madre-hijo y puntuaciones más altas de depresión. El apoyo a estas madres vulnerables y la facilitación de vínculos madre-hijo por parte del personal de la UCIN es de la mayor importancia.
... General symptoms of depression is: include fatigue, depressed mood, marked change in appetite or weight, loss of interest in most activities, insomnia or oversleeping, feelings of worthlessness or guilt, decreased concentration, death or suicide scars [6], agitation Acceptability, fear, lack of confidence, anger [7]. Maternal depression leads to: Decreased maternal self-care, inadequate nutrition during pregnancy, substance abuse, use of harmful substances to the fetus, spontaneous abortion, preeclampsia and postpartum depression [8], prematurity, low birth weight and infant death [9], the child's cognitive disorders (10), mother-infant relationship disorder [11], suicide [12] and parenting become dysfunctional [13]. Depressed women are unable to meet their social and emotional needs and their children are more prone to anxiety disorders and depression [14]. ...
Introduction: Depression can have unfavorable complications for the mother and the baby. Given the probable relationship of social support with the amount of depression, the present study aimed to determine the relationship between perceived social support and depression, before and after cesarean in the pregnant women referring to Besat Hospital in Sanandaj in 2018. Materials and methods: The present study is descriptive co-relational and cross-sectional, and was conducted on 180 pregnant women enrolled for the cesarean section referring to Besat hospital in 2018 who were selected according to available sampling method. The demographic information questionnaire, the perceived social support of MOS-SSS, and the depression, questionnaires Dass 21 were used to collect data. Using the SPSS 16 software, the data was analyzed through descriptive statistics, Pearson co-relation. Results : Results indicated that the degree of the overall rate of depression, before cesarean was 35.5% and in the post operation stage 21.7% respectively. In addition, there was a negative significant difference between social support and depression, before the operation (p<0.05, r=-0.816), and depression, after cesarean (P<0.05, r=-0.788). Conclusion: The results of the study showed that there is a negative and significant relationship between perceived social support and depression, before and after cesarean section. Hence it is advised that interventions be designed to identify and promote the level of social support in the pregnant women enrolled for Cesarean.
... As mentioned above, maternal anxiety or depression during the perinatal period are associated with negative influences on the mother-infant relationship, with diminished maternal responsiveness, sensitivity or emotional availability widely considered to interfere with mutual interactional synchrony between the dyad (Murray, 1992;Beck, 1995;Brummelte & Galea, 2016;Field, 2017). Consequently, PPD may cause difficulties in mother-infant bonding, in some cases leading to indifference to their newborn infant (Ohoka et al., 2014), lack of affection, and even abuse or neglect (Kumar, 1997). Mothers with postpartum depression may also be more likely to struggle with breastfeeding and to stop sooner (Dennis & McQueen, 2007, possibly adding further pressure to mother-infant interactions. ...
PhD thesis about maternal experience of childbirth, infant behaviour and early temperament
... Postpartum women are especially important to examine in considering the impact of the pandemic given the potential negative effects not only on them but also on their children. Data evaluating postpartum mental illnesses demonstrate negative impacts on infant social and behavioral development (Murray 1992) and mother-child attachment (Ohoka et al. 2014). Additionally, evidence suggests children of mothers who experienced postpartum mental illnesses are at increased risk of developing their own emotional, behavioral, or cognitive problems (Bauer et al. 2015). ...
This study compared postpartum and control women on depressive, anxiety, and OCD-type symptoms, and eating disorder symptoms during the 2019-nCOV pandemic and evaluated if associations between 2019-nCOV distress and these mental health symptoms differed for postpartum compared to control women. A community sample of women, ages 18–39, who had either given birth in the past 12 months (n = 232) or had no pregnancy history (n = 137; controls), was recruited to complete an online survey about their depressive, anxiety, OCD, and eating disorder symptoms. Postpartum women reported greater OCD-type symptoms related to concerns about both contamination and responsibility for harm (ps < .05) compared to controls. After controlling for general stress and mental health history, the association between 2019-nCOV distress and OCD-type symptoms related to concerns about contamination was stronger among postpartum compared to control women (ps < .002). For all women, 2019-nCOV distress was positively related to general anxiety symptoms, total OCD-type symptoms, and OCD-type symptoms related to concerns about responsibility for harm after controlling for general stress and mental health history (ps < .03). Data are first to suggest postpartum women may be at elevated risk for OCD-type symptoms during 2019-nCOV pandemic, and pandemic distress is associated with anxiety and OCD-type symptoms among postpartum women more so than control women.
... While the EPDS is a quick informative clinical screening tool for PND, the EPDS also assesses symptomatology of several other major psychiatric illnesses including anxiety, bipolar disorder, posttraumatic stress disorder, and obsessive compulsive disorder (Lydsdottir et al., 2014). Furthermore, the EPDS does not assess for all symptoms of depression, with some prior research solely using a variety of EPDS cutoff scores to categorize women with and without PND (O'Higgins et al., 2013;Ohoka et al., 2014). This is one of the first studies to include a semistructured research interview specifically for anxiety (i.e., the HAM-A) and semistructured research diagnostic interview (i.e., SCID) in addition to the EPDS, improving research rigor. ...
Background
Peripartum depression (PND) impairs mother–infant boding and perceived social support, yet limited research has examined if women at‐risk for PND (AR‐PND) also experience impairment. We examined if pregnant women AR‐PND, women with PND, and healthy comparison women (HCW) differed in their mother–infant bonding and social support. As PND is highly comorbid with anxiety, we also examined if peripartum anxiety impacted postpartum diagnosis of PND.
Methods
A total of 144 pregnant women AR‐PND or euthymic were assessed twice antepartum and twice postpartum. We utilized regression models to examine the impact of PND risk group status and diagnostic status on mother–infant bonding and perceived social support postpartum. We conducted a sensitivity analysis using a generalized estimating equations model to determine if anxiety (Hamilton Anxiety Rating Scale, HAM‐A) across all four time points was associated with the postpartum diagnosis of PND.
Results
Women AR‐PND experienced significantly worse mother–infant bonding compared to HCW (p = .03). Women diagnosed with PND experienced significantly worse mother–infant bonding and social support compared to HCW (p = .001, p = .002, respectively) and to those who were at‐risk for but did not develop PND (p = .02, p = .008, respectively). HAM‐A severity at each visit was associated with PND diagnosis status, where each increase in HAM‐A was associated with 15% increased odds of being diagnosed with PND postpartum.
Conclusions
Both women AR‐PND and those with PND experience worse mother–infant bonding. Peripartum anxiety should also be assessed as it represents a marker for later PND.
... It is estimated, that approximately 3-5% of women with PPD experience remission of their symptoms, indicating nearly 95% of women with PPD are not successfully treated [11]. Consequences associated with depression during the postnatal period (variably defined) include lack of attachment and bonding with the infant [2,12,13], significant impairment in maternal function including breastfeeding [14,15], maternal health issues [16], increased risk of unintentional injury for the infant [17], emotional and behavioral issues that emerge or persist during childhood [18,19], delays in the child's cognitive and language development [20], and depressive symptoms for the partner [21,22,23]. Additionally, the presence of maternal PPD is associated with higher health resource utilization and economic burden among children of mothers with PPD [24]. ...
