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Göbel A, Lüersen L, Asselmann E, Arck P, Diemert A, Garthus-Niegel S, Mudra S, Martini J. Psychometric properties of the Maternal Postnatal Attachment Scale and the Postpartum Bonding Questionnaire in three German samples. BMC Pregnancy Childbirth 2024; 24:789. [PMID: 39592992 PMCID: PMC11590467 DOI: 10.1186/s12884-024-06964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 11/07/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Forming an emotional bond towards the infant is an important developmental aspect of the mother-child relationship. Two questionnaires frequently used for the assessment of mother-infant bonding, namely the Maternal Postnatal Attachment Scale (MPAS) and the Postpartum Bonding Questionnaire (PBQ), have shown inconclusive psychometric properties. To ensure comparability of results across studies, it is crucial to examine the replicability of psychometric properties and previously proposed factor structures of measurements when adapted to other languages. AIM The study aim was to investigate the psychometric properties of the German versions of both MPAS and PBQ, across three different German-speaking study samples. METHODS Maternal data from three longitudinal studies from Hamburg, Germany (PAULINE-PRINCE study, N = 229), and Dresden, Germany (MARI study, N = 286; DREAM study, N = 1,968), were used to investigate the psychometric properties (descriptive statistics, item difficulty, inter-item correlations) and the factorial structure (confirmatory factor analysis, CFA; principal axis factoring, PAF) of both MPAS and PBQ. Correlations with maternal-fetal bonding, adult romantic attachment style, attachment style to one's own mother, postpartum depressive symptoms, and education level were investigated. RESULTS Across the three samples, both MPAS and PBQ showed convincing results regarding the psychometric properties for their total scores, with satisfying to excellent internal consistencies. A strong correlation between the MPAS and PBQ total scores was observed (r=-.71, p < .001). In PAF, for both questionnaires, factor structures on subscale level differed across samples and assessment points. For MPAS and PBQ total scores, significant small to medium-sized associations in the expected directions with maternal-fetal bonding and depressive symptoms, as well as for MPAS with adult romantic attachment style, and for PBQ with attachment towards one's own mother were found. In two samples, higher educated participants reported less optimal MIB. CONCLUSION The results across the three included samples provide evidence for the validity of the construct assessed with the German adaptations of both MPAS and PBQ. However, the factor analytical results on subscale level highlight the need to further investigate the concept of mother-infant bonding in the first year after birth as well as to develop instruments applicable for use in clinical and community samples with satisfying psychometric properties.
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Affiliation(s)
- Ariane Göbel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
| | - Lisa Lüersen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Asselmann
- Institute for Mental Health and Behavioral Medicine, Department of Psychology, HMU Health and Medical University, Potsdam, Germany
| | - Petra Arck
- Division of Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Susanne Mudra
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Martini
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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Isobel S. Birth trauma in a population requiring inpatient mental health care in the postpartum period. Australas Psychiatry 2024; 32:301-304. [PMID: 38616574 PMCID: PMC11318210 DOI: 10.1177/10398562241246150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
OBJECTIVE This study explores rates of birth-related symptoms of trauma in a population of parents experiencing severe perinatal mental illness. METHOD Birthing-parents admitted to a perinatal inpatient unit completed birth trauma measures on admission which were descriptively analyzed. RESULTS The population had higher rates of birth-related potentially traumatic events and trauma-related symptoms than the general population. CONCLUSIONS The findings highlight that assessing for and responding to experiences of birth trauma is highly relevant to an inpatient perinatal population.
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Affiliation(s)
- Sophie Isobel
- Sophie Isobel, Naamuru Parent & Baby Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Building 23, Cnr Susan & Grose St, Camperdown, NSW 2050, Australia.
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Orkaby N, Kalfon-Hakhmigari M, Levy S, Krissi H, Peled Y, Handelzalts JE. COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum. J Reprod Infant Psychol 2024; 42:550-562. [PMID: 36210511 DOI: 10.1080/02646838.2022.2132382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase. METHODS Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4. RESULTS Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12). DISCUSSION The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.
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Affiliation(s)
- Naomi Orkaby
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | | | - Sigal Levy
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan E Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, Michiga, USA
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Ozcalik HB, Aksoy YE. The relationship between maternal functioning and birth memory and trauma. Midwifery 2024; 132:103974. [PMID: 38503117 DOI: 10.1016/j.midw.2024.103974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
AIM This study aimed to determine the relationship between birth memory and trauma and maternal functioning in the postpartum period. METHODS This cross-sectional study included 584 mothers in the postpartum period between 1 January 2022 and 1 April 2022. Data were collected using a personal information form, the Barkin Index of Maternal Functioning (BIMF), the Birth Memories and Recall Questionnaire (BirthMARQ) and the City Birth Trauma Scale (CityBiTS). RESULTS The participants' mean scores for the overall BIMF, BirthMARQ and CityBiTS were 81.41 ± 9.28, 80.30 ± 21.21 and 15.85 ± 11.30, respectively. Their sociodemographic characteristics did not affect their maternal functioning; however, maternal functioning improved with the number of pregnancies. While emotional memory (BirthMARQ subscale) negatively affected maternal functioning (p < 0.001), the centrality of memory (BirthMARQ subscale) positively affected maternal functioning (p < 0.001). The hyperarousal (CityBiTS subscale) score significantly and negatively affected the total maternal functioning score, explaining 6 % of its variance (F = 9.176, p = 0.001). CONCLUSION This study demonstrated that birth memory and trauma affected maternal functioning. The mother's functional status in the postpartum period reflects the physical and psychosocial changes associated with pregnancy and birth. Therefore, for women to have positive birth memories and emotions when recalling the birth, their emotional health and physical care should be supported during labour and the postpartum period.
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Affiliation(s)
- Habibe Bay Ozcalik
- Selcuk University Faculty of Health Science, Midwifery Department, Konya, Turkey.
| | - Yasemin Erkal Aksoy
- Selcuk University Faculty of Health Science, Midwifery Department, Konya, Turkey
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Canet-Vélez O, Besa ME, Sanromà-Ortíz M, Espada-Trespalacios X, Escuriet R, Prats-Viedma B, Cobo J, Ollé-Gonzalez J, Vela-Vallespín E, Casañas R. Incidence of Perinatal Post-Traumatic Stress Disorder in Catalonia: An Observational Study of Protective and Risk Factors. Healthcare (Basel) 2024; 12:826. [PMID: 38667588 PMCID: PMC11050101 DOI: 10.3390/healthcare12080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Pregnancy and childbirth have a great impact on women's lives; traumatic perinatal experiences can adversely affect mental health. The present study analyzes the incidence of perinatal post-traumatic stress disorder (PTSD) in Catalonia in 2021 from data obtained from the Registry of Morbidity and Use of Health Resources of Catalonia (MUSSCAT). The incidence of perinatal PTSD (1.87%) was lower than in comparable studies, suggesting underdiagnosis. Poisson regression adjusting for age, income, gestational weeks at delivery, type of delivery, and parity highlighted the influence of sociodemographics, and characteristics of the pregnancy and delivery on the risk of developing perinatal PTSD. These findings underline the need for further research on the risk factors identified and for the early detection and effective management of PTSD in the perinatal setting.
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Affiliation(s)
- Olga Canet-Vélez
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Official College of Nurses of Barcelona, 08019 Barcelona, Spain
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain
| | - Meritxell Escalé Besa
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Institute, 08007 Barcelona, Spain
- Department of Gynegology and Obstetrics, Parc Taulí University Hospital, 08208 Sabadell, Spain
| | - Montserrat Sanromà-Ortíz
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Igualada Health Campus, University of Lleida, 25002 Igualada, Spain
| | - Xavier Espada-Trespalacios
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain
| | - Ramón Escuriet
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Catalan Health Service (CatSalut), Catalan Department of Health, 08028 Barcelona, Spain
| | - Blanca Prats-Viedma
- Public Health Agency of Catalonia (ASPCAT), Catalan Department of Health, 08005 Barcelona, Spain;
| | - Jesús Cobo
- Perinatal Mental Health Program, Mental Health Department, Parc Taulí University Hospital, 08208 Sabadell, Spain;
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Júlia Ollé-Gonzalez
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
| | - Emili Vela-Vallespín
- Information Systems, CatSalut, 08028 Barcelona, Spain;
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, 08908 Barcelona, Spain
| | - Rocio Casañas
- Global Health, Gender and Society (GHenderS), Blanquerna School of Health Sciences, Ramon Llull University, 08025 Barcelona, Spain; (O.C.-V.); (M.E.B.); (X.E.-T.); (R.E.); (J.O.-G.); (R.C.)
