Some early indicators for depressive symptoms and bonding 2 months postpartum--a study of new mothers and fathers

Partner and professional support are associated with father-infant bonding: A cross-sectional analysis of mothers, midwives, and child health nurses' influence on primiparous and multiparous fathers of infants in Sweden

OBJECTIVE

To assess if received professional and social support are associated with father-infant bonding among primiparous (first-time) and multiparous (multi-time) fathers.

BACKGROUND

Early father-infant bonding predicts several positive child outcomes. However, while received professional and social support positively impacts fathers' transition into parenthood, little research has tested if these factors are associated with a stronger father-infant bond.

METHODS

In total, 499 fathers (296 primiparous and 203 multiparous) of infants (aged 0-12 months) completed a cross-sectional online survey between November 2018 and March 2020. The survey included items related to socio-demographics, having a planned pregnancy, postnatal midwifery support, child health nurse support, child health center attendance, and social support. The parent-infant bonding questionnaire (PBQ) was used to assess the father-infant bond. Multiple linear regression models were estimated for the total sample and based on paternal parity. Missing data were managed through multiple imputation procedures.

FINDINGS

Fathers reported fewer bonding disturbances if they received support from their partners, postnatal midwives, child health nurses, and attended more child health visits. Primiparous fathers reported fewer bonding disturbances when receiving support from their partners, postnatal midwives, and the child health nurse. However, multiparous fathers had more bonding disturbances than primiparous fathers and received less professional and partner support.

CONCLUSIONS

Receiving more partner and professional support is associated with less father-infant bonding disturbances. To encourage a better father-infant bond, clinicians should invite and support all fathers, regardless of parity, as they transition to parenthood.

Maternal and paternal postpartum early mood and bonding

BACKGROUND

Whereas the maternal 'blues' has been widely researched, comparatively less is known about the "highs" following childbirth, and the relation between mothers and fathers' mood in this early period. We aimed to investigate the association between maternal 'blues' and 'highs' with paternal postpartum mood (here described as 'lows' and 'highs') in the early postpartum and their associations with the quality of child bonding.

METHODS

Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data.

RESULTS

The 'blues' scores were higher in mothers, whereas 'highs' and bonding were higher in fathers. Maternal 'blues' were significantly correlated with paternal 'lows' (rs = .23, p < .05) and maternal 'highs' were also associated with paternal 'highs' (rs = .22, p < .05). Parental 'highs' were significantly associated with better baby bonding (B = .13, p = .02).

CONCLUSIONS

Our study demonstrates moderate associations between both 'blues/lows' and 'highs' in mothers and fathers shortly after the birth of the child. Associations between mood, particularly 'highs', and bonding were similar for mothers and fathers. Greater consideration of 'blues/lows' and 'highs' in both parents is needed to promote adjustment in the postpartum period.

Impaired mother-infant bonding: a community study from India

PURPOSE

Impaired mother-infant bonding (MIB) is associated with inadequate maternal skills and pose a higher risk for impaired learning, child abuse, and psychiatric disorders in children. There are approximately 24 million births annually in India; however, community data on MIB from India is lacking.

METHODS

The study reports the findings of a cross-sectional survey of 8189 mothers with children of age between 13 and 15 months from the state of Kerala, India. Bonding was assessed using the Mother-infant bonding scale (MIBS). Other correlates assessed include obstetric and birth history, chronic pain, postpartum depression and temperamental issues in the infant.

RESULTS

The prevalence of impaired MIB in our sample was 12.3%. Those in extended/joint family, experiencing postpartum complications, supplementary breastfeeding in the first 6 months, postpartum depression and temperamental issues in infant were found to be associated with increased MIBS scores in a multivariate mixed-effect zero-inflated poisson model.

CONCLUSION

Experience of impaired MIB is not uncommon among mothers in India. More needs to be done to explore these issues, especially among those with higher risk to ensure appropriate interventions to mitigate long-term consequences.

Within-individual relationships between mother-to-infant bonding and postpartum depressive symptoms: a longitudinal study

BACKGROUND

Although the importance of the dynamic intra-individual relationship between mother-to-infant bonding and postpartum depressive symptoms has been widely recognized, the complex interplay between them is not well understood. Furthermore, the potential role of prenatal depressive symptoms and infant temperament in this relationship remains unclear. This study aims to examine the bidirectional influence of mother-to-infant bonding on postpartum depressive symptoms within individuals and to elucidate whether prenatal depressive symptoms and infant temperament would influence deviations from stable individual states.

METHODS

Longitudinal data were collected from 433 women in early pregnancy. Of these, 360 participants completed the main questionnaires measuring impaired mother-to-infant bonding and postpartum depressive symptoms at least once during the postpartum period. Data were collected at early and late pregnancy and several postpartum time points: shortly after birth and at one, four, ten, and 18 months postpartum. We also assessed prenatal depressive symptoms and infant temperament. A random-intercept cross-lagged panel model was used.

RESULTS

Within-individual variability in mother-to-infant bonding, especially anger and rejection, significantly predicted subsequent postpartum depressive symptoms. However, the inverse relationship was not significant. Additionally, prenatal depressive symptoms and difficult infant temperament were associated with greater within-individual variability in impaired mother-to-infant bonding and postpartum depressive symptoms.

CONCLUSIONS

The present study demonstrated that the within-individual relationship between mother-to-infant bonding and postpartum depressive symptoms is likely non-bidirectional. The significance of the findings is underscored by the potential for interventions aimed at improving mother-to-infant bonding to alleviate postpartum depressive symptoms, suggesting avenues for future research and practice.

Development of the Parent-to-Infant Bonding Scale: Validation in Swedish Mothers and Fathers in Community and Clinical Contexts

Valid measurement instruments are needed to investigate the impact of parental bonding on child health development. The aim was to develop and validate a self-report questionnaire, the Parent-to-Infant Bonding Scale (PIBS) to measure bonding in both mothers and fathers. Internal consistency and construct validity were analysed using data from Swedish parents from both clinical (N = 182), and community (N = 122) population samples. Overall, good or acceptable internal consistency of the PIBS appeared. Convergent validity (against the Postpartum Bonding Questionnaire, analysed in the clinical sample) and discriminant validity (against the mental health constructs of depressive symptoms and anxiety) were demonstrated. The results support the PIBS as a measure of maternal and paternal bonding in community and clinical populations. Assessments of criterion validity in these populations are desirable. The similarities in PIBS measurement properties between the parent groups suggest its usefulness for comparisons between mothers and fathers, and for future investigations of unique and interactive impacts of maternal and paternal bonding on child outcomes using community and clinical cohorts.