Objective: To quantify the economic burden of postpartum depression (PPD) that accrues to commercially insured households in the year following childbirth.
Methods: Administrative claims data from OptumHealth Care Solutions (2009-2016) were used to identify households that included women identified with PPD per the algorithm and propensity score–matched comparison households of women who were not identified with PPD or a history of depression after childbirth. Study outcomes included direct total all-cause medical and pharmaceutical costs during the first year following childbirth and number of outpatient visits at the household level stratified by household member.
Results: Households affected by PPD as identified by the algorithm (N = 7,769) incurred 22% higher mean total all-cause medical and pharmaceutical spending than unaffected matched controls (N = 41,308) during the first year following childbirth (29,448, P <0.01) and an average of 16 more outpatient visits than unaffected households (P <0.01). Costs accrued by mothers comprised the largest share (>50%) of total all-cause spending. Mothers identified with PPD had significantly higher annual mean direct total all-cause medical and pharmaceutical spending than their matched controls without PPD (15,410, P <0.01), driven primarily by an average of 11 more outpatient visits than unaffected mothers (P <0.01).
Conclusions: Households affected by PPD as identified by the algorithm incurred higher mean total all-cause medical and pharmaceutical spending during the first year following childbirth than did their matched controls identified without PPD, but not all costs were attributable to maternal treatment for PPD. These findings contribute to a better understanding of the potential economic burden associated with PPD and demonstrated costs may extend beyond the mother to members of the household.
Objective: The objective of this study was to clarify whether the marital relationships during pregnancy predict bonding during child-rearing.
Methods: We sent questionnaires to 11,910 pregnant mothers and fathers aged 20 years and older. The questionnaire consisted of the demographic data, Quality Marriage Index, Mother-to-Infant Bonding Questionnaire, and Edinburgh Postpartum Depression Scale. The survey periods were pregnancy, one week after childbirth, one month after childbirth, and four months after childbirth. Hierarchical multiple regression analysis was performed with bonding four months after childbirth as the dependent variable to clarify whether the marital relationship of each mother and father predicts bonding.
Results: We enrolled 172 mothers and 141 fathers who answered all the items of the questionnaire. The marital relationships during pregnancy predicted the bonding of mothers and fathers during four months after childbirth, even after considering depression (Mothers: β = –0.210, p < 0.01, Fathers: β = –0.199, p < 0.05).
Conclusion: The findings revealed that a good marital relationship during pregnancy is a contributing factor to the formation of good bonding during the four months after childbirth, and suggested the necessity of a good marital relationship during pregnancy.
Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2-4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.
Nurturing relationships are crucial for adaptive child development. The objectives of the study were to investigate whether nature availability was associated with early nurturing parenting practices, mother-infant bonding, and infant socioemotional function. Data were from the Australian Temperament Project ( n = 809 infants to 515 parents residing in Victoria, Australia) and were linked cross-sectionally to residential greenness (i.e., Normalized Difference in Vegetation Index). There were no observable associations between residential greenness within a 1,600 m network radius and parenting practices, mother-infant bonding, or infant socioemotional function. The findings were largely corroborated by sensitivity analyses (i.e., NDVI within 100, 250, 500, and 1,000 m and distance to park). Shorter distances to a park were associated with less hostile parenting. More residential greenness (1,000 and 1,600 m) was associated with stronger father-infant bonding and more hostile parenting amongst the most stressed parents in exploratory analyses. Residential greenness might be a socioecological precursor for father-infant bonding.
This study examined the associations between parental mental health and children’s social-emotional outcomes among Japanese families. Children (n = 493) were identified from the Japan Household Panel Study and the Japan Child Panel Survey. Parental mental health was associated with children’s social-emotional outcomes. The effects of maternal mental health on children’s social-emotional outcomes were moderated by paternal mental health status. Children demonstrated better social-emotional outcomes when both parents had better mental health status. Mental health policies and programs should focus on families as a whole rather than solely on the child or the parents and provide awareness of and connection to program
Purpose:
Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking.
Methods:
The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant.
Results:
The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model.
Conclusion:
Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.
Bu çalışmada üreme tedavisinde anne-bebek bağlanması kavramının analizi yapılarak, tedavide kilit role sahip olan infertilite hemşirelerine ve anne-bebek bağının devam etmesini sağlayan kadın sağlığı ve hastalıkları, pediatri hemşireleri için yol gösterici olması amaçlanmaktadır. Literatür incelemesi; Clinical Key Elsevier, Science Direct, Taylor&Francis Online, Ulakbim, Pubmed, Dergipark, Yöktez veri tabanlarında “Anne-bebek, bağlanma, kavram analizi, bonding, attachment, neonatal bonding, concept analysis” anahtar kelimeleri ile yapılan taramalar sonucunda kavram analizi için uygun ve ulaşılabilen 14 Türkçe, 3 İngilizce makale, 1 kitap, Türk Dil Kurumu Sözlüğü, Chambridge İngilizce Sözlük ve Psikoloji Sözlüğü ele alınmıştır. Walker and Avant’ın kavram analizi yöntemine uygun olarak yapılan analizin ilk adımında kavram “üreme tedavisinde anne-bebek bağlanması” olarak seçilmiş, ikinci adımda analizin amacına yer verilmiştir. Üçüncü adımda kavramının sözlük tanımı ve diğer kullanım alanları belirlenerek tanımlar belirtilmiştir. Dördüncü adımda kavramın tanımlayıcı özellikleri; ilişki, yakınlık ve bağlılık olarak belirlenmiştir. Beşinci ve altıncı adımda kavram tanımlayıcı özellikler doğrultusunda model, sınırda ve karşıt vakalarda açıklanmıştır. Yedinci adımda kavramın ortaya çıkmasını sağlayan hazırlayıcı faktörler ve sonuçlar anne-bebek açısından ele alınmıştır. Son adımda ise kavramın değerlendirilmesi için ölçekler sunulmuştur. Üreme tedavisinde anne-bebek bağlanması kavramının kavram analizi yöntemiyle ayrıntılı bir şekilde incelenmesinin, bağlanma kavramının netleştirilmesine ve hemşirelerin, üreme tedavisinde, annelerin bebekleriyle güvenli bir bağlanma yaşamasına katkı sağlayacağı düşünülmektedir.
Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother‐infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.
The purpose of this study was to illuminate pediatric neonatal nurses' (PNNs') experiences of enhancing early attachment for the premature children in neonatal intensive care (NIC). An interview study with 8 PNNs in NIC in southeastern Sweden was conducted, and analyzed by content analysis. Result, illustrated three categories: Enabling closeness between the child and the parents, Supporting parents’ sense of parenthood, and Obstacles to enhancing attachment. Discussion, PNNs have a great role to supporting parents, but several barriers need to be addressed to make it easier for the PNN in NIC to enhance attachment for the child.