- Blanquerna School of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain
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Nakić Radoš S, Hairston I, Handelzalts JE. The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis. J Reprod Infant Psychol 2024; 42:142-165. [PMID: 36588501 DOI: 10.1080/02646838.2022.2162487] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Despite the emerging body of literature on mother-to-infant bonding and the associated variables, there are various definitions of bonding construct. Also, there is a lack of a comprehensive conceptual framework of antecedents and consequences of bonding that would guide empirical work. OBJECTIVE Aim of the study was to provide a systematic review and synthesis of concept analysis studies on maternal-foetal, mother-infant, or father-infant bonding. METHOD A systematic search was performed in PubMed, EBSCOHost (including PsycINFO), ProQuest, and CINAHL. In addition, a hand search was conducted. Papers were eligible for inclusion if they conducted concept analyses on mother or father to foetus/infant bonding. A qualitative meta-synthesis was applied to synthesise the findings. RESULTS Eight papers on concept analyses were eligible for inclusion. In meta-synthesis, six aspects of parent-to-(unborn) child bonding emerged, including direction, domain, process, timing, endurance, and parental gender. Defining attributes are (i) a close relationship, (ii) filled with positive parental affection, (iii) manifested during pregnancy as monitoring foetal development and behaviour and after childbirth in proximity and interaction. Antecedents, affecting factors, and consequences of the parent-child bonding have been summarised. CONCLUSION Parent-infant bonding refers to an emotional, behavioural, cognitive, and neurobiological tie of the parent to the (unborn) child, as a process from intention to have a child throughout infancy. This is a parental-driven process which can continue to evolve throughout child's and parent's life, characterised as enduring, committed, and engaged. Based on meta-synthesis, a conceptual structure of parent-infant bonding has been provided, which needs further empirical testing.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Ilana Hairston
- Tel-Hai Academic College, Tel-Hai, Israel
- The Institute of Information Processing and Decision Making (IIPDM), Haifa University, Haifa, Israel
| | - Jonathan Eliyahu Handelzalts
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Frankham LJ, Thorsteinsson EB, Bartik W. Birth related PTSD and its association with the mother-infant relationship: A meta-analysis. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 38:100920. [PMID: 37847956 DOI: 10.1016/j.srhc.2023.100920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/02/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE There is a growing body of research showing that birth related posttraumatic stress disorder (PTSD) symptoms may impact the mother-infant relationship. The present study assessed the strength of the association between birth related PTSD symptoms and the mother-infant relationship. METHOD A total of twelve studies (5,572 participants) were included based on database searches using PubMed, EBSCO and ProQuest. RESULTS The findings showed that greater levels of birth related PTSD symptoms were associated with poorer mother-infant relationship, r = -0.36, 95% CI: [-0.43 - -0.28], random effects model. The outcomes appeared to be heterogeneous (Q(11) = 81.63, p <.001, tau2 = 0.0123, I2 = 80.73%), despite all outcomes being in the same direction as the overall outcome. CONCLUSIONS The results indicated that birth related PTSD symptoms are negatively associated with the mother-infant relationship. Further investigation into the prevention of birth related trauma is suggested. Improving birthing experiences for mothers is likely to contribute to improved infant mental health, thereby reducing overall social and economic costs.
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Affiliation(s)
- Lucy J Frankham
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia.
| | - Einar B Thorsteinsson
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia
| | - Warren Bartik
- Faculty of Medicine and Health, School of Psychology, University of New England, Armidale, NSW 2351, Australia
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Gerymski R, Dymecka J, Iszczuk A, Bidzan M. Perceived stress and life satisfaction in pregnant women during the COVID-19 pandemic: the mediating role of fear of childbirth and self-esteem. HEALTH PSYCHOLOGY REPORT 2023; 12:197-208. [PMID: 39234025 PMCID: PMC11370735 DOI: 10.5114/hpr/174380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/05/2023] [Accepted: 10/22/2023] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic adversely affected the functioning and well-being of pregnant women. Negative feelings during pregnancy and the difficult pandemic situation may be the reason behind the perceived fear of childbirth, which can negatively affect the pregnant women's life satisfaction. On the other hand, some protective factors, such as self-esteem, might mediate the relationship between perceived stress and well-being in pregnant women. PARTICIPANTS AND PROCEDURE Our study aimed to determine the relationship between perceived stress, fear of childbirth, self-esteem and life satisfaction. A total of 262 Polish pregnant women participated in this study. The Perceived Stress Scale (PSS-10), Fear of Childbirth Scale (KLP II), Self-Esteem Scale (SES) and Satisfaction with Life Scale (SWLS) were used in the study. RESULTS The results showed that perceived stress, fear of childbirth and self-esteem acted as significant predictors of life satisfaction in the tested group of pregnant women. Additionally, fear of childbirth and self-esteem played a mediational role in the relationship between perceived stress and life satisfaction. CONCLUSIONS According to Diener's concept, life satisfaction is an important component of one's subjective well-being and health. Therefore, it is important to analyse factors that may mediate the impact of stress on pregnant women's life satisfaction. The present results might suggest that during pregnancy and preparation for childbirth, women should be provided with appropriate psychological care. Support from medical and psychological specialists, as well as from relatives, can reduce the level of perceived fears and strengthen personal resources. Based on the present results, we conclude that the fear of childbirth and the self-esteem of pregnant women should not be underestimated, as they are important predictors of their life satisfaction.
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Affiliation(s)
- Rafał Gerymski
- Department of Health Psychology and Quality of Life, Institute of Psychology, Opole University, Opole, Poland
| | - Joanna Dymecka
- Department of Health Psychology and Quality of Life, Institute of Psychology, Opole University, Opole, Poland
| | | | - Mariola Bidzan
- Department of Clinical and Health Psychology, Institute of Psychology, University of Gdansk, Gdansk, Poland
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Nie R, Pan M, Liu X. The mediation role of resilience and postpartum traumatic stress disorder on parental attachment and the maternal-infant bonding. BMC Psychol 2023; 11:359. [PMID: 37891637 PMCID: PMC10612154 DOI: 10.1186/s40359-023-01370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
AIMS This study aimed to evaluate the correlation between parental attachment, resilience, postpartum traumatic stress disorder (PTSD), and maternal-infant bonding at 1 to 3 months postpartum. The mediation effect of resilience and PTSD on the postpartum parental attachment and maternal-infant bond was also evaluated. DESIGN A cross-sectional research design was used. METHODS A total of 400 postpartum women examined at a tertiary hospital in Wuhan from January 2021 to June 2021 were enrolled in the study. At about 1 to 3 months after giving birth, the women were asked to complete the Postpartum Bonding Questionnaire (PBQ), Connor-Davidson Resilience scale(CD-RISC), PTSD CheckList-Civilian version (PCL-C), and the Parental Bonding Instrument (PBI). The data were summarized using descriptive statistics. Mediation analyse and the Spearman correlation (r) were used to correlate the resilience and PTSD questionnaire scores. RESULTS The care attachment dimension was significantly associated with resilience (r = 0.24, p < 0.01), PTSD (r = - 0.27, p < 0.01), and maternal-infant bonding (r = 0.10, p < 0.01), and the overprotection attachment dimension was significantly associated with resilience (r = - 0.11, p < 0.01), PTSD (r = 0.33, p < 0.01), and maternal-infant bonding (r = 0.16, p < 0.01). Resilience and PTSD can mediate the relationship between attachment and maternal-infant bonding. CONCLUSION Parental attachment, resilience, and PTSD significantly affect maternal-infant bonding at 1 to 3 months postpartum. IMPACT This study demonstrated that new interventions aimed at addressing PTSD symptoms and improving resilience might increase parental attachment and maternal-infant bonding after birth. However, further research is required to evaluate the success of these interventions.