Resilience, optimism and posttraumatic growth in first-time mothers

This study examines the association between posttraumatic growth (PTG) and two psychological attributes, resilience and optimism, in first-time mothers, after controlling for demographic and motherhood-related characteristics. PTG, the self-examination triggered by life-changing events, contains five factors: (1) relating to others, (2) new possibilities, (3) personal strength, (4) spiritual change, and (5) appreciation of life. Outcomes from studies conflict on whether PTG is associated with the two psychological attributes of resilience (the ability to resume one's life after adversity) and optimism (viewing life in a positive light). This study used a cross-sectional design. A convenience sample of first-time mothers whose infants were between 3 months and 1 year (N = 415) completed questionnaires containing several standardized and reliable instruments including those measuring the independent variables of resilience and optimism, and the dependent variable of PTG. A STROBE checklist guided the reporting of this study. Resilience was associated with overall PTG and four of its five factors. Optimism also was associated with overall PTG but only associated with two of its five factors. PTG profiles and squared semipartial correlations indicated that resilience had the stronger association, compared to optimism, with PTG and most of its factors. Our study's findings on the strong link between resilience and PTG suggest the need for research examining the impact of specific psychosocial nursing activities (e.g., providing emotional support; assisting others to identify their own strengths; encouraging the mobilization of one's internal resources; furnishing needed resources and referrals; and supplying health education and information), as these activities may not only promote resilience but also may contribute to PTG.

Factors associated with new onset of father-to-infant bonding failure from 1 to 6 months postpartum: an adjunct study of the Japan environment and children's study

PURPOSE

This study aimed to determine the factors associated with new onset father-to-infant (paternal) bonding failure from 1 to 6 months postpartum.

METHODS

This was a prospective birth-cohort study. Paternal bonding failure was evaluated using the Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) at 1 and 6 months postpartum. For cut-off scores, overall bonding failure, MIBS-J total scores ≥ 5; subscale for lack of affection, MIBS-J_LA scores ≥ 3; and subscale for anger/rejection, MIBS-J_AR scores ≥ 3 were used in this study. Multivariate regression analysis was performed to analyze relative variables.

RESULTS

We analyzed 872 fathers. The frequency of new-onset overall bonding failure, lack of affection, and anger/rejection was 5.6%, 4.9%, and 6.3%, respectively. For new-onset overall bonding failure, significant associated factors were paternal childcare leave (adjusted odds ratio [AOR] 3.192; 95% confidence interval [CI] 1.203-8.469), paternal new-onset depression symptoms (AOR 3.181; 95% Cl 1.311-7.716), and maternal new-onset overall bonding failure (AOR 4.595; 95% Cl 1.119-18.866). For new-onset lack of affection, significant associated factors were preterm birth (AOR 4.189; 95% Cl 1.473-11.913) and paternal new-onset depression symptoms (AOR 3.290; 95% Cl 1.294-8.362). For new-onset anger and rejection, significant associated factors were paternal childcare leave (AOR 3.142; 95% Cl 1.138-8.676), paternal new-onset depression symptoms (AOR 2.829; 95% Cl 1.133-7.068), and maternal new-onset anger/rejection (AOR 7.064; 95% Cl 2.300-21.700).

CONCLUSIONS

The factors associated with new-onset paternal bonding failure from 1 to 6 months postpartum were paternal childcare leave, preterm birth, paternal postpartum depression symptoms, and maternal bonding failure.

Effects of Parity and Postpartum Depression on Mother-Infant Bonding in the First Month Postpartum: A Retrospective Study

Objective This study aimed to examine the relationship between parity, postpartum depression (PPD), and mother-infant bonding (MIB) failure in the first month postpartum. Methods The study included 1,509 Japanese patients (748 primiparous and 761 multiparous). MIB was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J), which was translated in 2012, and its subscales, including lack of affection (LA) and anger and rejection (AR). Postpartum depression (PPD) was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) and its subscales, including anxiety (ANX), anhedonia (ANH), and depression (DEP). Multiple regression analyses using interaction terms were performed to examine the association of parity with the MIBS-J and EPDS. Results Parity was significantly associated with AR. ANX and ANH were strongly associated with LA, and ANX and DEP were strongly associated with AR. The interaction term "parity×EPDS total" was significantly associated with MIBS-J total, LA, and AR scores. Conclusions Primiparas and mothers with high ANX had more negative emotions toward their children during the first month postpartum, and mothers with high ANX or ANH had less interest in their children.

Changes in relationship satisfaction in the transition to parenthood among fathers

To date, research on the transition to parenthood and associated changes in relationship satisfaction (RS) has focused predominantly on mothers with their firstborn. This study targeted fathers to investigate their trajectories of RS with a particular focus on emerging differences between first- and second-time fathers. It furthermore considered various predictors such as the role of age, education, income, duration of relationship, marital status, child's biological sex, and child temperament. Data from a total of 606 fathers from the prospective longitudinal cohort study DREAM were analyzed. The analyses included assessments of four measurement time points (T1: prepartum; T2-T4: postpartum) over a period of more than 2 years. Latent growth curve modeling was applied with RS as the dependent variable and number of children as one of eight predictors of growth over time. First-time fathers showed higher initial RS, however experienced a steeper decline in the transition to parenthood than second-time fathers. At 8 weeks postpartum, first-time fathers still reported higher RS than second-time fathers. While RS continued to decline for first-time fathers up until 14 months postpartum, second-time fathers experienced an increase in RS. At 14 months and 2 years postpartum, second-time fathers showed higher RS scores than first-time fathers. Similar to first-time mothers, first-time fathers seem to experience a stronger RS decline during the transition to parenthood than second-time fathers, suggesting that especially couples becoming parents for the first time should be prepared for expected changes in their relationship.

Hebrew validation of the postpartum bonding questionnaire: a study of mothers and fathers

OBJECTIVE

The Postpartum Bonding Questionnaire (PBQ) is a self-report questionnaire designed to screen disorders of the mother-infant relationship. The PBQ was adapted to several countries, though there is no agreement on the accepted number of items and factors. This study aimed to assess the validity and reliability of the Hebrew version for both mothers and fathers.

METHODS

Participants (602 mothers and 144 fathers) from two separate samples were randomly recruited in the maternity ward of a large tertiary health centre. The mothers' samples were combined and redivided to form subsamples A and B. At T1 (1-4 days postpartum), the participants completed demographic questionnaire in person the PBQ and the Edinburgh Postpartum Depression Scale (EPDS) were administered online at T2 (8-12 weeks postpartum). The PBQ was also administrated at T3 (six-months).