Background: Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. Methods: We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings: 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6–18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2–5%) in Singapore to 38% (35–41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. Interpretation: The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
Postpartum Bonding Questionnaire (PBQ) was widely used to measure the emotional thoughts of mothers towards the infant. Postpartum Bonding Questionnaire is helpful for the assessment of mother-infant bonding problems in mothers with postpartum depression. Therefore it is necessary to translated PBQ into Urdu language to make it understandable for Pakistani mothers. In the present study, Postpartum Bonding Questionnaire (PBQ) developed by Brockington et al. (2001) and revised by Brockington, Fraser and Wilson (2006) was translated for the assessment of mother-infant bonding problems in a sample of Pakistani postpartum mothers with postpartum depression. Four hundred postpartum mothers were screened on Edinburgh Postnatal Depression Scale (EPDS) and 150 depressed mothers of age range 18 to 45 years were selected to participate in the study through purposive sampling technique. PBQ was translated into Urdu using Back-translation method of Brislin (1976). The alpha reliability coefficients for the subscales of Postpartum Bonding Questionnaire Urdu –version were ranged from .33 to .93. Findings also showed that PBQ has satisfactory internal validity. The PBQ Urdu-version would be very useful for identifying problems of the mother-infant bonding in mothers with postpartum depression. In the future researches PBQ Urdu-version would also be useful for the researchers working in the same area.
When left untreated, perinatal mood and anxiety disorders (PMADs) are associated with increased risk for numerous adverse effects for the mother, the infant, and the mother-infant dyad. The significant risks of untreated symptoms must be weighed against the risks of treatment options in pregnancy and lactation. It is paramount that providers and patients understand the risk of not treating during pregnancy, as the symptoms themselves can lead to great harm. This chapter will review the correlated risks of untreated symptoms in detail, as well as the impact on lactation and breastfeeding. Lastly, the economic impact of untreated PMADs will be addressed.
The majority of research investigating the impact of stress and stress-related disorders on the parent–infant dyad has focused on how stress affects offspring development with much less work investing how stress affects the parent; from behavioral, physiological, and neurobiological perspectives. Our emphasis in this chapter is to review clinical and basic research on how gestational stressors affect parenting. We focus on gestational stress effects on parental care-giving behaviors with a discussion of neurobiological and physiological mechanisms related to these behaviors. Key studies on both maternal and paternal care are included. We also discuss the role that offspring play in the effects of gestational stress on parenting. Finally, there is a need to intervene and prevent the intergenerational effect of gestational stress; therefore, interventions that may be used to minimize the effects of gestational stress on the early parent–infant relationship are included. The transition to parenthood is a critical window for determining mental and physical health for parents in midlife and beyond, thus every effort should be made to improve the transition to parenthood for the sake of the parent and child.
Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming-in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming-in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1-4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming-in conditions. In addition, women in partial rooming-in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming-in women. A situational factor such as full rooming-in, which occurs at a critical time point for the mother-infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming-in, can be personalized and thus beneficial in moderating personal risk factors for PPD.
Objective
The postnatal period can be both a rewarding and challenging time. Research has found that experiences of motherhood that are less positive than expected are associated with depressive symptoms, however, no known study to date has examined expectations across the separate domains of motherhood and how they impact on attachment. The aim of this cross‐sectional study was to investigate whether discrepancies in a mother's expectations regarding their infant, levels of support, and sense of self and their actual experiences post birth impact on maternal feelings of attachment and depression in the postnatal period.
Method
Two hundred and thirty‐eight mothers in Australia (aged 19–44) who had given birth in the last 12-months voluntarily completed an online survey.
Results
As predicted, results revealed that postnatal experiences that were less positive than expected regarding support and sense of self were associated with higher levels of depression and lower levels of attachment. Regarding infant expectations, experiences that were less positive than expected were associated with lower levels of attachment; however, experiences that were more positive than expected were, unexpectedly, associated with higher levels of depression.
Conclusion
These findings highlight the importance of providing realistic expectations of motherhood through prenatal education and media messages to promote greater wellbeing and bond between mothers and infants which may maximise the chances of positive infant development.
Objective: To follow mothers' mood through pregnancy and after childbirth and compare reported symptoms of depression at each stage.
Design: Longitudinal cohort study.
Setting: Avon.
Participants: Pregnant women resident within Avon with an expected date of delivery between 1 April 1991 and 31 December 1992.
Main outcome measures: Symptom scores from the Edinburgh postnatal depression scale at 18 and 32 weeks of pregnancy and 8 weeks and 8 months postpartum. Proportion of women above a threshold indicating probable depressive disorder.
Results: Depression scores were higher at 32 weeks of pregnancy than 8 weeks postpartum (difference in means 0.88, 95% confidence interval 0.79 to 0.97). There was no difference in the distribution of total scores or scores for individual items at the four time points. 1222 (13.5%) women scored above threshold for probable depression at 32 weeks of pregnancy, 821 (9.1%) at 8 weeks postpartum, and 147 (1.6%) throughout. More mothers moved above the threshold for depression between 18 weeks and 32 weeks of pregnancy than between 32 weeks of pregnancy and 8 weeks postpartum.
Conclusions: Symptoms of depression are not more common or severe after childbirth than during pregnancy. Research and clinical efforts need to be moved towards understanding, recognising, and treating antenatal depression.
Recent studies have displayed increased interest in examining the relationship between personality traits and the onset, treatment response patterns, and relapse of depression. This study aimed to examine whether or not harm avoidance (HA) was a risk factor for postpartum depression measured by the Edinburgh Postnatal Depression Scale (EPDS) and the state dependency of HA.
Pregnant women (n=460; mean age 31.9±4.2 years) who participated in a prenatal program completed the EPDS as a measure of depressive state and the Temperament and Character Inventory (TCI) as a measure of HA during three periods: early pregnancy (T1), late pregnancy (around 36 weeks), and 1 month postpartum (T2). Changes in EPDS and HA scores from T1 to T2 were compared between the non depressive (ND) group and the postpartum depressive (PD) group.
There was no significant difference in the level of HA between the ND and PD groups at T1. In the ND group, EPDS and HA scores did not change significantly from T1 to T2. In the PD group, both scores increased significantly from T1 to T2 (EPDS, p<0.0001; HA, p<0.048). In the ND and PD groups, a significant positive correlation was observed in changes in EPDS and HA scores from T1 to T2 (r=0.31, p=0.002).
These results suggest that HA cannot be considered a risk factor for the development of postpartum depression measured by EPDS. Furthermore, HA may be state dependent.