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Affiliation(s)
- Rong Nie
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, China
| | - Mengxia Pan
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
- Department of Nursing, Zhejiang Provincial People's Hospital, (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Xinwen Liu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
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Vagos P, Mateus V, Silva J, Araújo V, Xavier A, Palmeira L. Mother-infant bonding in the first nine months postpartum: the role of mother's attachment style and psychological flexibility. J Reprod Infant Psychol 2023:1-15. [PMID: 37525320 DOI: 10.1080/02646838.2023.2242379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Mother's bond to the infant in the postpartum period plays an important role in the subsequent mother-infant relationship and the infant's socio-emotional functioning. Several maternal characteristics, such as attachment style and psychological flexibility, may contribute to the quality of mother-infant bonding, though literature examining these variables is still scarce. The present study aimed to examine the impact of mother's attachment on mother-infant bonding in the first month postpartum and the mediating role of psychological flexibility on that association. METHODS Participants were 226 mothers of an infant up to 9 months old, who reported on their own attachment style (in terms of anxiety, comfort with proximity, trust in others), psychological flexibility (in terms of openness to experience, behavioural awareness, valued action) and mother-infant bonding. RESULTS Results showed that mother's attachment anxiety predicted a bond with the infant directly and indirectly via mother's psychological flexibility, specifically through behavioural awareness and valued action. Trust in others had an impact on mother-infant bonding through behavioural awareness, whereas comfort with proximity influenced mother-infant bond indirectly, via valued action. Finally, mothers' civil status, schooling and number of children were relevant to better understand the variance of our mediating and dependent variables. DISCUSSION Our findings highlight the importance of mother's attachment and psychological flexibility in promoting the quality of mother-infant bonding, which can inform future intervention programmes targeting modifiable factors, such as psychological flexibility, to promote early positive parent-infant relationships, particularly for single, first-time mothers, with higher levels of education.
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Affiliation(s)
- Paula Vagos
- Portucalense Institute for Psychology (I2P), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
- William James Center for Research, Department of Education and Psychology, Universidade de Aveiro, Aveiro, Portugal
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Vera Mateus
- Portucalense Institute for Psychology (I2P), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Joana Silva
- Portucalense Institute for Psychology (I2P), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
| | - Vânia Araújo
- Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
| | - Ana Xavier
- Portucalense Institute for Psychology (I2P), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Lara Palmeira
- Portucalense Institute for Psychology (I2P), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention, (CINEICC), University of Coimbra, Coimbra, Portugal
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Spurlock EJ, Pickler RH, Terry RE, Drake E, Roux G, Amankwaa L. Narrative Review of Use and Continued Relevance of the Maternal Infant Responsiveness Instrument. J Perinat Neonatal Nurs 2023; 37:205-213. [PMID: 37494689 PMCID: PMC10372724 DOI: 10.1097/jpn.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND The Maternal Infant Responsiveness Instrument (MIRI) was developed in 2002 to measure a critical aspect of maternal-infant health. The objective of this analysis was to examine use, results, and continued relevance of the MIRI 20 years after its creation. METHODS For the completion of this narrative review, 5 electronic databases were accessed using key search terms. Inclusion criteria were English-language, peer-reviewed research using the MIRI. Hand searches of reference lists were conducted. Five authors performed screening, data extraction, appraisal, and summarized findings. RESULTS Fifteen studies were included. All studies reported an internal consistency of α > 0.70 for the MIRI. Positive correlations were reported with self-efficacy, infant temperament, and life satisfaction. Inverse relationships were reported with stress, depression, and experiential avoidance. Depressive symptomatology, life satisfaction, self-esteem, self-efficacy, and previous childcare experience were predictors of maternal responsiveness. DISCUSSION Maternal well-being (postpartum depression and stress) can affect maternal responsiveness. Given the pervasive disparities in maternal health and well-being, it is important to have reliable measures of the effects of those disparities. The MIRI, a valid and reliable measure, may be useful for assessing the effectiveness of interventions designed to improve infant and maternal well-being.
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Affiliation(s)
- Elizabeth J. Spurlock
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Newton Hall 324, Columbus, OH 43210
| | - Rita H. Pickler
- College of Nursing, The Ohio State University, 200V Heminger Hall, 1577 Neil Avenue, Columbus, OH 43210
| | - Rollins E. Terry
- Children’s Hospital of Philadelphia, University of Virginia, School of Nursing, Charlottesville, VA
| | - Emily Drake
- University of Virginia, School of Nursing, CMNEB 3007, Charlottesville, VA
| | - Gayle Roux
- University of North Dakota, College of Nursing & Professional Disciplines, 430 Oxford St, Stop 9025, Grand Forks ND 58202-9025
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12
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Volling BL, Tan L, Rosenberg L, Bader LR. Will I love my second baby as much as my first? Prevalence and psychosocial correlates of maternal-fetal relationship anxiety for second-time mothers. Infant Ment Health J 2023; 44:541-553. [PMID: 37149744 PMCID: PMC10524320 DOI: 10.1002/imhj.22060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 03/21/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
Most mothers have more than one child. Second-time mothers may worry about whether they will love the second baby as much as their first child. The current study examined mothers' maternal-fetal relationship anxiety (MFRA) to their second baby, the prediction of mother-infant bonding (MIB) and infant-mother attachment security post-partum, and the psychosocial correlates of mothers' MFRA during pregnancy. Mothers (N = 241, 85.9% White, 5.4% Black, 2.9% Asian/American, 3.7% Latina) and their second-born infants (55% boys) living in the Midwestern United States participated in a longitudinal investigation starting in the last trimester of pregnancy, and 1, 4, 8, and 12 months postpartum. Most women reported little to no anxiety about forming an attachment to their second baby (89.1%). MFRA predicted less maternal warmth toward the baby at 1, 4, and 8 months postpartum, but did not predict security of the infant-mother attachment at 12 months. Prenatal MFRA was also related to maternal depressive symptoms, an insecure attachment with the first child, more marital distress, and more adult attachment avoidance and ambivalence prenatally. Mothers worrying about loving a second baby as much as their first child may be experiencing other psychosocial risks that have repercussions for the developing mother-infant relationship.
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Affiliation(s)
| | - Lin Tan
- Department of Health Behavior and Health Systems, University of North Texas, Health Science Center
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13
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Vatanparast A, Kamrani A, Shakiba S, Amouchie R, Akbari E, Ayers S. The latent factor structure and assessment of childbirth-related PTSD: psychometric characteristics of the City Birth Trauma Scale-Persian version (City-BiTS-P). Front Psychiatry 2023; 14:1204392. [PMID: 37409157 PMCID: PMC10318432 DOI: 10.3389/fpsyt.2023.1204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Objective There is no validated Persian questionnaire to measure childbirth-related PTSD (CB-PTSD) symptoms. To cover this gap, the present study aimed to provide a Persian version of the City Birth Trauma Scale (CityBiTS-Pr) and to determine its psychometric properties. Method Since this is a cross-sectional study, sampling was done using a convenient sampling method. In total, 300 Persian-speaking women took part in this study and completed the City Birth Trauma Scale (CityBiTS-Pr), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Edinburgh Postnatal Depression Scale (EPDS), the Anxiety Subscale of the Depression, and the Anxiety and Stress Scale (DASS-21). In addition, sociodemographic information was completed. A confirmatory factor analysis of two- and four-factor models and a bi-factor model with a general factor and two specific factors were tested. Fit indices were calculated for all three models. Reliability, convergent, divergent, and discriminant validity also were examined. R v4.2.1 and SPSS v23 were used for data analysis. Results The four-factor model comprised intrusion, avoidance, negative cognitions and mood, and hyper-arousal showed a poor fit. The two-factor model composed of "birth-related symptoms" and "general symptoms" provided the best results based on all fit indices. The bi-factor result was relatively good, but the loadings indicated that the general symptoms factor is not well defined. Conclusion The Persian version of the City Birth Trauma Scale (CityBiTS-Pr) is a valid and reliable questionnaire for evaluating postpartum PTSD.