RESULTS

EFA on subsample A resulted in a two-factor structure, which was tested using CFA on subsample B. The model's fit was very good; χ(35)2 = 83.68, p < .001, CFI = .97, TLI = .91, RMSEA = .07, SRMR = .03. Additional reliability and validity analyses showed a very good fit for mothers. Scalar measurement invariance across mothers and fathers yielded satisfactory results. CFA among fathers, revealed adequate goodness of fit; χ2/df = 87.65/46, p < .001, CFI = .95, TLI = .89, RMSEA = .08, SRMR = .05.

CONCLUSIONS

The Hebrew version of the PBQ demonstrated satisfactory validity for both mothers and fathers. The revised version, with 14 items, measures bonding as a continuum rather than measuring bonding disorders like the original version. These findings emphasise the importance of validating the scale in different cultural contexts.

Identifying Core Items of the Japanese Version of the Mother-to-Infant Bonding Scale for Diagnosing Postpartum Bonding Disorder

The Japanese version of the mother-to-infant bonding scale (MIBS-J), a self-report of postpartum bonding disorder, is used in clinical settings for screening postpartum bonding disorder at various time points. However, its psychometric properties, particularly measurement invariance, have rarely been reported, and the validity of comparing scores across time points and sex is unclear. We aimed to select and validate the MIBS-J items suitable for parents at three time points. Postpartum mothers (n = 543) and fathers (n = 350) were surveyed at 5 days, 1 month, and 4 months postpartum. All participants were randomly divided into two subgroups, one for exploratory factor analyses (EFAs) and another for confirmatory factor analyses. Measurement invariance of the best model was tested using the entire sample, between fathers and mothers, and across the three observation periods. A three-item structure (items 1, 6, and 8) extracted through EFAs showed acceptable configural invariance. This model was accepted for scalar invariance between fathers and mothers and for metric invariance across the three time points. Our findings suggest that the three-item MIBS-J is sufficient for diagnosis of postpartum parental bonding disorder through continuous observation for at least 4 postpartum months, in order to detect the priority of parents who need support.

Paternal postpartum depression, coparenting, and father-infant bonding: Testing two mediated models using structural equation modeling

BACKGROUND

Impaired father-infant bonding is a mental health issue that has been understudied. The current study aimed to examine the extent to which fathers' depression symptoms and coparenting relationship, respectively, are associated with infant bonding, as well as how these two variables mediate in the association with infant bonding.

METHODS

Cross-sectional data from 612 fathers of infants (0-24 months) were used in this study. Path analyses on two competing mediation models were used to examine the direct and indirect associations between fathers' depression symptoms, coparenting relationship, and infant bonding, after controlling for several known covariates.

RESULTS

Whether fathers reported depression symptoms (Model 1) or reported lower levels of coparenting relationships (Model 2), they also reported higher levels of impaired infant bonding, rejection and anger, and anxiety about care after controlling for the covariates. The analysis further found significant indirect associations between father depression symptoms and father-infant bonding via the coparenting relationship (Model 1) as well as significant indirect associations between the coparenting relationship and father-infant bonding via father depression symptoms (Model 2).

LIMITATIONS

The cross-sectional data cannot show causal links. Specific efforts were made to recruit fathers with depression symptoms, and therefore prevalence rates may appear skewed.

CONCLUSIONS

Decreasing depression symptoms and improving coparenting quality can potentially improve father-infant bonding. Fathers' depression symptoms and coparenting quality can be bi-directionally related in the association with father-infant bonding. Early detection and preventive treatments for paternal depression symptoms and coparenting are warranted.

Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament

Maternal bonding is key for infant development and well-being. Research to date focused on prenatal bonding experience, with fewer studies looking at the postnatal period. Moreover, evidence suggests significant associations among maternal bonding, maternal mental health, and infant temperament. The joint impact of maternal mental health and infant temperament on maternal postnatal bonding remains unclear, with limited research reporting longitudinal data. Hence, the present study aims (1) to explore the impact of maternal mental health and infant temperament on postnatal bonding at both 3 and 6 months of age, (2) to explore postnatal bonding stability from 3 to 6 months, and (3) to determine which factors are linked with 3-to-6-month changes in bonding. At the infants' 3 months (n = 261) and 6 months of age (n = 217), mothers provided measures of bonding, depressive and anxious symptoms, and infant temperament via validated questionnaires. At 3 months, higher levels of maternal bonding were predicted by lower levels of anxiety and depression in the mothers and by higher infants' regulation scores. At 6 months, lower levels of anxiety and depression predicted higher levels of bonding. Moreover, mothers showing decreases in bonding were characterized by 3-to-6-month increases in depression and anxiety, as well as increased reported difficulties in regulation dimensions of infant temperament. This study highlights the impact of both maternal mental health and infant temperament on maternal postnatal bonding in a longitudinal sample and could offer useful information for early childhood prevention and care.

The Current Concept of Paternal Bonding: A Systematic Scoping Review

Bonding is crucial to perinatal mental health. Despite an extensive body of literature on maternal bonding, few studies have focused on paternal bonding. This scoping review aimed to clarify the current state of the concept of paternal-infant/fetus bonding. The eligibility criteria were drawn from the population concept and context elements to answer the following questions: "what is paternal bonding?" and "what are the constructs of the concept of paternal bonding?" The review comprised 39 studies. Paternal bonding was associated with both positive and negative paternal behavior and thought and may be determined based on fathers' beliefs and rearing history. Most studies showed that father-child interaction is one of the factors promoting paternal bonding. However, fathers generally felt more distant from their babies post-delivery than mothers. Only a few studies originally defined paternal bonding; most relied on the definitions of maternal bonding. We found different descriptions lacking consensus. Few studies examined the differences between paternal and maternal bonding. No consensus exists on the concept, constructs, and assessment of paternal bonding. The causal relationship between paternal bonding and other variables is unexplored. Future studies should explore fathers' perspectives and experiences, focusing on the unknown aspects of paternal bonding identified in this review.