Background: There is a need in primary care for an easily administered instrument to give early indications of disorders in mother-infant relationships. Methods: An 84 item questionnaire was administered to 104 subjects, including normal mothers, depressed mothers with a normal mother-infant relationship and mothers with bonding disorders. A principle component analysis was used to select items for scale construction. Scale scores were compared with interview data. Reliability, sensitivity and specificity of the scales were measured. Findings: 4 factors of clinical relevance were obtained and used to construct 4 scales. The questionnaire was reduced to 25 questions. Scale 1 (impaired bonding) had a sensitivity of 0.93 in detecting mothers with bonding disorder. Scale 2 (rejection and anger) specifically identified mothers with severe disorders. Scale 3 may be useful in anxious mothers. Scale 4 signalled the presence of incipient abuse, requiring urgent intervention. Interpretation: This questionnaire can be used, with the Edinburgh Postnatal Depression Scale, by midwives and health visitors, for the early diagnosis of mother-infant bonding disorders.
Adverse effects of maternal anxiety and depression are well documented, namely on the foetus/child behaviour and development, but not as much attention has been given to the mother's emotional involvement with the offspring. To study mother's prenatal and postpartum stress, mood and emotional involvement with the infant, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale and the Mother-to-Infant Bonding Scale were filled in and cortisol levels were measured, 3 months before and 3 months after childbirth, in a sample of 91 Portuguese women. From pregnancy to the postpartum period, mother's cortisol levels, anxiety and emotional involvement toward the child decrease. No significant change was observed regarding mother's depression. Mother's depression predicted a worse emotional involvement before childbirth, while mother's anxiety predicted a worse emotional involvement with the infant after childbirth. Additionally, pregnant women with a worse emotional involvement with the offspring are at risk of poorer emotional involvement with the infant and higher anxiety and depression at 3 months postpartum. It should be given more attention to mother's poor emotional involvement with the offspring during pregnancy, as it interferes with her emotional involvement with the infant and her psychological adjustment 3 months after childbirth.
A controlled prospective study was undertaken to determine the extent to which pregnancy and the puerperium are associated with increased risk for minor and major depression, depressive symptom-atology, and poor social adjustment. A large sample of childbearing (CB) women were recruited during the second trimester of pregnancy along with an equal sized, matched sample of nonchild-bearing (NCB) women. Ss were assessed multiple times during pregnancy and after delivery by questionnaire and through personal interview on measures of depression and other mood states and marital and social adjustment. There were no differences between CB and NCB Ss with respect to rates of minor and major depression during pregnancy or after delivery. However, CB women experienced significantly higher levels of depressive symptomatology and poor social adjustment than NCB women during late pregnancy and the early puerperium.
This review summarises the psychiatry of the puerperium, in the light of publications during the past 5 years. A wide variety of disorders are seen. Recognition of disorders of the mother-infant relationship is important, because these have pernicious long-term effects but generally respond to treatment. Psychoses complicate about one in 1000 deliveries. The most common is related to manic depression, in which neuroleptic drugs should be used with caution. Post-traumatic stress disorder, obsessions of child harm, and a range of anxiety disorders all require specific psychological treatments. Postpartum depression necessitates thorough exploration. Cessation of breastfeeding is not necessary, because most antidepressant drugs seem not to affect the infant. Controlled trials have shown the benefit of involving the child's father in therapy and of interventions promoting interaction between mother and infant. Owing to its complexity, multidisciplinary specialist teams have an important place in postpartum psychiatry.
Some mothers find it hard to relate to their new baby, and such failure may have long-term effects on the infant. This has been a neglected area of research. A new simple 8 item self-rating mother-to-infant bonding questionnaire has been designed to assess the feelings of a mother towards her new baby. A principal components and reliability analysis demonstrated an alpha score of 0.71. One hundred and sixty two women filled in the Kennerley Blues Scale, the Edinburgh Postnatal Depression Scale (EPDS) the Highs Scale and the new Mother to Infant Bonding Scale on day 3 postpartum. Twelve weeks later they were sent the EPDS and the Bonding scales again. One hundred and forty four returned all questionnaires. There was a strong correlation between the Bonding scores at 3 days and at 12 weeks (r(s)=0.54 p<0.001). Multiple regression analysis showed that those with raised Blues scores had worse, and those with raised Highs scores had better bonding at 3 days. Those with raised EPDS scores at 3 days (13 and over) had worse bonding scores in the "first few weeks" (median 4 versus 1, p = 0.028), as recalled at 12 weeks. This simple questionnaire is acceptable for use with mothers and gives significant correlations with their early mood.
The emotions and attitudes of mothers towards their infants are crucial for the child's well-being and development. Some mothers experience a delay in the onset of maternal affection after childbirth and occasionally a longer lasting failure to bond will ensue. Little is known about the precise prevalence of these difficulties, how they relate to maternal mental health, how they develop over time and what their biological and psychosocial correlates are. In research studies the mother-infant relationship has traditionally been assessed using observational methods but these are time consuming and not suited for screening in clinical practice. Two self-rating instruments have recently been developed to assess maternal bonding. Both can be used in large samples of recently delivered mothers including those suspected to be at high risk of bonding disorders. In this study, the psychometric properties of the 8-item Mother-to-Infant Bonding Scale (MIB) and the 25-item screening questionnaire for mother-infant bonding disorders, namely the Postpartum Bonding Questionnaire (PBQ), were examined in a sample of first-time mothers in order to establish their reliability and validity. Ninety-six women completed the MIB, PBQ and the Kennerley Blues Scale on day 2-4 postpartum. Both bonding instruments demonstrated acceptable reliability and reasonable validity, with the exception of the PBQ subscale of risk of abuse.
This study estimated the prevalence of diagnosed depression and treatment among women before, during, and after pregnancies ending in live births.
A previously validated algorithm identified health plan members with at least one pregnancy between Jan. 1, 1998, and Dec. 31, 2001. Women with a pregnancy ending in one or more live births and continuously enrolled from 39 weeks before pregnancy through 39 weeks after pregnancy were eligible. Maternal depression was identified from the medical records. Depression treatment included antidepressant medication and/or mental health visits. The authors examined the prevalence of depression and treatments received.
Among 4,398 continuously enrolled women with eligible pregnancies ending in live births, 678 (15.4%) had depression identified during at least one pregnancy phase; 8.7%, 6.9%, and 10.4% had depression identified before, during, and/or after pregnancy, respectively. Among women with identified depression during the 39 weeks before pregnancy, 56.4% also had a depression diagnosis during pregnancy. Of women identified with depression during the 39 weeks following pregnancy, 54.2% had depression diagnoses either during or preceding pregnancy. Most women diagnosed with depression received antidepressant medications and/or had at least one mental health visit. Having at least one mental health visit did not vary before, during, or after pregnancy; however, antidepressant use was lower during pregnancy than before or after pregnancy.
Approximately one in seven women was identified with and treated for depression during 39 weeks before through 39 weeks after pregnancy, and more than half of these women had recurring indicators for depression.
Recently published reports of physical assault by women in late pregnancy upon their unborn children have elicited a response of incredulity in many professionals. This response is identical to that which followed the publication of the first cases of child abuse in the 1960s. The present paper attempts a preliminary exploration of the incidence of the urge to "hurt or punish" the unborn child using a sample of 112 normal pregnant women and their male partners. Eight percent of the women and 4% of the men acknowledged experiencing such an urge. The male partner appeared to be aware of the woman's aggressive feelings toward the fetus and the male's reports tend to validate the female findings. Despite some methodological shortcomings, the findings suggest that the urge to physically assault the fetus is not rare. The need for further investigation of the phenomenon is highlighted, as it may well represent the earliest precursor of later physical child abuse.