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Affiliation(s)
- Amin Vatanparast
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ali Kamrani
- Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shima Shakiba
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ramin Amouchie
- Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Elnaz Akbari
- Paramedical Department, Islamic Azad University, Rasht Branch, Rasht, Iran
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, University of London, London, United Kingdom
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14
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Vanwalleghem S, Miljkovitch R, Sirparanta A, Toléon C, Leclercq S, Deborde AS. Maternal Attachment Networks and Mother-Infant Bonding Disturbances among Mothers with Postpartum Major Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6155. [PMID: 37372742 DOI: 10.3390/ijerph20126155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
The literature suggests that maternal insecure attachment is a risk factor for postpartum depression which, in turn, affects motherinfant bonding. However, recent research in attachment suggests that the investigation of attachment networks provides further insight in the understanding of psychological outcomes. This study aims to test a model according to which mothers' attachment towards each of their parents contributes to explain attachment towards their romantic partners, which itself is associated with maternal postpartum depression and, in turn, with motherinfant bonding. The Attachment Multiple Model Interview, the Edinburgh Postnatal Depression Scale, and the Postpartum Bonding Questionnaire were administered to 90 mothers of infants under 6 months of age (32 with postpartum major depression). Results showed that attachment towards the partner (1) is best explained by attachment to the father and (2) mediates the link between attachment to the father and depression severity. Also, depression severity mediates the link between attachment to the partner and motherinfant bonding. These results highlight the role of attachment models towards the romantic partner and the father in the perinatal period and the relevance of attachment-focused therapeutic programs in treating postpartum maternal depression.
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Affiliation(s)
- Stéphanie Vanwalleghem
- Unité de Recherche CLIPSYD, Paris Nanterre University, 200 Avenue de la République, 92000 Nanterre, France
| | - Raphaële Miljkovitch
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Aino Sirparanta
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Camille Toléon
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
| | - Stéphanie Leclercq
- Centre Hospitalier la Chartreuse, Unité Père-Mère-Bébé, 1 Boulevard Chanoine Kir, 21000 Dijon, France
| | - Anne-Sophie Deborde
- Laboratoire Paragraphe, Paris 8 University, 2 Rue de la Liberté, 93200 Saint-Denis, France
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15
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Fameli AL, Costa DSJ, Coddington R, Hawes DJ. Assessment of childbirth-related post traumatic stress disorder in Australian mothers: Psychometric properties of the City Birth Trauma Scale. J Affect Disord 2023; 324:559-565. [PMID: 36586608 DOI: 10.1016/j.jad.2022.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The City Birth Trauma Scale (BiTS; Ayers, Wright & Thornton, 2018) is self-report measure of Post-Traumatic Stress Disorder (PTSD) symptoms following childbirth, based on DSM-5 criteria. We report on the first study of the psychometric properties of the BiTS in the Australian population. METHODS Participants were mothers of infants aged 0-12 months (N = 705), who completed the BiTS and measures of related constructs. Confirmatory factor analysis was performed to assess the factor structure of the BiTS. Examination of the reliability, convergent, divergent and discriminant validity and acceptability of the BiTS was also examined. RESULTS Confirmatory factor analysis supported a bi-factor model of Birth-related Symptoms (BRS) and General Symptoms (GS) of post-partum PTSD as well as a global CB-PTSD factor. Internal consistency was found for the BiTS total scale and two proposed subscales (BRS and GS). BiTS total scores were significantly associated with an established measure of PTSD, providing support for convergent validity. Evidence of discriminant validity was examined by comparing the BiTS to an established measure of postpartum depression. LIMITATIONS The present sample may over-represent participants with traumatic birth experiences in comparison to the general public. Furthermore, use of self-report measures limits the capacity to confirm the diagnostic status of participants. CONCLUSION These findings suggest that the BiTS is a valid and reliable measure of childbirth-related PTSD, suited for use in postpartum populations. Total scores on the measure may be informative for clinical and research purposes, while evidence suggests strong support for interpretation of subscale scores.
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Affiliation(s)
| | - Daniel S J Costa
- School of Psychology, University of Sydney, Australia; Pain Management Research Institute, Royal North Shore Hospital, St Leonards, Australia
| | - Rebecca Coddington
- School of Nursing and Midwifery, University of Technology Sydney, Australia
| | - David J Hawes
- School of Psychology, University of Sydney, Australia.
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16
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Leiße A, Dötzer J, Ruhnau A, Aschentrup L, Fischer F, Wrona KJ. Pregnancy Care during the COVID-19 Pandemic in Germany: A Public Health Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2721. [PMID: 36768087 PMCID: PMC9916077 DOI: 10.3390/ijerph20032721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic.
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Affiliation(s)
- Antonia Leiße
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Julia Dötzer
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Alice Ruhnau
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Leona Aschentrup
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
- Faculty of Engineering and Mathematics, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
| | - Florian Fischer
- Institute of Public Health, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Kamil J. Wrona
- Faculty of Engineering and Mathematics, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
- Faculty of Health, University of Applied Sciences Bielefeld, 33619 Bielefeld, Germany
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17
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Van Sieleghem S, Danckaerts M, Rieken R, Okkerse JME, de Jonge E, Bramer WM, Lambregtse-van den Berg MP. Childbirth related PTSD and its association with infant outcome: A systematic review. Early Hum Dev 2022; 174:105667. [PMID: 36152399 DOI: 10.1016/j.earlhumdev.2022.105667] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Maternal postnatal mental health problems may negatively impact child development. Postpartum research has mainly focused on the impact of maternal depression and anxiety due to their high prevalence (13-25 % and 10-18 %, respectively). However, maternal childbirth-related PTSD (CB-PTSD) could be another important risk factor in child development (estimated prevalence: 4.7 %). OBJECTIVE We investigated whether maternal CB-PTSD (symptoms) are associated with a negative mother-child relationship and/or child developmental outcome for children aged 0-5 years. Furthermore, we examined whether maternal trauma-focused therapy can positively impact mother and child outcomes. METHODS We performed a systematic review by searching three databases (Embase, Medline, PsycInfo). Search terms involved: 'birth or delivery modes', 'PTSD psychological trauma', and 'child development or child behavior'. Two independent reviewers evaluated all eligible papers. RESULTS Thirty-five papers (30 samples) were included and qualitatively reported. Results suggest a negative association of maternal CB-PTSD (symptoms) with mother-infant attachment and child behavior. However, confounding factors may explain this association. The evidence on associations with breastfeeding, sleeping, socio-emotional development, and weight gain is insufficient. Research investigating the effect of maternal trauma-focused therapy on a child's outcome is scarce, contradictory, and of low quality. CONCLUSION This systematic review suggests that maternal CB-PTSD may be associated with an increased number of problems in mother-infant attachment and child behavior, but other domains remain scarcely investigated and methodologic issues are present (cross-sectional study design, influence of confounding variables, sample representativeness, diversity in assessment tools). Our results support a multidisciplinary approach to providing early prevention and screening of the maternal mental health state.
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Affiliation(s)
- Sofie Van Sieleghem
- Department of Child and Adolescent Psychiatry, UPC KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Marina Danckaerts
- Department of Child and Adolescent Psychiatry, UPC KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rob Rieken
- Department of Child and Adolescent Psychiatry/psychology, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands
| | - Jolanda M E Okkerse
- Department of Child and Adolescent Psychiatry/psychology, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands
| | - Ellen de Jonge
- Department of psychiatry, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Child and Adolescent Psychiatry/psychology, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands; Department of psychiatry, Erasmus MC - Erasmus University Hospital Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands
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18
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Effect of Mothers' Parental Bonding Style on Their Maternal Attachment. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1112154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: This study was aimed to investigate the relationship between mothers’ parental bonding styles and their maternal attachment levels.
Methods: This descriptive and cross-sectional study involved 216 mothers. The data were collected using the Personal Information Form, the Maternal Attachment Inventory (MAI), and the Parental Bonding Instrument (PBI).