Mental Health Benefits of Breastfeeding: A Literature Review

Pregnancy is typically viewed as a time of emotional well-being for prospective mothers, but for some, this period can negatively impact mental health. However, the relationship between postpartum mental health and breastfeeding is not clearly understood. Considering that many health authorities recommend breastfeeding, clearly defining this relationship is important. This review aims to illustrate the effects that breastfeeding has on the mental health of postpartum mothers. An extensive computerized search was performed through databases of PubMed, CINAHL, and Medline. All studies conducted to determine the effects of breastfeeding on mental health were screened and included in this review. Search terms related to breastfeeding, postpartum, and mental health were used. This review on breastfeeding and postpartum depression (PPD) begins by discussing the correlation between lactation and the maternal stress response. Another component discussed is the duration of breastfeeding and its importance in limiting PPD symptoms. The review then shifts to focus more on the psychological aspects of breastfeeding, notably on changes to the sleep-wake cycle and mother-infant interactions. The final part of the review emphasizes the danger that early breastfeeding cessation imposes on a mother’s mental health, portraying how prenatal and early-onset postpartum depression may lead to early breastfeeding cessation. This composite collection of studies clarifies the importance of breastfeeding in reducing the incidence and severity of maternal postpartum depression.

Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3 months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3 months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3 months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3 months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3 months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3 months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3 months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

Home phototherapy of term neonates improves parental bonding and stress: Findings from a randomised controlled trial

AIM

We aimed to evaluate whether in-home phototherapy for hyperbilirubinaemia could reduce the poorer parent-infant bonding and increased parental stress associated with neonatal hospital treatment.

METHODS

In this multicentre randomised controlled trial, we allocated families to either home phototherapy or standard hospital care. The primary outcome was parent-infant bonding measured on the Postpartum Bonding Questionnaire directly after therapy and 4 months later. Secondary outcomes were results on four other instruments measuring parental bonding, quality of life and mental health.

RESULTS

We randomised 78 of 147 newborn infants to intervention and 69 to the control group. No significant differences were detected in length of stay, mean bilirubin, or weight gain. Parents in the intervention group had better scores on bonding both at discharge (p = 0.034) and at 4 months (p = 0.008; effect size r = 0.2) and lower levels of stress at 4 months (p = 0.024) than controls. No statistically significant outcomes were found for the secondary outcomes.

CONCLUSION

In-home phototherapy improved bonding and reduced parental stress in comparison with usual in-hospital treatment. Caregivers should consider offering home phototherapy to families of non-immunised term infants with hyperbilirubinaemia.

Alexithymic traits and parental postpartum bonding: Findings from the FinnBrain Birth Cohort Study

In the postpartum period, some parents experience problems in bonding with the infant, which can lead to difficulties in adjusting to the parental caregiving role. Alexithymia, through deficits in emotional processing, could potentially be associated with problems in parental postpartum bonding. In the current study, this association has been explored in a large population-based sample of mothers and fathers, and to our knowledge, this is the first study to investigate this association. The study population (n = 2,671) was part of the FinnBrain Birth Cohort study and included 1,766 mothers and 905 fathers who returned The Postpartum Bonding Questionnaire (PBQ) at three months postpartum and the 20-item Toronto Alexithymia Scale (TAS-20) at six months postpartum. Correlation analyses and hierarchical regression modeling, adjusted for selected background factors, were performed separately for mothers and fathers. The alexithymia dimension "Difficulty Identifying Feelings" (DIF) in mothers and fathers, and additionally dimensions of "Difficulty Describing Feelings" (DDF) and "Externally Oriented Thinking" (EOT) in fathers were associated with weaker postpartum bonding, when related background factors were controlled for. To our knowledge this was the first study to investigate the relationship between parents' alexithymic traits and postpartum bonding within a large birth cohort study population. The main finding was that especially higher levels of maternal DIF and paternal EOT were associated with weaker postpartum bonding. Longitudinal studies are needed to establish the potential causality of this relationship.

The association between maternal lifetime interpersonal trauma experience and perceived mother-infant bonding

BACKGROUND

Interpersonal traumas are common among expectant and new mothers and are found to have considerable impacts on women's mental health. These experiences may disrupt maternal perceptions of the mother-infant relationship, which is essential for healthy infant development, but findings are inconsistent. This study aims to explore associations between lifetime interpersonal traumas and their impact on self-reported mother-infant bonding.

METHODS

Secondary data analysis of a representative cohort of 453 women attending at a South London maternity service. Lifetime interpersonal trauma experience and its association with self-reported mother-infant bonding (Postpartum Bonding Questionnaire) was assessed in uni- and multivariable linear regressions, the latter adjusted to account for antenatal depressive and posttraumatic symptoms, measured using the Edinburgh Postnatal Depression Scale and Posttraumatic Stress Disorder Scale, and key sociodemographic risk factors.

RESULTS

Maternal lifetime trauma was not associated with perceived difficulties in mother-infant bonding at three months postnatal; however antenatal depressive symptoms, both with continuous EPDS score (0.33, 95% CI 0.17-0.50, p<0.001) and clinical cut-off ≥13 (4.26, 95% CI 2.02-6.49, p<0.001) were associated with self-reported bonding difficulties.

LIMITATIONS

The composite trauma measurement did not allow for a comprehensive assessment of individual trauma types.

CONCLUSIONS

There was no evidence for a link between maternal lifetime trauma experiences and self-reported bonding difficulties. However, an association between antenatal depressive symptoms and perceived postpartum bonding impairment was found. This highlights the importance of identification and treatment of depressive symptoms during pregnancy and offering women support in facilitating a positive mother-infant relationship.

External Validation and Test-Retest Reliability of Postpartum Bonding Questionnaire in Spanish Mothers

The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4-6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Postpartum period is a critical time that requires adjustments not only for mothers but also for fathers and may pose risk for depression. Studies show that the prevalence of paternal postpartum depression (PPD) is between 1.2% and 25.5%. PPD is an under-recognized public health issue and its reported influencing factors are still inconclusive.

OBJECTIVE

The purpose of this paper is to extend the literature by examining influencing factors that affect paternal PPD and describe the strength their associations.

METHODS

We conducted keyword search of Web of Science, PubMed, Embase, the Cochrane Library and PsycARTICLES electronic databases up to Jan 17, 2020, without language restrictions, for observational studies investigating the factors influencing paternal PPD and its effects. Fixed or random effect model was used to pool odds ratio (OR) and 95% confidence intervals (CI) with Stata software 12.0. Heterogeneity between studies was evaluated using Cochran's chi-squared test (Cochran's Q) and I² values.