This prospective study tracked hassles, pregnancy-specific stress, and state anxiety during pregnancy. A second objective was to identify predictors of each stress dimension. Pregnant women n=161 completed the Hassles Scale, the Pregnancy-Specific Stress Questionnaire (PEQ), and the state-anxiety scale (STAI-state) monthly, beginning in the third month of pregnancy. Hassles were found to be stable throughout the pregnancy. Women reported significantly higher pregnancy-specific stress in the first and third trimester of pregnancy, whereas state anxiety increased in the third trimester compared with the first and second trimesters. Poorer marital adjustment predicted higher Hassles during pregnancy and higher PEQ and STAI-state in the third trimester. Women who reported that the pregnancy would have a negative impact on their career scored higher on Hassles during pregnancy and higher on the PEQ in the third trimester. The occurrence of a gestational complication during pregnancy was related to higher pregnancy-specific stress in the third trimester. Younger women also reported higher PEQ results in the third trimester. The data provide support for a multidimensional conceptualization of stress during pregnancy.
As part of a longitudinal study of the influence of postnatal depression on child development, the cognitive functioning of index and control children was assessed at age 5 years. There was no evidence of an adverse effect of postnatal depression, even amongst sub-groups of children suggested to be vulnerable (boys and children from low SES families). However, early experience of insensitive maternal interactions predicted the persistence of poorer cognitive functioning. A number of factors in the child's current environment, including stimulation at home, social class and, for boys, the experience of schooling, contributed to cognitive performance. The findings are considered in relation to the ongoing debate on sensitive periods.
Abstract— The speech of depressed and well mothers during play with their infants at two months was compared on dimensions of structure and semantics. No differences between maternal groups were found on measures of complexity and syntax. However, the speech of depressed women expressed more negative affect, was less focused on infant experience, and tended to show less acknowledgement of infant agency. Speech style of depressed women also varied according to infant gender. Regression analyses indicated that the quality of maternal communication with the infant, and particularly the focus of speech, mediated the association between depression and infant cognitive development in the first 18 months.
The primary objective of this study was to analyze the pattern of depressive moods related to pregnancy and postpartum in a dataset collected prospectively. A secondary objective was to assess the association between (1) low moods during pregnancy and postpartum depressive symptoms, and (2) maternity blues and postpartum depressive symptom.
Three hundred eighty-seven women completed self-administered questionnaires. The participants were asked to respond to Stein's Maternity Blues Scale (Stein's Scale) on five consecutive days after delivery and to the Edinburgh Postnatal Depression Scale (EPDS) during both pregnancy and postpartum.
32.0% of the women were identified as having a score of more than 9 on EPDS during pregnancy and postpartum. 21.6% of the women scored above the Stein's Scale cut-off point for at least 1 day during the 5-day period following delivery. The odds ratio (95% CI) for postpartum low mood if the women experienced low mood during pregnancy was 4.46 (2.48-8.04), while the odds ratio for postpartum depressive symptoms if the women experienced symptoms of maternity blues was 5.48 (2.74-10.98). In logistic regression analysis, the number of days in which women scored over the cut-off point by Stein's Scale proved to be the more significant predictor of scoring over the EPDS cutoff (8/9) [OR (95% CI)=2.74 (1.89-3.96)].
The rate of maternity blues in our findings was similar to the rates previously reported in Japan, but lower than the rates observed in Western countries. Furthermore, our longitudinal study confirms the likelihood of subsequent postpartum depressive symptoms if low moods during pregnancy and/or maternity blues are present.
A large sample of primiparous women was screened for depression after childbirth. Those identified as depressed, women with a previous history of depression and a control group were followed up to 18 months, when their infants were assessed on measures of cognitive, social and behavioral development. Infants of postnatally depressed mothers performed worse on object concept tasks, were more insecurely attached to their mothers and showed more mild behavioural difficulties. Postnatal depression had no effect on general cognitive and language development, but appeared to make infants more vulnerable to adverse effects of lower social class and male gender.
Plasma cortisol, adrenocorticotrophic hormone (ACTH), beta-endorphin and corticotrophin releasing hormone or factor (CRF) all rise progressively as pregnancy advances, and fall postnatally. The placenta produces large amounts of CRF in the third trimester and this is released into the maternal circulation. Present evidence suggests that it stimulates the maternal pituitary to produce ACTH while desensitizing the maternal pituitary to further stimulation with CRF. Maternal control of ACTH production is retained, allowing a persistent response to stress and a diurnal rhythm, perhaps through the secretion of vasopressin. The placenta also produces pro-opiomelanocortin peptides; however, the nature of the fragments produced from the precursor differs from that formed in the anterior pituitary of the mother and the role of these fragments in the control of maternal adrenal function is unclear. These changes in the hypothalamo-pituitary-adrenal axis during pregnancy are associated with loss of the normal suppression of cortisol by dexamethasone and elevated basal levels of cortisol with preservation of a diurnal rhythm, features also found in some patients with endogenous depression. Several studies have suggested a relationship between alterations in maternal concentrations of cortisol and beta-endorphin and the development of postnatal mood disturbances.
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
Recently published reports of physical assault by women in late pregnancy upon their unborn children have elicited a response of incredulity in many professionals. This response is identical to that which followed the publication of the first cases of child abuse in the 1960s. The present paper attempts a preliminary exploration of the incidence of the urge to "hurt or punish" the unborn child using a sample of 112 normal pregnant women and their male partners. Eight percent of the women and 4% of the men acknowledged experiencing such an urge. The male partner appeared to be aware of the woman's aggressive feelings toward the fetus and the male's reports tend to validate the female findings. Despite some methodological shortcomings, the findings suggest that the urge to physically assault the fetus is not rare. The need for further investigation of the phenomenon is highlighted, as it may well represent the earliest precursor of later physical child abuse.
Physical assault by a woman or her partner upon their unborn child has received minimal attention in the psychiatric or obstetric literature. The spectrum concept facilitates the application of knowledge about one type of fetal abuse (e.g., physical assault in response to fetal movements) to other types (e.g., neglect or failure to protect the fetus from chemical assault by alcohol, nicotine, or drugs). Three illustrative case histories are presented, including two cases of assault by the mother via the anterior abdominal wall. Fetal abuse may be one antecedent of child abuse, and this paper attempts to transpose the known correlates of child abuse into an antenatal time framework. The resultant preliminary etiological model also draws upon research findings from neonaticide, the psychology of pregnancy, and the psychology of aggression. In addition, recent research on the maternal-paternal-fetal triad is reviewed in an attempt to delineate under what circumstances ambivalence in the parental-fetal relationship may find expression as fetal abuse. The characteristics of individuals most at risk of perpetrating fetal abuse are outlined.