Results: The mean MAI score of the mothers was found to be 96.72 ± 8.75 which indicated a high level of maternal attachment. The mean score from the PBI-mother form was found to be 49.13 ± 14.60 and PBI-father form was 46.12 ±14.90 which indicated that the mothers had a positive bonding with their parents.The relationship between an individual’s maternal attachment was found to be positive, moderate, and significant to her own parental bonding. Parental bonding with mother and parental bonding with father explained 35% and 23% of the total variance found in maternal attachment, respectively.
Conclusion: Mothers’ parental bonding showed an effect on their maternal attachment as well. The families and couples should be trained on how positive or negative bonding with their children can affect their life cycles and future lives.
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Nie X, Cheng L, Huang F, Zhang T, Yao Y, Tan J, Ke Y. Construct validity and psychometric properties of the Chinese version of the City Birth Trauma Scale. J Obstet Gynaecol Res 2022; 48:2946-2955. [DOI: 10.1111/jog.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Li Cheng
- Hubei University of Medicine Shi Yan China
| | - Fei Huang
- Hubei University of Medicine Shi Yan China
| | | | - Yin‐Di Yao
- Hubei University of Medicine Shi Yan China
| | - Jing Tan
- Hubei University of Medicine Shi Yan China
| | - Yu‐Ye Ke
- Hubei University of Medicine Shi Yan China
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20
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Postpartum PTSD and Birth experience in Russian-speaking women. Midwifery 2022; 112:103385. [DOI: 10.1016/j.midw.2022.103385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
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21
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Davis AMB, Sclafani V. Birth Experiences, Breastfeeding, and the Mother-Child Relationship: Evidence from a Large Sample of Mothers. Can J Nurs Res 2022; 54:518-529. [PMID: 35389289 DOI: 10.1177/08445621221089475] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND It is a priority for public health professionals to improve global breastfeeding rates, which have remained low in Western countries for more than a decade. Few researchers have addressed how maternal perceptions of birth experiences affect infant feeding methods. Furthermore, mixed results have been shown in research regarding breastfeeding and mother-child bonding, and many studies are limited by small sample sizes, representing a need for further investigation. PURPOSE We aimed to examine the relationship between subjective birth experiences and breastfeeding outcomes, and explored whether breastfeeding affected mother-infant bonding. METHODS 3,080 mothers up to three years postpartum completed a cross - sectional survey. RESULTS Mothers who had more positive birth experiences were more likely to report breastfeeding their babies. Moreover, mothers who perceived their birth as more positive were more likely to breastfeed their child for a longer period (over 9 months) than those who had more negative experiences. In line with recent research, breastfeeding behaviours were not associated with reported mother-infant bonding. CONCLUSIONS Mothers who reported better birth experiences were most likely to breastfeed, and breastfeed for longer. We find no evidence to suggest that feeding methods are associated with bonding outcomes.
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Affiliation(s)
- Abi M B Davis
- School of Psychology, 4547University of Lincoln, Lincoln, UK
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22
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Hildingsson I, Rubertsson C. Postpartum bonding and association with depressive symptoms and prenatal attachment in women with fear of birth. BMC Pregnancy Childbirth 2022; 22:66. [PMID: 35078403 PMCID: PMC8788067 DOI: 10.1186/s12884-021-04367-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Co-morbidity is prevalent in women with fear of birth. Depressive symptoms and lack of prenatal attachment might influence the postpartum bonding between the mother and the new-born. Aim To examine the underlying dimensions of the Postpartum Bonding Questionnaire and to investigate associations between depressive symptoms, prenatal attachment and postpartum bonding in women with fear of birth. Methods A longitudinal study comprising 172 women with fear of birth. Data were collected by questionnaires in mid- and late pregnancy and two months after birth. The Edinburgh Postnatal Depressive Scale, Prenatal Attachment Inventory and Postpartum Bonding Questionnaire were investigated. Results Two factors of the Postpartum Bonding Questionnaire were identified: Factor 1 mirrored caring activities and the women’s perceptions of motherhood, whereas Factor 2 reflected negative feelings towards the baby. The Postpartum Bonding Questionnaire was negatively correlated with the Prenatal Attachment Inventory and positively with The Edinburgh Postnatal Depressive Scale. Women with fear of birth and depressive symptoms both during pregnancy and postpartum showed the highest risk of impaired bonding after birth. Primiparity and being single were also associated with impaired bonding. Conclusion A focus on women’s mental health during pregnancy is necessary in order to avoid the negative effects of impaired bonding on the infant. Depressive symptoms could be concurrent with fear of birth and, therefore, it is important to determine both fear of birth and depressive symptoms in screening procedures during pregnancy. Caregivers who meet women during pregnancy need to acknowledge prenatal attachment and thereby influence adaptation to motherhood.
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23
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He Z, Chiu JWT, Lin Y, Akinwunmi B, Wong TH, Zhang CJP, Ming WK. The Construct Structures of Psychological and Behavioral Responses to COVID-19 Pandemic in Pregnant Women. Front Psychiatry 2022; 13:796567. [PMID: 35903641 PMCID: PMC9323087 DOI: 10.3389/fpsyt.2022.796567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
AIM The present study aimed to investigate the construct structure behind the psychosocial response, behavioral response, prenatal depression, and post-traumatic stress disorder (PTSD) in pregnant women during the COVID-19 pandemic in China. METHOD The validated Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), PTSD CheckList (PCL)-6, and two newly established scales for COVID-19-related psychological and behavioral responses were used. Structural equation modeling (SEM) analysis was applied to evaluate the structural relationships of psychological and behavioral responses during the COVID-19 pandemic. RESULTS Of the 1,908 mothers who completed the questionnaires, 1,099 met the criteria for perinatal depression, and 287 were positively screened for PTSD, where 264 women exceed the cut-off points for both. Pregnant women with full-time or part-time jobs tended to have the lowest scores of EPDS (10.07 ± 5.11, P < 0.001) and stress levels (23.85 ± 7.96, P = 0.004), yet they were more likely to change their behavior in accordance with the COVID-19 outbreak (13.35 ± 3.42, P = 0.025). The structural model fit the data (χ2 = 43.260, p < 0.001) and resulted in satisfactory fit indices (CFI = 0.984, TLI = 0.959, RMSEA = 0.072, and χ2/df = 10.815), all path loadings were significant (p < 0.05). The SEM indicates that the level of QoL was attributable to the occurrence of PND, leading to PTSD, and COVID-19 related behavioral and psychological responses. CONCLUSION The inter-relationships between the COVID-19-related psychosocial and behavioral responses have been assessed, indicating that the pandemic increased the burden of perinatal depression. Psychoeducation, as well as other psychological interventions, may be needed to alleviate the COVID-19-based anxiety and increase their engagement in protective behaviors.
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Affiliation(s)
- Zonglin He
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong SAR, China
| | - Joyce Wai-Ting Chiu
- International School, Jinan University, Guangzhou, China.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Department of Psychology, University of York, York, United Kingdom
| | - Yuchen Lin
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Babatunde Akinwunmi
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.,Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States
| | - Tak Hap Wong
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China
| | - Casper J P Zhang
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
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24
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Infante-Gil L, Silverio SA, Fallon V, Wendland J. Postpartum specific anxiety in a French population: Validation of the French version of the Postpartum Specific Anxiety Scale [PSAS-FR]. Perspect Psychiatr Care 2022; 58:418-428. [PMID: 33955561 DOI: 10.1111/ppc.12808] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/08/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to validate the Postpartum-Specific-Anxiety-Scale (PSAS) as a French-language instrument, which assesses maternal and infant-related anxieties during the postpartum period. DESIGN AND METHODS The methodology included six stages: preliminary French translation; selection of most articulate items and back-translation; rectification of discrepancies; pilot study (n = 257); reliability and validity studies (n = 258; n = 874); and test-retest reliability study (n = 231). FINDINGS The PSAS-FR demonstrated good acceptability, high internal consistency of the global scale (Cronbach's α = 0.93), and each of the factors; along with good validity, and test-retest reliability. The receiver operating characteristic analysis suggested a satisfactory screening tool. PRACTICE IMPLICATIONS The PSAS-FR appears to be a valid and reliable tool to screen for postpartum anxieties in the French-speaking population.