RESULTS

Nineteen cross-sectional studies and eighteen cohort studies published from 1996 to 2019 were included in this review and seventeen studies in the meta-analysis. Factors affecting paternal PPD can be classified into paternal, maternal, infant and family factors. In Meta-analysis, 9 of 17 influencing factors were revealed to be statistically significant: 1) paternal factors: unemployment OR= 2.59 (95%CI:1.42-4.74), low social support OR=1.05 (95%CI:1.03-1.08), negative life events OR=1.45 (95%CI:1.13-1.87), perceived stress OR=1.08 (95%CI:1.03-1.12), financial strain OR=2.07 (95%CI:1.13-3.81), history of mental illness OR=3.48 (95%CI:2.49-4.86); 2) maternal factors: parity OR=1.36 (95%CI:1.13-1.65) and maternal postnatal depression OR=1.17 (95%CI:1.03-1.33); 3) family factors: low marital satisfaction OR=1.40 (95%CI:1.22-1.61). No statistically significant association with infant factors was found in the meta-analysis.

LIMITATIONS

There was publication bias since we only included English studies. Samples were under-represented in low-and middle-income countries. The meta-analysis results are subject to unobserved confounding factors and cannot explain causality.

CONCLUSION

This overview of the evidence suggests a relationship between paternal employment, psychological status, history of maternal mental illness, first pregnancy, marital relationship and paternal PPD. The low number of studies for some infant factors in meta-analysis leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal relationship still remain unclear. The awareness of the serious long-term consequences of paternal PPD should encourage better identification of those at risk and the development of effective interventions to protect fathers from PPD.

Father-child bonding among Japanese fathers of infants: A municipal-based study at the time of the 4-month child health checkup

We aimed to clarify the factor structure of a bonding measure among Japanese fathers with infants and the factors associated with the subscales. Among fathers of children attending the 4-month health checkup, the Japanese version of the Mother-to-Infant Bonding Scale had a two-factor structure comprising "anger" and "lack of affection." Anger was associated with fathers' work demands and poor mental condition, and lack of affection with fathers' older age, poor mental condition, and interpersonal problems at home. Paternal parenting support needs to account for not only the fathers themselves, but also interpersonal communication at home and in the work environment.

[Questionnaires for the Assessment of Bonding During Pregnancy and after Birth (Part 3 of a series on psychological assessment during the peripartum period)]

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.

Development and validation of the maternal blues scale through bonding attachments in predicting postpartum blues

BACKGROUND

Postpartum blues in Indonesia has a high prevalence at 37% to 67%. Postpartum blues syndrome has been described as varying changes in the affective domain, such as feelings, behavior, or thoughts, that can be influenced by the roles and tasks of women, along with their social, cultural, and economic support. Instruments that measure maternal blues through bonding attachment behavior have never before been developed in Indonesia.

OBJECTIVE

This study aimed to develop a maternal blues scale through bonding attachments to predict postpartum blues.

METHOD

The research design consisted of three stages: 1) phenomenology design and focus group discussion; 2) development and construction of the maternal blues scale, and 3) a cross-sectional study to measure validation of the scales. Respondents were postpartum mothers in the first week after birth. The sample comprised 501 participants. Sampling was done by consecutive sampling at the Public Health Center (PUSKESMAS) in the South Jakarta area. Data analysis used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), correlation, and a diagnostic testing .

RESULTS

Item analysis produced 32 items consisting of 24 items regarding the mother's role and duties as internal factors and eight factors involving social, cultural, and economic support as external factors. Both factors were valid and reliable in predicting postpartum blues with indicators (t loading factors ≥ 1.96, standardized loading factor (SLF) ≥.50, internal factors: construct reliability (CR) ≥ .70 and extraction variants (VE) ≥ .50 and external factors: CR ≥ .74 to .83 VE ≥ .50 to .63). The relationship with Kennerley's maternity blues as a gold standard was significant. Internal factors had a score of 53, with a sensitivity of 60.2%. The external factors score was 19, with a sensitivity of 77.3%.

CONCLUSION

The new scale for postpartum blues prediction developed displayed internal consistency and validity of each indicator (internal and external factors) that was good (CR ≥ .70; VE ≥ .50). This scale provides a feasible tool to predict postpartum blues.

Infant temperament as a predictor of maternal attachment: A Jordanian study

AIM

To investigate the relationship between maternal bonding and infant temperament during the first year of infant's life. Moreover, it also wanted to explore which perinatal factors could influence the quality of maternal attachment.

METHOD

A cross-sectional study design was used to collect data from a sample of 277 mothers during the period of May-October 2018. The participants were asked to complete a three-part survey that was developed to collect data on maternal attachment and infant temperament. Data was collected between March 2019-June 2019.

RESULTS

The analysis of the data revealed that there was a significant relationship between infant temperament and maternal attachment [F(2, 95) = 6.783, p-value = .001]. It also revealed that the factors that most influenced maternal attachment were infant temperament and planned pregnancy, which together explained 54% of the variance in maternal attachment (R2   =  7.5).

CONCLUSION

Maternal attachment in Jordanian mothers can be explained by two significant factors: infant temperament and planning for pregnancy.

The Applicability and Performance of Tools Used to Assess the Father-Offspring Relationship in Relation to Parental Psychopathology and Offspring Outcomes

Introduction: Father-infant interactions are important for optimal offspring outcomes. Moreover, paternal perinatal psychopathology is associated with psychological and developmental disturbances in the offspring, and this risk may increase when both parents are unwell. While, the father-offspring relationship is a plausible mechanism of risk transmission, there is presently no "gold standard" tool for assessing the father-offspring relationship. Therefore, we systematically searched and reviewed the application and performance of tools used to assess the father-offspring relationship from pregnancy to 24-months postnatal. Methods: Four electronic databases (including MEDLINE, PsycINFO, Maternity and Infant Care Database, and CINAHL) were searched. Selected articles included evidence of father-offspring relationship assessment in relation to parental perinatal psychopathology and/or offspring outcomes. Data was extracted and synthesized according to the following: (i) evidence supporting the performance of tools in terms of their psychometric properties when applied in the context of fathers, (ii) tool specific characteristics, and (iii) study specific methodological aspects in which the tool was embedded. Results: Of the 30,500 records eligible for screening, 38 unique tools used to assess the father-offspring relationship were identified, from 61 studies. Ten tools were employed in the context of paternal psychopathology, three in the context of maternal psychopathology, and seven in the context of both maternal and paternal psychopathology, while nine tools were applied in the context of offspring outcomes only. The remaining nine tools were used in the context of both parental psychopathology (i.e., paternal, and/or maternal psychopathology) and offspring outcomes. Evidence supporting the psychometric robustness of the extracted observational, self-report and interview-based tools was generally limited. Most tools were originally developed in maternal samples-with few tools demonstrating evidence of content validation specific to fathers. Furthermore, various elements influencing tool performance were recognized-including variation in tool characteristics (e.g., relationship dimensions assessed, assessment mode, and scoring formats) and study specific methodological aspects, (e.g., setting and study design, sample characteristics, timing and nature of parental psychopathology, and offspring outcomes). Conclusion: Given the strengths and limitations of each mode of assessment, future studies may benefit from a multimethod approach to assessing the father-offspring relationship, which may provide a more accurate assessment than one method alone.