A group of first-time mothers (119) were interviewed repeatedly at fixed intervals during their pregnancies and until their babies were a year old; they were then followed up at four years. A similar investigation was carried out on 38 other primiparae and 39 multiparae, but only postnatally.
The incidence of depressive neurosis rose significantly in early pregnancy and in the first three months after delivery (10 per cent and 14 per cent of the main sample respectively). Subjects mainly suffered either from antenatal or postnatal depression, not both. Marital conflict and severe doubts about having the baby were associated with depression at either time. Bereavement and preterm birth were the only life events to relate with the onset of depression and bereavement had a greater impact during pregnancy.
Depressed mothers were more likely to express negative or mixed feelings about their three-month-old babies. Many who had become depressed for the first time in their lives continued to experience psychological problems for up to four years after childbirth.
A 24-item scale with five subscales was developed to measure the construct of maternal-fetal attachment during pregnancy and tested on 71 subjects in the third trimester of pregnancy. Content validity was built into the scale. A coefficient of reliability of .85 was demonstrated for the scale with the reliability of the subscales ranging from .52 to .73. Scores of the MFA scale were positively correlated with the amount of available social support reported by women and with their perceptions of babies three days after birth. There was a negative association between MFA scores and the amount of stress perceived by the women. Further refinement of the scale is indicated.
Information about perceptions of labour and delivery and about immediate emotional reactions to their newborn babies was obtained from two groups of primiparous women (n = 112 and n = 41) and from 40 multiparae. About 40 per cent of primiparae and 25 per cent of multiparae recalled that their predominant emotional reaction when holding their babies for the very first time had been one of indifference. Maternal affection was more likely to be lacking after delivery if the mother had had a forewater amniotomy and had, in addition, either experienced a painful and unpleasant labour or been given more than 125 mg of pethidine.
Most mothers developed affection for their babies within a week of delivery and, in all groups of subjects, no longer term adverse effects were seen, such as post-natal depression or aggressive impulses directed at the baby. Three months post-natally it was, however, found that a mother was more likely to express feelings of dislike or indifference towards her baby if she was clinically depressed at the time.
The three main conditions that are associated with childbirth are the maternity blues, postnatal depression and post-partum psychosis. The prevalence of the blues, which are mild, transient and very common disturbances of postnatal mood, does not appear in a major way to be related to environmental, social or cultural factors. Postnatal depression, which has a predominantly psychosocial etiology, surprisingly does not appear to vary in incidence across different cultures in the few studies reported that permit direct comparisons. There is also no good evidence for or against the theory that postnatal depression is partly the consequence of the customs and rituals that traditionally mark the transition to parenthood being stripped away in developed Western societies. However, the lack of relevant research and limitations of method severely restrict any conclusions that can be drawn. There is much firmer evidence for a consistent incidence of post-partum psychosis across cultural and ethnic divides; this observation, together with clinical data and historical evidence of an unchanging incidence rate during the past 150 years, points to a primarily endogenous etiology for the psychoses, which may be triggered by the physiology of childbirth. The transcultural approach to postnatal psychiatric disorders provides a unique opportunity not only to test hypotheses about social and cultural contributions to the etiology of psychotic and non-psychotic reactions to childbirth, but also an opportunity to study the ways in which social factors can influence the evolution of psychopathology. It is also possible that in some cultures the family and social milieu may play a major part in buffering infants from the adverse effects of maternal postnatal illness, but the evidence is anecdotal. Systematic research across cultures will lead to better recognition of maternal illness as well as to better prevention and management.
Synopsis
One hundred and twenty women recruited from attenders at the antenatal clinic of the Obstetrics Department of a general hospital were asked to complete ad hoc questionnaires during pregnancy; they were then interviewed by psychiatrists using a structured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia (SADS). Nineteen (16%) women were identified as having an onset of an affective disorder during the period of pregnancy, mainly (68%) during the first trimester. As compared with the women without any such onset (controls), the women with pregnancy-related affective disorder (PRAD) were characterized by (1) it being their first pregnancy or first delivery with past termination of pregnancy, (2) early loss of either parent by death, (3) high Eysenck Personality Questionnaire (EPQ) Neuroticism (N) and Psychoticism (P) scores, (4) living in a flat with either a plan to stay there after the forthcoming childbirth or an expectation that their accommodation would be crowded, and (5) negative response to the news of the pregnancy by the husband with low intimacy. The effects of these factors were additive since the probability of developing a PRAD episode was highly correlated with the number of factors reported.
Psychiatrists are sometimes asked to express an opinion about the competence and motivation of a mentally ill mother to be a consistent, adequate and safe parent of her recently born infant. There are no reliable methods for assessing mother-infant interaction and relationship in a psychiatric context.
The Bethlem Mother-infant interaction Scale (BMIS) was developed by the staff of a specialised psychiatric mother and baby unit. Of the seven subscales, four measured different aspects of the mother's contribution to the dialogue with her baby, one measured her capacity to organise and maintain routine care, one attempted to rate the perception by staff of risk to the child, and the remaining subscale rated the baby's contribution to their interaction. In normal clinical practice the ratings were made consensually by nurses and they encompassed observations that had been made by them during the previous week.
Despite the simple and global nature of the ratings of the BMIS, moderate to high coefficients of inter-rater reliability were obtained for weekly ratings by nurses as well as for intra-rater reliability of ratings of videotaped interactions between mothers and their infants. Ratings of mothers and babies in day-to-day activity in the unit that were based on one hour's observation only were much less reliable. The internal consistency of the BMIS was high and comparisons with other methods used in non-clinical settings showed good criterion-related validity.
Using the BMIS facilitated attempts to reliably assess disturbances of mother-infant interaction and the scale was acceptable and clinically useful. The nurses' ratings of their perceptions of 'risk' to the infant, which are in some ways the most important, were the least reliable. Repeated weekly ratings gave a valuable impression of change or lack of it over time. The predictive validity of the scale has yet to be determined.
As part of a longitudinal study of the influence of postnatal depression on child development, the cognitive functioning of index and control children was assessed at age 5 years. There was no evidence of an adverse effect of postnatal depression, even amongst sub-groups of children suggested to be vulnerable (boys and children from low SES families). However, early experience of insensitive maternal interactions predicted the persistence of poorer cognitive functioning. A number of factors in the child's current environment, including stimulation at home, social class and, for boys, the experience of schooling, contributed to cognitive performance. The findings are considered in relation to the ongoing debate on sensitive periods.