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Affiliation(s)
- Lilliam Infante-Gil
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Université de Paris, Paris, France
| | - Sergio A Silverio
- Department of Women & Children's Health, School of Life Course Sciences, King's College London, London, UK.,Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jaqueline Wendland
- Psychopathology and Health Processes Laboratory, Institute of Psychology, Université de Paris, Paris, France.,Vivaldi Parent-Infant Mental Health Unit, Pitié-Salpêtrière University Hospital - AP-HP, Paris, France
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25
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Rusanen E, Vierikko E, Kojo T, Lahikainen AR, Pölkki P, Paavonen EJ. Prenatal expectations and other psycho-social factors as risk factors of postnatal bonding disturbance. Infant Ment Health J 2021; 42:655-671. [PMID: 34505721 DOI: 10.1002/imhj.21941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/23/2021] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- Erja Rusanen
- Open University, University of Helsinki, Helsinki, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Elina Vierikko
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tiina Kojo
- Social and Family Services, Family Counselling, Oulu, Finland
| | | | - Pirjo Pölkki
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - E Juulia Paavonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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26
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Hendrix YMGA, van Dongen KSM, de Jongh A, van Pampus MG. Postpartum Early EMDR therapy Intervention (PERCEIVE) study for women after a traumatic birth experience: study protocol for a randomized controlled trial. Trials 2021; 22:599. [PMID: 34488847 PMCID: PMC8419663 DOI: 10.1186/s13063-021-05545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Up to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively influencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience. METHODS The PERCEIVE study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or 'care-as-usual'. Patients in the EMDR group receive two sessions of therapy between 14 (T0) and 35 days postpartum. All participants will be assessed at T0 and at 9 weeks postpartum (T1). At T1, all participants will undergo a CAPS-5 interview about the presence and severity of PTSD symptoms. The primary outcome measure is the severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at multiple midwifery practices in Amsterdam, the Netherlands. DISCUSSION It is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience. TRIAL REGISTRATION Netherlands Trial Register NL73231.000.20 . Registered on 21 August 2020.
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Affiliation(s)
- Y M G A Hendrix
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, the Netherlands.
| | - K S M van Dongen
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, the Netherlands
| | - A de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, the Netherlands.,Research Department, PSYTREC, Bilthoven, the Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
| | - M G van Pampus
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, the Netherlands
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27
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Kalfon Hakhmigari M, Peled Y, Krissi H, Levy S, Molmen-Lichter M, Handelzalts JE. Anxious Attachment Mediates the Associations Between Early Recollections of Mother's Own Parental Bonding and Mother-Infant Bonding: A 2-Month Path Analysis Model. Front Psychiatry 2021; 12:682161. [PMID: 34366916 PMCID: PMC8336863 DOI: 10.3389/fpsyt.2021.682161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
Parental bonding (recollection of own parents' parenting), adult attachment, and mother-infant bonding are all closely related yet distinct concepts of the parent-child relationship, sometimes used interchangeably in the literature. This study aimed to examine the associations between these concepts in a longitudinal path analysis design. A total of 262 postpartum women who gave birth at the maternity ward of a large tertiary health center in Israel completed a demographic questionnaire, the Experiences in Close Relationships Scale (ECR), the Parental Bonding Instrument (PBI) at 1-4 days postpartum, and the Postpartum Bonding Questionnaire (PBQ) at 2 months postpartum. Parental care factor (PBI) was found to be associated with mother-infant bonding (PBQ), directly and indirectly through insecure anxious attachment (ECR). Denial of autonomy factor (PBI) was found to be associated with mother-infant bonding (PBQ) only through insecure anxious attachment (ECR). Encouragement of behavioral freedom factor (PBI) was found to be associated with mother-infant bonding (PBQ) in a simple correlation but not in the complete model. The results highlight the intergenerational aspects of parenting and suggest that early childhood interventions with parents may have a long-term impact on child-rearing though generations, and by that on children's development.
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Affiliation(s)
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
| | - Maayan Molmen-Lichter
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
| | - Jonathan E. Handelzalts
- School of Behavioral Sciences, The Academic College of Tel Aviv-Yafo, Tel Aviv, Israel
- Psychiatry Department, University of Michigan, Ann Arbor, MI, United States
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28
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Weigl T, Garthus-Niegel S. [Questionnaires for the Assessment of Bonding During Pregnancy and after Birth (Part 3 of a series on psychological assessment during the peripartum period)]. Z Geburtshilfe Neonatol 2021; 225:468-472. [PMID: 34058778 DOI: 10.1055/a-1471-8017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bonding of (expectant) parents with their child is of great importance for the psychological well-being of both the parents and the child. This is especially true if parents suffer from mental health problems like depression. Furthermore, attachment experiences during early childhood can affect both the child's mental health as well as later relationships. However, typical assessment methods like the Strange Situation Test are not very suitable in clinical practice in neonatology and obstetrics, especially since the focus here is primarily on the child's attachment behavior. In addition, bonding with the unborn child cannot be assessed in this way. Therefore, questionnaires represent a more feasible method for the assessment of parental bonding. Instruments have been developed for the time during pregnancy and after birth, but most of them were developed for women. Also, there is a need for further methodological development of these questionnaires. Cut-offs and norm values are highly relevant for clinical practice, but still need to be established in some cases. Assessment of parental bonding using questionnaires can potentially be beneficial and will most likely help to initiate timely supportive interventions.
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Affiliation(s)
- Tobias Weigl
- Psychology School, Hochschule Fresenius - University of Applied Sciences, Düsseldorf, Deutschland
| | - Susan Garthus-Niegel
- Fakultät Medizin, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Deutschland.,Institut und Poliklinik für Arbeits- und Sozialmedizin, TU Dresden, Dresden, Deutschland
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29
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Kjerulff KH, Attanasio LB, Sznajder KK, Brubaker LH. A prospective cohort study of post-traumatic stress disorder and maternal-infant bonding after first childbirth. J Psychosom Res 2021; 144:110424. [PMID: 33756149 PMCID: PMC8101703 DOI: 10.1016/j.jpsychores.2021.110424] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate risk factors for childbirth-related post-traumatic stress disorder (CR-PTSD) measured 1-month after first childbirth, and the association between CR-PTSD and maternal-infant bonding. METHODS In this prospective cohort study 3006 nulliparous women living in Pennsylvania, USA, were asked about CR-PTSD at 1-month postpartum, and maternal-infant bonding at 1, 6 and 12-months postpartum. Multivariable logistic regression models identified risk factors for CR-PTSD and associations between CR-PTSD and maternal-infant bonding at 1, 6 and 12-months postpartum, controlling for confounding variables - including postpartum depression, stress and social support. RESULTS Nearly half (47.5%) of the women reported that during labor and delivery they were afraid that they or their baby might be hurt or die, and 225 women (7.5%) reported experiencing one or more CR-PTSD symptoms at 1-month postpartum. Depression, stress and low social support during pregnancy were associated with CR-PTSD, as well as labor induction, delivery complications, poor pain control, and unplanned cesarean delivery. Women with CR-PTSD reported a less positive childbirth experience, less shared decision-making, and were more likely to score in the bottom third on maternal-infant bonding at 1-month postpartum (adjusted odds ratio [aOR] 2.5, 95% CI 1.8-3.3, p < 0.001); at 6-months postpartum (aOR 2.1, 95% CI 1.5-2.8, p < 0.001); and at 12-months postpartum (aOR 2.2, 95% CI 1.6-3.0, p < 0.001). CONCLUSION In this large-scale prospective cohort study we found that CR-PTSD was consistently associated with lower levels of maternal-infant bonding over the course of the first year after first childbirth.
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Affiliation(s)
- Kristen H. Kjerulff
- Departments of Public Health Sciences and Obstetrics and Gynecology, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Laura B. Attanasio
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kristin K. Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Laura H. Brubaker
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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30
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Zhang L, Wang L, Yuan Q, Huang C, Cui S, Zhang K, Zhou X. The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester. BMC Pregnancy Childbirth 2021; 21:307. [PMID: 33863310 PMCID: PMC8052769 DOI: 10.1186/s12884-021-03779-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/30/2021] [Indexed: 01/27/2023] Open
Abstract
Background Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus. Methods The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA. Results The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality. Conclusions Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03779-5.