Measuring bonding or attachment in the parent-infant-relationship: A systematic review of parent-report assessment measures, their psychometric properties and clinical utility

BACKGROUND

Meaningful, valid and reliable self-report measures can facilitate the identification of important parent-infant-relationship factors, relevant intervention development and subsequent evaluation in community and clinical contexts. We aimed at identifying all available parent-report measures of the parent-infant-relationship or bond and to appraise their psychometric and clinimetric properties.

METHOD

A systematic review (PROSPERO: CRD42017078512) was conducted using the, 2018 COSMIN criteria. Eight electronic databases were searched. Papers describing the development of self-report measures of the parent-infant-bond, attachment or relationship from pregnancy until two years postpartum or the assessment of their psychometric properties were included.

RESULTS

Sixty-five articles evaluating 17 original measures and 13 modified versions were identified and reviewed. The studies' methodological quality (risk of bias) varied between 'very good' and 'inadequate' depending on the measurement property assessed; however, scale development studies were mostly of 'inadequate' quality. Although most measures had good clinical utility, the psychometric evaluation of their properties was largely poor. The original or modified versions of the Postpartum Bonding Questionnaire collectively received the strongest psychometric evaluation ratings with high quality of evidence.

CONCLUSIONS

This novel review revealed that only a few antenatal and postnatal measures demonstrated adequate psychometric properties. Further studies are needed to determine the most robust perinatal measures for researchers and clinicians.

First-Time Mothers' and Fathers' Developmental Changes in the Perception of Their Daughters' and Sons' Temperament: Its Association With Parents' Mental Health

OBJECTIVE

Most studies investigating the role of parenting behaviors on a child's development are directed to mothers. However, recent analyses show that mothers and fathers have a different influence on a child's functioning, specifically her/his temperament. The present study explored the developmental change of parents' perception of their daughters' and sons' temperament and its association with parental mental health problems.

METHODS

The sample included 188 parents (94 couples) and their at-term 94 babies (55.3% boys, 44.7% girls). Assessments by self-reports were conducted at 3 (Time 1) and 12 (Time 2) months after the children's birth; at Time 1, mothers and fathers independently answered: the State-Trait Anxiety Inventory (STAI), the Edinburgh Postnatal Depression Scale (EPDS), and the Infant Behavior Questionnaire (IBQ-R). At Time 2, EPDS, STAI, and IBQ-R were again administered to mothers and fathers.

RESULTS

In general, mothers and fathers would give similar descriptions of their child's temperament throughout the first year of life; however, infant temperament showed developmental changes as well as gender differences. Mother and father anxiety and depression symptoms are associated with the infants' negative affectivity. Also, mothers with high anxiety and depression levels perceive their infants with a minor tendency to approach novelty, to seek environmental stimulation, and to express/experience positive emotions.

CONCLUSION

The results highlight the need to screen for infants' temperament vulnerabilities in the context of maternal and paternal depression in order to protect the child from behavioral, cognitive, and emotional difficulties and to create specific programs aimed at preventing dysfunctional parent-infant relationships.

Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.

Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression

BACKGROUND

Postpartum depression is a psychiatric disorder that starts from the second to the sixth week after birth. Breastfeeding is considered a protective factor for postpartum mood swings. This paper aims to examine the effect of breastfeeding on postpartum depression and anxiety, and how it affects child development.

METHODS

The study included 209 pregnant women, 197 puerperea, and 160 women at the end of the third month after delivery, followed through three time-points. The instruments used in the study were the Edinburgh Postpartum Depression Scale (EPDS), Beck's Depression Inventory (BDI), and Beck's Anxiety Inventory (BAI).

RESULTS

Postpartum mothers with low risk of PPD breastfed their children more often than mothers with a mild or severe risk of perinatal depression. Mean values on the BDI scale three months after giving birth were higher in mothers who did not breastfeed their child (M = 3.53) than those who did breastfeed their child (M = 2.28). Postpartum anxiety measured by BAI was statistically negatively correlated (rs-, 430) with the duration of breastfeeding.

CONCLUSION

Nonbreastfeeding mothers are more depressed and anxious compared to breastfeeding mothers.

A Swedish translation and validation of the Mother-to-Infant Bonding Scale

Aim: This study aimed to test initial validity, reliability, and feasibility of the Mother-to-Infant Bonding Scale in a sample of Swedish mothers. Methods: A translation was performed through 11 steps using a forward-backward bilingual technique. For criterion validity, the Swedish translation of the Mother-to-Infant Bonding Scale (S-MIBS) was compared with the Postpartum Bonding Questionnaire, sub-scale 1 (PBQ1) and 2 (PBQ2) and Edinburgh Postnatal Depression Scale (EPDS) in a sample of 63 Swedish mothers. Internal consistency was calculated with Cronbach's alpha. For feasibility testing, the mothers were asked to grade their experience of S-MIBS and PBQ on a four-point scale. Results: The results show a correlation between S-MIBS and PBQ1 (r=0.80, p<0.001), PBQ2 (r=0.69, p<0.001) and EPDS (r=0.44, p<0.001). Internal consistency was α=0.68. Most mothers (93.1%) found S-MIBS to be easy or very easy to complete compared with PBQ (88.7%). Conclusions: The initial testing of the Swedish translation of the Mother-to-Infant Bonding Scale shows usability to measure the mother's emotions towards her healthy full-term infant.