A total of 98 Japanese mothers who became pregnant in England were monitored from 36 weeks gestation to 3 months postpartum. Psychiatric status was assessed by self-report, using a Japanese translation of the Edinburgh Postnatal Depression Scale (EPDS) and by an interview with Japanese psychiatrists, using Japanese translations of the Schedule for Affective Disorders and Schizophrenia (SADS) and Research Diagnostic Criteria (RDC). Rates of depression were similar to those observed in Japanese women having babies in Japan. Twelve mothers (12%) were categorised as having new onsets of depression (six major and six minor depressive disorder) during the 3 months following delivery. Depression was associated with having had a stressful life event or obstetric but without grandmothers' support-depressed and non-depressed women were equally likely to have had their mothers visit England to attend the delivery. Women who became depressed had significantly higher EPDS scores at 1 month postpartum than those who remained well. However, depressions were not detected when the EPDS was used as a screening instrument. With an EPDS cut-off of greater than 12, the criterion used in western samples, sensitivity was zero. Lowering the criterion to improve the instrument's sensitivity merely reduced its specificity. These results suggest that Japanese women may be less likely to express depressive symptoms by self-report, at least when instruments designed for western samples are used.
This paper describes severe, disorders of maternal affection and behaviour and suggests that there is an early process of mother-to-infant bonding which can go seriously wrong.
Forty-four self-selected women who had suffered from at least one episode of postnatal mental illness described an unexpected and often catastrophic failure to love one or more of their babies.
These women reported absent affection, sometimes hate, rejection, neglect or impulses to harm, in relation to at least one of their children. These feelings often began immediately or very shortly after the birth, and with one exception, were specific to one child; such characteristics are best encapsulated by the term 'maternal bonding disorder'. Twenty-nine of the women were multiparae; first-borns were not significantly more likely to be the focus for such feelings. There was no direct evidence of predisposing maternal personality traits or previous experiences. Postnatal mental illness and recalled severe pain during labour were significantly associated with such disorders which, in their severe forms, did not occur in the absence of postnatal mental illness.
The nature of the link between postnatal mental illness and disorders of maternal bonding remains unclear. Because, in multiparae, the disorder often 'missed' the first child, factors such as maternal personality traits or early childhood experiences cannot be regarded as sufficient causes.
Maternal-foetal attachment represents the earliest and most basic form of human intimacy, and has both theoretical and clinical significance. Utilizing a previously published self-report questionnaire to assess antenatal attachment, the present paper explores its correlates using 238 women in the third trimester of pregnancy. Extrapolating from studies of maternal-infant attachment, it was hypothesized that depression and a lack of social support would be detrimental to the development of maternal antenatal attachment. The findings confirmed these hypothesized effects. In particular, the subgroup of women having low attachment was characterized by high levels of depression and anxiety, low levels of social support (outside the partner relationship) and high levels of control, domination and criticism within the partner relationship. Antenatal attachment may be predictive for future maternal-infant attachment. The findings suggest that negative mood states and lack of social support during pregnancy may warrant greater attention than has previously been accorded them.
This prospective study tracked hassles, pregnancy-specific stress, and state anxiety during pregnancy. A second objective was to identify predictors of each stress dimension. Pregnant women (n=161) completed the Hassles Scale, the Pregnancy-Specific Stress Questionnaire (PEQ), and the state-anxiety scale (STAI-state) monthly, beginning in the third month of pregnancy. Hassles were found to be stable throughout the pregnancy. Women reported significantly higher pregnancy-specific stress in the first and third trimester of pregnancy, whereas state anxiety increased in the third trimester compared with the first and second trimesters. Poorer marital adjustment predicted higher Hassles during pregnancy and higher PEQ and STAI-state in the third trimester. Women who reported that the pregnancy would have a negative impact on their career scored higher on Hassles during pregnancy and higher on the PEQ in the third trimester. The occurrence of a gestational complication during pregnancy was related to higher pregnancy-specific stress in the third trimester. Younger women also reported higher PEQ results in the third trimester. The data provide support for a multidimensional conceptualization of stress during pregnancy.
This study was conducted for evaluating incidence of maternity blues in Japan, in addition to clarifying the relationship between maternity blues and maternal attachment, and the factors involved.
A questionnaire survey was conducted on 417 mothers having given birth at the Nagoya Daini Red Cross Hospital. The questionnaire consisted of Zung's self-rating depression scale, and a 'postpartum maternal attachment' scale, consisting of subscales on 'core maternal attachment' and 'anxiety regarding children'. The survey was conducted 5.2 days +/-1.46 postpartum.
ZSDS scores over 40 amounted to 66.8% of the responses. Analysis of the two scales revealed significant correlation/inverse correlation between 'maternity blues' and 'anxiety regarding children'/ 'core maternal attachment'. Path analysis revealed 'maternity blues' to be influencing 'core maternal attachment' and 'anxiety regarding children'.
It was found that the incidence of maternity blues may be higher in Japan than was believed previously, and that an intimate association exists between 'maternity blues' and 'postpartum maternal attachment'.
Approximately 13% of women experience postpartum depression. Early recognition is one of the most difficult challenges with this mood disorder because of how covertly it is suffered.
The purpose of this meta-analysis was to update the findings of an earlier meta-analysis of postpartum depression predictors that had synthesized the results of studies conducted mostly in the 1980s.
A meta-analysis of 84 studies published in the decade of the 1990s was conducted to determine the magnitude of the relationships between postpartum depression and various risk factors. Using the software system Advanced Basic Meta-Analysis, effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score.
Thirteen significant predictors of postpartum depression were revealed. Ten of the 13 risk factors had moderate effect sizes while three predictors had small effect sizes. The mean effect size indicator ranges for each risk factor were as follows: prenatal depression (.44 to .46), self esteem (.45 to. 47), childcare stress (.45 to .46), prenatal anxiety (.41 to .45), life stress (.38 to .40), social support (.36 to .41), marital relationship (.38 to .39), history of previous depression (.38 to .39), infant temperament (.33 to .34), maternity blues (.25 to .31), marital status (.21 to .35), socioeconomic status (.19 to .22), and unplanned/unwanted pregnancy (.14 to .17).
Results confirmed findings of an earlier meta-analysis and in addition revealed four new predictors of postpartum depression: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy.
Little is known as to whether or not the seven personality dimensions of Cloninger's theory, particularly the three character dimensions newly included in the theory, are independent of the states of depression.
One hundred and eight patients with major depression filled out the Temperament and Character Inventory (TCI) before and after a 16-week antidepressant treatment.
The level of depression, as assessed by the Hamilton Rating Scale for Depression, was correlated positively to the harm avoidance score and negatively to the self-directedness and cooperativeness scores. During the treatment, the scores on these three dimensions significantly changed toward normal values in treatment-responders, but were stable in treatment-nonresponders. The changes in these dimensions were significantly explained by the change in the depression severity during treatment. Scores on novelty seeking, reward dependence, persistence, and self-transcendence were not correlated significantly to the level of depression and did not change significantly during the treatment in either treatment-responders or nonresponders.
The changes in the TCI scores during treatment in this study may reflect a non-specific tendency for the scores to change on retest.
The results suggest that a depressive state can significantly affect assessments of harm avoidance, self-directedness, and cooperativeness in major depression. The administration of the TCI during a depressive episode may elevate the HA score, and may lower the SD and C scores. These findings highlight the importance of considering the state of depression before drawing conclusions about the TCI personality traits, when a patient with major depression is still experiencing a depressive episode.