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Affiliation(s)
- Ling Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Lei Wang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Qiuyu Yuan
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Cui Huang
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Shu Cui
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 238000, China
| | - Kai Zhang
- Chaohu Hospital, Anhui Medical University, Hefei, 238000, China.
| | - Xiaoqin Zhou
- Chaohu Hospital, Anhui Medical University, Hefei, 238000, China.
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Handelzalts JE, Levy S, Molmen-Lichter M, Ayers S, Krissi H, Wiznitzer A, Peled Y. The association of attachment style, postpartum PTSD and depression with bonding- A longitudinal path analysis model, from childbirth to six months. J Affect Disord 2021; 280:17-25. [PMID: 33202334 DOI: 10.1016/j.jad.2020.10.068] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/22/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is substantial evidence that postpartum depression (PPD) is associated with a poor mother-infant bond, however, fewer studies have examined the role of other postpartum psychopathologies such as birth-related PTSD or relevant trait variables such as adult attachment styles in the quality of the mother-infant bond. METHODS 210 postpartum women were sampled in a maternity ward of a tertiary health care center. Participants completed questionnaires at three-time points. Demographics questionnaire and the Adult Attachment style scale were administrated at 1-4 days postpartum, the City Birth Trauma Scale and the Edinburgh Postpartum Depression Scale two months postpartum and the Postpartum Bonding questionnaire at six months postpartum. RESULTS The associations between adult attachment styles and postpartum bonding were fully mediated by postpartum psychopathology. Avoidant attachment had indirect effects on bonding through general PTSD symptoms (Beta=0.05, p=.019) and PPD (Beta=0.06, p=.010). Anxious attachment also had indirect effects on bonding through general PTSD symptoms (Beta=0.04, p=.044) and PPD (Beta=0.10, p=.001). In contrast, birth-related PTSD symptoms were not associated with bonding. The model presented a good fit. LIMITATIONS Women sampled from one health-care center and self-report measures used. CONCLUSIONS Our results suggest that although birth-related PTSD symptoms may cause difficulties, importantly they may not be associated with bonding difficulties six months postpartum. Therefore, women could be reassured that their birth-related PTSD symptoms, may not impact on bonding. Consequently, if interventions are specifically aimed at improving the mother-infant bond, the general-related PTSD, PPD symptoms and insecure attachment styles should be the focus of treatment.
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Affiliation(s)
- Jonathan E Handelzalts
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
| | - Sigal Levy
- School of Behavioral Sciences, Academic College of Tel-Aviv-Yafo, Tel-Aviv, Israel
| | | | - Susan Ayers
- School of Health Sciences, City, University of London, London, UK
| | - Haim Krissi
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arnon Wiznitzer
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Peled
- The Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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32
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Martínez-Vazquez S, Rodríguez-Almagro J, Hernández-Martínez A, Delgado-Rodríguez M, Martínez-Galiano JM. Long-Term High Risk of Postpartum Post-Traumatic Stress Disorder (PTSD) and Associated Factors. J Clin Med 2021; 10:488. [PMID: 33573115 PMCID: PMC7866544 DOI: 10.3390/jcm10030488] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Postpartum post-traumatic stress disorder (PTSD) is not a specific process but can last for months and may manifest itself during any subsequent pregnancies or even become chronic. This study aimed to determine the factors associated with long-term PTSD symptoms one year after delivery. A cross-sectional study was conducted on 1301 Spanish puerperal women. Data were collected on sociodemographic, obstetric, and neonatal variables. The Perinatal Post-Traumatic Stress Disorder Questionnaire (PPQ) was administered online through midwives' associations across Spain. Crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals were calculated. A PPQ score ≥ 19 (high-risk) was recorded for 13.1% (171) of the participants. Identified risk factors were not respecting a birth plan (aOR = 1.89 (95% CI 1.21-2.94)), formula-feeding of the baby at discharge (aOR = 2.50 (95% CI 1.20-5.17)), postpartum surgical intervention (aOR = 2.23 (95% CI 1.02-4.85)), hospital readmission (aOR = 3.45 (95% CI 1.21-9.84)), as well as verbal obstetric violence (aOR = 3.73 (95% CI 2.52-5.53)) and psycho-affective obstetric violence (aOR = 3.98 (95% CI 2.48-6.39)). During childbirth, some clinical practices, such as formula-feeding of the newborn at discharge or types of obstetric violence towards the mother, were associated with a higher risk of PTSD symptoms one year after delivery.
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Affiliation(s)
- Sergio Martínez-Vazquez
- Department of Nursing, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain; (S.M.-V.); (J.M.M.-G.)
| | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
| | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, 13071 Ciudad Real, Spain;
| | - Miguel Delgado-Rodríguez
- Department of Health Science, University of Jaen, 23071 Jaen, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, Faculty of Health Sciences, University of Jaen, 23071 Jaen, Spain; (S.M.-V.); (J.M.M.-G.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Responses to Stress: Investigating the Role of Gender, Social Relationships, and Touch Avoidance in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020600. [PMID: 33445696 PMCID: PMC7828124 DOI: 10.3390/ijerph18020600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 12/12/2022]
Abstract
Stress is a physiological response to internal and external events we call “stressors”. Response to the same daily stressors varies across individuals and seems to be higher for women. A possible explanation for this phenomenon is that women perceive sociality, relationships, and intimacy—important sources of both stress and wellbeing—differently from how men experience them. In this study, we investigate how gender, attachment, and touch avoidance predict stress responses on a sample of 335 Italians (216 females; age = 35.82 ± 14.32). Moreover, we analyze the network of relationships between these variables through multiple linear regression and exploratory network analysis techniques. The results recontextualize the role of gender in determining stress responses in terms of (lack of) confidence and touch avoidance toward family members; attitudes toward relationships seem to be the main determinants of stress responses. These results have implications for reducing stress in both clinical settings and at a social level.
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34
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Catala P, Suso-Ribera C, Marin D, Peñacoba C. Predicting postpartum post-traumatic stress and depressive symptoms in low-risk women from distal and proximal factors: a biopsychosocial prospective study using structural equation modeling. Arch Gynecol Obstet 2020; 303:1415-1423. [PMID: 33159548 DOI: 10.1007/s00404-020-05857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Posttraumatic stress (PTSD) and depression (PPD) are common mental disorders in the postpartum that constitute a threat both to the mother and the baby. It is unclear whether both disorders share similar antecedents, which is important to plan efficient interventions. The goal of this study was to examine the contribution of set of biopsychosocial predictors on both PTSD and PPD. METHODS The study design was prospective. The study was conducted at Hospital Universitario de Fuenlabrada, a public university hospital located in the south of Madrid (Spain). The sample was composed of 116 pregnant women with low pregnancy risk. STROBE reporting guidelines were followed. RESULTS The multivariate results show that psychopathology severity assessed during the first trimester (ß = 0.50, p < .001) and the Apgar score 5 min after delivery (ß = - 0.19, p = .030) were the two variables to significantly contribute to postpartum depressive symptoms. Conversely, only satisfaction with home care after delivery was independently associated with postpartum posttraumatic stress (ß = - 0.26, p = .016). The proposed model explained 21.8% of the variance of postpartum depressive symptoms (p = .041) and 27.1% of the variance of posttraumatic stress symptoms (p = .014). CONCLUSION Special attention should be given to shared and unique predictive factors of PDD and PTSD to develop effective prevention programs in perinatal care.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, Madrid, 28922, Alcorcón, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Dolores Marin
- Department of Nursing and Stomatology. Rey Juan Carlos University, Avda. Atenas s/n, Alcorcón, Spain.,Obstetrics Department, Hospital Universitario de Fuenlabrada, Madrid, Fuenlabrada, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, Madrid, 28922, Alcorcón, Spain.