Maternal and paternal trajectories of depressive symptoms predict family risk and children's emotional and behavioral problems after the birth of a sibling

The current study examined trajectories of maternal and paternal depression in the year following the birth of an infant sibling, and relations with family risk factors and firstborn children's internalizing and externalizing behavior problems. Latent class growth analysis was conducted on 231 families in a longitudinal investigation (prebirth and 1, 4, 8, and 12 months postbirth) and revealed four classes of families: both mother and father low in depressive symptoms (40.7%); mother high-father low (25.1%); father high-mother low (24.7%), and both mother and father high (9.5%). Families with both mothers and fathers high on depressive symptoms were higher on marital negativity, parenting stress, and children's internalizing and externalizing problems, and lower on marital positivity and parental efficacy than other classes. Children, parents, and marital relationships were more problematic in families with fathers higher on depressive symptoms than in families in which mothers were higher, indicating the significant role of paternal support for firstborn children undergoing the transition to siblinghood. Maternal and paternal depression covaried with an accumulation of family risks over time, no doubt increasing the likelihood of children's problematic adjustment after the birth of their infant sibling.

The association between prenatal maternal anxiety disorders and postpartum perceived and observed mother-infant relationship quality

INTRODUCTION

Prenatal maternal anxiety disorders have been associated with adverse outcomes in offspring including emotional, behavioral and cognitive problems. There is limited understanding of the mechanisms underpinning these associations, although one possible candidate is an impaired mother-infant relationship. The authors investigated whether prenatal anxiety disorders were associated with poorer postpartum mother-infant relationship quality, measured by maternal self-reported bonding and observed mother-infant interactions.

METHODS

A cohort of 454 pregnant women recruited from an inner-city maternity service in London (UK) were assessed for mental disorders using the Structured Clinical Interview for DSM-IV and followed up at mid-pregnancy and 3-months postpartum. Depressive symptoms were assessed at baseline and mid-pregnancy (using the Edinburgh Postnatal Depression Scale). At three months postpartum, women were assessed for self-reported bonding difficulties (using the Postpartum Bonding Questionnaire) and a subsample (n = 204) participated in video-recorded mother-infant interaction, coded using the Child-Adult Relationship Experimental Index by an independent rater.

RESULTS

Prenatal anxiety disorders were associated with higher perceived bonding impairment, but not associated with observed poor mother-infant interaction quality. Higher levels of depressive symptoms were associated with lower maternal sensitivity.

CONCLUSIONS

Interventions for anxiety disorders in the perinatal period could be tailored to address anxieties about mother-infant relationship and co-morbid depressive symptoms.

Does childbirth experience affect infant behaviour? Exploring the perceptions of maternity care providers

OBJECTIVE

High levels of childbirth interventions are known to increase risk of health complications for mother and infant, alongside having a negative impact upon maternal wellbeing. However less is understood about how childbirth experience may affect infant behaviour (e.g. how calm or unsettled an infant is). This study explores maternity care provider perceptions of how and why childbirth experience may affect infant behaviour.

DESIGN

A qualitative semi-structured interview study.

SETTING

Bristol, Swansea and West Wales, UK.

PARTICIPANTS

18 maternity care providers.

MEASUREMENTS AND FINDINGS

A semi-structured interview schedule was developed to explore maternity care providers' perceptions of how maternal experience of childbirth could influence infant behaviour. Findings highlighted how maternity care providers perceived childbirth experience to sometimes impact positively or negatively on infant behaviour. A calmer birth and postnatal experience was believed to lead to a calmer infant, whilst physical and emotional stress was associated with more challenging infant behaviours such as crying and being unsettled. Pathways were perceived to be direct (pain and stress during birth might physiologically affect the infant) and indirect (birth was perceived to affect maternal wellbeing and subsequently her interactions with her baby). However, postnatal factors such as skin to skin, postnatal environment and emotional support were believed to mediate these impacts.

KEY CONCLUSIONS

Birth experience was considered to affect infant behaviour. Promoting as positive a birth experience as possible, including postnatal care, was viewed as significant in supporting positive infant behaviours. Maternity care providers believed this could help facilitate bonding, attachment, and mother-infant wellbeing in the postnatal period.

IMPLICATIONS FOR PRACTICE

The findings highlight maternity care providers' views concerning supporting normal birth and protecting emotional wellbeing during birth and postnatally. Where interventions are necessary, ensuring a calm environment, and enabling normal postnatal behaviours such as skin to skin and breastfeeding were perceived as important. Midwives, it was claimed, need time to nurture mothers alongside providing physical care.

LIMITATIONS

Participants were self-selecting and might therefore have been biased.

Depression and paternal adjustment and attitudes during the transition to parenthood

BACKGROUND

Depression symptoms may negatively affect the achievement of developmental tasks within the transition to parenthood, increasing the risk of paternal adjustment problems and negative paternal attitudes.

OBJECTIVE

This study analysed the effect of men's depression symptoms on paternal adjustment and paternal attitudes trajectories from the second trimester of pregnancy to six months postpartum.

METHODS

A sample of 127 men completed measures of depression symptoms and paternal adjustment and paternal attitudes at the second trimester of pregnancy and at six months postpartum.

RESULTS

From the second trimester of pregnancy to six months postpartum, men with more depression symptoms revealed a decrease on positive attitudes towards sex (while men with fewer depression symptoms revealed an increase), a steeper decrease in the satisfaction with marital relationship (than men with fewer depression symptoms), and a decrease in positive attitudes towards pregnancy and the baby (while men with fewer depression symptoms revealed an increase).

CONCLUSION

Depression symptoms early in pregnancy may represent a risk factor to increased paternal adjustment problems and negative paternal attitudes during the transition to parenthood.

Postpartum depression: A multi-disciplinary approach to screening, management and breastfeeding support

Postpartum depression (PPD) is a common condition affecting 11%-20% of all postpartum women. Depression can have significant consequences for both mother and infant. There are many risk factors associated with PPD, all of which contribute to an inflammatory response in the mother. An inverse relationship exists between PPD and breastfeeding; women with PPD are less likely to have a positive breastfeeding experience which can lead to early weaning, while long-term exclusive breastfeeding is associated with decreased rates of PPD. A multi-disciplinary approach to managing PPD, including strong breastfeeding support, will lead to improved mental health outcomes for women and their children.

Factors associated with paternal perinatal depression in fathers of newborns in Nigeria

INTRODUCTION

There is a lack of information on paternal postnatal depression in developing countries such as Nigeria.

METHODS

This study aims to assess the prevalence of depression in fathers at the birth of their infants and the incidence of paternal postnatal depression at 6 weeks postpartum. We also examined the correlation between paternal postpartum depression (PPD) at 6 weeks and maternal PPD as well as the sociodemographic and other correlates of paternal PPD at 6 weeks.