This paper is part of a prospective, epidemiologic study concerning postpartum depression (PPD). The women were first examined during pregnancy; after delivery they were seen with their infants at 3 and 18 months. The present study focuses on the 3-months-postpartum results.
A sample of 570 women and their infants were examined 3 months after delivery. Using the EPDS (Edinburgh Postnatal Depression Scale; Cox et al., 1987. Br. J. Psychiatry 150:782-786), 10.2% of these new mothers presented PPD. The focus of the study concerned the effects of this neurotic disorder on the mother, the infant and on the mother-infant relationship.
The deleterious effects concerning the infant were functional disorders such as eating or sleeping difficulties. The 'depressed' dyads presented less vocal and visual communications, less corporal interactions and less smiling. Conditions surrounding delivery and tiredness at 3 months are linked to difficulties in mother-infant relationship for the non-depressed mothers. Logistic models showed that primiparous PPD mothers have difficulties bathing their infants, whereas multiparous PPD mothers are more tired.
This study did not take into account either protective factors or the effects of the infant himself.
Knowledge of the mothers' and infants' difficulties may help caregivers to detect these at-risk dyads and initiate therapeutic measures.
In recent years, attention has been turned to maternal mental health in relation to the mother-child relationship accompanying a widening in focus, i.e. taking into account not only the puerperium, but also the stage of pregnancy. This applies to studies that have revealed a connection between depression and maternal attachment in the postpartum period and late pregnancy. This study, however, was designed to evaluate the maternal-fetal relationship in the first and second trimesters, being the first one to address this issue in these early stages.
Zung's Self-Rating Depression Scale (ZSDS), the original Antenatal Maternal Attachment Scale (AMAS), and a questionnaire addressing peripheral factors were given to 216 pregnant women (3-6 months of gestation) who visited the Nagoya University Hospital between September 1998 and June 2001.
Contrary to reports on the latter stages of pregnancy, no direct association was observed between depression in mothers and maternal-fetal attachment before fetal movement was perceived.
However, education, form of employment, planning of pregnancy, and premenstrual mood changes were found to be associated with the ZSDS score (mean: 41.9), while form of employment, feelings regarding pregnancy, and sources of support were extracted as factors associated with the AMAS, which are of interest in terms of the subsequent association between depression and maternal-fetal attachment in the peri- and postnatal periods.
Postpartum depression (PPD) is known to have important negative effects on mother, infant and mother-child relationship.
We present a case-control study of 35 mothers and their 18-month-old infants. These mothers suffered from postpartum depressive symptoms (PDS) when the infants were three months old, as rated with the Edinburgh Postnatal Depression Scale (EPDS, Cox 1987). A control group of 35 mothers without postpartum depressive symptoms (NPDS) with their 18-month-old infants was also evaluated. The infants were assessed using the Infant Behavior Record of the Bayley Scales of Infant Development, the Strange Situation and an object concept task.
15 months later, the PDS mothers were less affectionate and more anxious than the NPDS mothers. The PDS dyads demonstrated less verbal interaction and less playing interaction. 18-month-old infants of PDS mothers performed less well on object concept tasks, and were more often insecurely attached to their mothers. Only some results were linked to the mothers' depressive state (D-mothers) diagnosed at 18 months (e. g. responsiveness to persons).
The important negative effects observed at 18 months on mother and infant of maternal PDS at 3 months confirm the need for early identification and therapeutic or preventive interventions.
This pilot study aimed to elucidate whether or not mothers who receive neonatal home visits tend to suffer from depressive disorders during the first postpartum year and to examine what kinds of factors were related to the postnatal depression observed in these mothers. The subjects consisted of 70 Japanese mothers who received neonatal home visits and completed the 1-year study. At their first visit, the health visitors asked about their personal backgrounds and early postpartum mood, and depression was assessed by a Japanese translation of the Edinburgh Postnatal Depression Scale (EPDS). At 12 months postpartum, a diagnostic interview using the Structured Clinical Interview for DSM-IV (SCID) was performed to confirm the maternal diagnosis by a psychiatrist. An assessment of infant development using the Denver Developmental Screening Test (DDST) was administered to each infant by a psychologist. Nineteen mothers (27%) were categorized as having had a new onset of depression (12 major depressive disorders and seven depressive disorders not otherwise specified). In comparison to the non-depressed mothers, infant-related health problems that required either outpatient treatment or hospitalization were significantly related to postnatal depression. Pediatric diseases in infants did not always precede their mother's depression. The extra burden of caring for a sick infant tends to increase the risk of developing postpartum depression. As a result, neonatal home visits by health visitors may therefore be a potentially crucial opportunity to provide emotional support, particularly for mothers with the extra burden of having to care for sick infants.
Depression during pregnancy is a common problem and, as the case report indicates, is unlikely to remit unless it is actively managed. Untreated depression in pregnancy is associated with poorer maternal health practices and less favourable obstetric outcomes. Clinicians should ask about depressive symptoms as a routine part of antenatal care. If necessary, women should receive psychotherapeutic or psychopharmacological treatments, in the context of individual symptoms and risks. Women with an established history of mood disorder should be managed by specialist psychiatric services.
Objective:
Validating self-reported questionnaires to detect depression during pregnancy, compared to depression during postpartum, has gained much less attention. Furthermore, it is unknown whether it is appropriate to use the same cutoff point to detect depression on different trimesters of pregnancy. The aims of this study, conducted in pregnant Taiwanese women, were: (a) to validate the Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of the Beck Depression Inventory (BDI-II); (b) to compare the EPDS-T and the BDI-II on their validity in detecting depression; and (c) to determine if these scales have different cutoff points in detecting major depressive disorder for different trimesters.
Method:
One hundred eighty-five pregnant Taiwanese women who completed the EPDS-T and the BDI-II were interviewed by psychiatrists with the structural interview Mini-International Neuropsychiatric Interview (MINI) to establish a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of major depressive disorder. We analyzed and compared the sensitivity, specificity and validity of the EPDS-T and the BDI-II against the MINI diagnosis on the second and third trimesters.
Results:
We identified 12/13 as the optimal cutoff of the EPDS-T, at which the sensitivity of the scale was 83% and the specificity was 89%. The optimal cutoff of the BDI-II was 11/12, at which the sensitivity of the scale was 74% and the specificity was 83%. The area under the curve of the receiver operating characteristic analysis was 0.92 for the EPDS-T and 0.84 for the BDI. There exist different optimal cutoff points of the EPDS-T for detecting major depression during different trimesters: 13/14 for the second trimester and 12/13 for the third trimester. No different optimal cutoff point for the BDI-II was found for different trimesters.
Conclusion:
The EPDS-T has satisfactory sensitivity and specificity and better validity than the BDI-II for detecting major depressive disorder during pregnancy in pregnant Taiwanese women. We suggest that more studies with larger sample sizes be performed to confirm if there exist different cutoff points in detecting depression for different trimesters of gestation.
Maternity blues and attachment to children in mothers of full-term normal infants
- Nagata