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35
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Little KK, Sockol LE. Romantic Relationship Satisfaction and Parent-Infant Bonding During the Transition to Parenthood: An Attachment-Based Perspective. Front Psychol 2020; 11:2068. [PMID: 33013525 PMCID: PMC7493658 DOI: 10.3389/fpsyg.2020.02068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/27/2020] [Indexed: 01/09/2023] Open
Abstract
An important element of well-being during the transition to parenthood is new parents’ relationships with their partners and babies. Attachment theory posits that early caregiving experiences influence close relationships throughout the lifespan. Disruptions to the parent-child relationship, such as parental divorce or separation, may therefore have intergenerational effects as adult children of divorce navigate changes in their later relationships. This study examined whether new parents who have experienced a divorce or separation in their family of origin report greater romantic relationship dissatisfaction or impairment in the parent-infant bond during the early postpartum period, and if these associations are mediated by adult attachment. First-time parents of infants through 6 months of age (N = 94) completed measures of adult attachment, romantic relationship satisfaction, and parent-infant bonding. New parents who had experienced parental divorce or separation did not differ from those from intact families with regard to romantic relationship satisfaction, parent-infant bonding, attachment anxiety, or attachment avoidance. Attachment anxiety and avoidance were both associated with romantic relationship dissatisfaction and greater impairment in the parent-infant bond. These findings suggest that the experience of parental divorce or separation, in and of itself, does not confer increased risk for negative relational outcomes among new parents. Securely attached adults, regardless of their own parents’ marital status, report more positive relationships with their partners and infants during the early postpartum period.
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Affiliation(s)
- Kathleen K Little
- Department of Psychology, Davidson College, Davidson, NC, United States.,Department of Psychology, University of Miami, Miami, FL, United States
| | - Laura E Sockol
- Department of Psychology, Davidson College, Davidson, NC, United States
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36
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Nordahl D, Rognmo K, Bohne A, Landsem IP, Moe V, Wang CEA, Høifødt RS. Adult attachment style and maternal-infant bonding: the indirect path of parenting stress. BMC Psychol 2020; 8:58. [PMID: 32513300 PMCID: PMC7278048 DOI: 10.1186/s40359-020-00424-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The quality of maternal-infant bonding is related to important child outcomes. The literature has assumed that the ability to form relationships is a relatively stable trait, and research studies have suggested that a mother's attachment style in close adult relationships is related to mother-infant bonding. The transition to parenthood is also often stressful, and the adult attachment style may relate to parenting stress in the first year after birth. Such stress could possibly have a negative relationship with the mother-infant bond. In the present study, we examined the associations between maternal adult attachment styles and the quality of mother-infant bonding and whether this relationship is mediated by parenting stress. METHODS The present study sample comprised 168 women (mean age 31.0 years, SD 4.23 years). Between weeks 31 and 41 of gestation, the anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR). Between 5 and 15 weeks after birth mother-infant bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parent Domain (PSI-PD), respectively. RESULTS Both attachment-related avoidance and attachment-related anxiety correlated significantly and negatively with mother-infant bonding. However, a regression analysis showed that only attachment-related avoidance was a significant predictor of mother-infant bonding when controlling for demographic variables and maternal mental health history. The relationship between the adult attachment style and bonding was mediated by parenting stress. Higher scores on attachment avoidance and anxiety were related to increased stress, which was related to decreased quality of bonding. The overall parent domain and the subscale of competence in the parent-related stress dimension mediated between attachment avoidance and bonding, and the overall parent domain and the subscales of competence and role restriction mediated between attachment anxiety and bonding. There was no direct relationship between the adult attachment style and mother-infant bonding when parenting stress was included as a mediator. CONCLUSIONS This study illustrates that maternal adult attachment style relates to mother-infant bonding. This relationship was mediated by parenting stress. The results may have implications for the early identification of mothers at risk of having bonding difficulties.
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Affiliation(s)
- Dag Nordahl
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway.
| | - Kamilla Rognmo
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Agnes Bohne
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
| | - Inger Pauline Landsem
- Division of Child and Adolescent Health, University Hospital of Northern Norway, Tromsø, Norway
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vibeke Moe
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, East and South, Norway
| | | | - Ragnhild Sørensen Høifødt
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Takács L, Smolík F, Kaźmierczak M, Putnam SP. Early infant temperament shapes the nature of mother-infant bonding in the first postpartum year. Infant Behav Dev 2020; 58:101428. [DOI: 10.1016/j.infbeh.2020.101428] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/17/2020] [Accepted: 02/15/2020] [Indexed: 12/01/2022]
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Dudek J, Colasante T, Zuffianò A, Haley DW. Changes in Cortical Sensitivity to Infant Facial Cues From Pregnancy to Motherhood Predict Mother-Infant Bonding. Child Dev 2018; 91:e198-e217. [PMID: 30511459 DOI: 10.1111/cdev.13182] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The transition to motherhood triggers changes in human brain structure that may facilitate mother-infant bonding. Although much research on maternal cortical responses to infant faces has focused on the postpartum period, no previous study has examined whether longitudinal functional changes in the maternal cortex during pregnancy and postpartum are associated with mother-infant bonding. Using electroencephalography, prenatal to postnatal changes in cortical sensitivity (P1, P2, late positive potential, N170 event-related potentials) to infant and adult faces were examined in relation to reported mother-infant bonding in 40 mothers (Mage = 30.5 years). Prenatal to postnatal increases in P1 and P2 responses to infant faces predicted stronger bonding. Findings suggest that cortical changes in attention allocation rather than in face-specific encoding enhance bonding.
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Handelzalts JE, Hairston IS, Matatyahu A. Construct Validity and Psychometric Properties of the Hebrew Version of the City Birth Trauma Scale. Front Psychol 2018; 9:1726. [PMID: 30279671 PMCID: PMC6153334 DOI: 10.3389/fpsyg.2018.01726] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022] Open
Abstract
As many as third of the women perceive their childbirth as traumatic and although prevalence rates vary between studies, around 2-5% of women in community samples may develop childbirth-related postpartum post-traumatic stress disorder (PPTSD). The City Birth Trauma Scale (BiTS) was developed to address the need for a DSM-5-based instrument that assesses PPTSD. The BiTS is a self-report questionnaire, which covers all DSM-5 PTSD criteria, including the four symptom clusters - re-experiencing, avoidance, negative mood and cognitions and hyperarousal symptoms. The present study aimed to describe the psychometric properties and validate the Hebrew version of the BiTS. Five hundred and four mothers of 0- to 12-month-old infants were sampled using social media and the snowball method. Respondents completed an online survey consisting of a demographic questionnaire and the Hebrew versions of the BiTS, the impact of event scale-revised (IES-R), the Edinburgh postpartum depression scale (EPDS), and the Pittsburgh Sleep Quality Index (PSQI). The Hebrew BiTS demonstrated high internal consistency for the total scale (Cronbach α = 0.90) and good internal consistency (Cronbach's α = 0.75-0.85) for the subscales. An exploratory factor (EFA) analysis yielded a two-factors solution, accounting for 45% of variance, with general symptoms loaded on Factor 1, and childbirth-related symptoms loaded on Factor 2, with both factors demonstrating high internal consistency (Cronbach's α = 0.90, 0.85, respectively). High convergent validity for the symptom cluster subscales was demonstrated with the parallel IES-R subscales, EPDS and PSQI. A two-step cluster analysis indicated that dysphoric and hyperarousal symptoms best differentiated the severity of symptoms of respondents across measures. In sum, the Hebrew BiTS was psychometrically sound, indicating its utility for clinical and non-clinical research. The EFA and cluster analyses support the differentiation between symptoms of dysphoria and hyperarousal from trauma (i.e., childbirth) specific symptoms, suggesting that symptoms relating to specific aspects of the trauma differ qualitatively from general symptom in the phenomenology of PPTSD. Further research using clinical samples and comparing the BiTS to DSM-5 diagnosis using clinical interview is needed.
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Affiliation(s)
| | - Ilana S. Hairston
- Department of Psychology, Tel-Hai Academic College, Qiryat Shemona, Israel
- Psychiatry Department, University of Michigan, Ann Arbor, MI, United States
| | - Adi Matatyahu
- School of Behavioral Science, The Academic College of Tel Aviv-Yaffo, Yaffo, Israel
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