RESULTS

All the 331 fathers recruited at baseline completed the study. Prevalence of depression in fathers at birth of their babies was 10 (3%). After excluding the 3%, the incidence of PPD in fathers (N = 321) at 6 weeks was 19 (5.9%). In all, 29 (8.8%) fathers had PPD. The prevalence of depression in mothers at 6 weeks postpartum was 57 (17.8%). The prevalence of depression in mothers at 6 weeks was significantly higher than the incidence of depression in fathers at 6 weeks (X² = 26.2, p < .001). There was no significant correlation between maternal PPD and paternal PPD. At baseline, prevalence of PPD among the unemployed fathers was higher than in the employed, 3 (21.4%) versus 7 (2.2%), this was significant (FE p < .01). There was no significant correlate of paternal PPD at 6 weeks.

DISCUSSION

Postpartum mental health services should be extended to fathers of newborns especially those who are unemployed. Our findings have implications for family health.

Effectiveness of Kangaroo Care for a Patient with Postpartum Depression and Comorbid Mother-Infant Bonding Disorder

The presently reported patient was a 37-year-old married primipara with peripartum depression comorbid with bonding disorder. Care anxiety and a lack of affection towards her baby first appeared at around the time of delivery, and the patient developed major depression at one month after the birth of her healthy baby. At first, standard treatment for major depression including the use of antidepressants, electroconvulsive therapy, and supportive psychotherapy were provided. However, bonding problems appeared to impede and obstruct the amelioration of depression. Although treatment methods for bonding disorder have not yet been established, Kangaroo Care was introduced to facilitate skin-to-skin contact. We also educated her in better parenting behavior and provided repeated motivational interviews with her family because a lack of partner and social support and personal temperament (low self-directedness and cooperativeness) were thought to be related to her bonding disorder. This case suggests the effectiveness of Kangaroo Care, which promotes a humanizing maturation of both baby and parent alike, for mothers with postpartum depression and comorbid severe bonding disorder.

The Effects of Early Postpartum Depression on Infant Temperament

Research linking postpartum depression (PPD) with negative child outcomes has predominantly examined PPD at six weeks postpartum or later, and has not controlled for depression during pregnancy. The present study examined associations between PPD at three weeks postpartum and temperament in 6-month-old infants in a sample of women who were not depressed during pregnancy. Depression was assessed at three weeks and six months postpartum using the Postpartum Depression Screening Scale (PDSS). Observed and maternal report of infant temperament was assessed when infants were 6-months-old. PPD symptoms significantly predicted observed temperament behaviour and marginally explained maternal report of infant temperament. Symptoms of PPD at three weeks postpartum were a stronger predictor than at six months. Findings suggest that early depressive symptoms may be particularly problematic, and have implications for early assessment and treatment of PPD even in women who were not depressed during pregnancy or are otherwise considered low risk.

A single Spanish version of maternal and paternal postnatal attachment scales: validation and conceptual analysis

Background

Postnatal bonding constitutes a major process during the postpartum period, and there is evidence that bonding difficulties have negative consequences for parents’ mental health and the child’s development. However, the conceptualization of postnatal bonding presents inconsistencies, as well as problems in having instruments that encompasses the father figure. The objective was to adapt the maternal postnatal attachment scale (MPAS) and the paternal postnatal attachment scale (PPAS) to Spanish, to evaluate its validity and reliability and to analyze the construct dimensionality of both questionnaires from a gender perspective.

Methods

Instrumental design. In 2016–2017, a sample of 571 mothers and 376 fathers, with children between 6 and 11 months of age, responded to the Spanish version of MPAS and PPAS, respectively. After a process of translation-back-translation of the instrument, we empirically analyzed the internal consistency (Cronbach alpha, composite reliability (CR)) construct and concurrent validity (with regard to postpartum depression and dyadic adjustment). Additionally, we studied the instrument’s content validity, using the Delphi methodology; and the differential analysis in both samples (mothers and fathers), examining the invariance.

Results

A short version of 15 items was obtained, common for mothers and fathers. The results of the Delphi methodology showed a 100% inter-judge agreement, highlighting the absence of differences in the adequacy of the items as a function of the parents’ gender. Confirmatory factor analysis showed a good fit of three original factors proposed by the authors. The global Cronbach alpha coefficients in the total sample were adequate (mothers, 0.70; fathers, 0.78); and Cronbach alpha of each dimension in the case of mothers was 0.50 (Quality of bonding), 0.55 (Absence of hostility), and 0.60 (Pleasure in interaction); in the case of fathers, it was respectively 0.54, 0.64, and 0.72. CR of each dimension were: quality of bonding, 0.74 in mothers and 0.80 in fathers; absence of hostility, 0.93 in mothers and 0.94 in fathers; pleasure in interaction, 0.83 in mothers and 0.90 in fathers. With regard to the analysis of group invariance, the results revealed empirical evidence of configural and metric invariance. Concurrent validity showed moderate negative correlations for postnatal depression (mothers, r = −0.41, p < 0.001; fathers, r = −0.38, p < 0.001), and positive correlations for dyadic adjustment (mothers, r = 0.39, p < 0.001; fathers, r = 0.44, p < 0.001).

Discussion

A new version of the instrument was generated, with good psychometric properties, adequate for use both with mothers and with fathers. This scale helps evaluate postnatal maternal and paternal bonding, allowing to study it from within the family system, a necessary step forward to advance perinatal mental health.

Mother-infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample

This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother-infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6-7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women's risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.

Spouses' prenatal autonomous motivation to have a child and postpartum depression symptoms

OBJECTIVES

Maternal postpartum depression symptoms (PDS) are linked with negative personal, family, and child developmental outcomes. However, paternal PDS, let alone dyadic process, are understudied. Grounded in the Self-Determination Theory of motivation, this longitudinal study examined whether mothers' and fathers' type of prenatal motivation to have a child predicted depression symptoms 3-6 months after birth.

METHOD

The data (N = 90 heterosexual couples) were analyzed using the Actor-Partner Interdependence Model.

RESULTS

Dyadic analyses showed that a person's prenatal autonomous motivation to have a child significantly predicted own PDS and partner's PDS. Importantly, these finding were equivalent across genders.

CONCLUSIONS

The findings highlight the importance of dyadic prenatal motivational processes as antecedents of PDS.

Relationship between maternal depression and bonding failure: A prospective cohort study of pregnant women

AIM

Although the association between maternal depression and bonding failure during pregnancy and after delivery has been investigated, the causal relationships remain unclear.

METHODS

A total of 751 women (mean [SD] age, 32.1 [4.4] years) completed the Mother-Infant Bonding Questionnaire and the Edinburgh Postnatal Depression Scale during early pregnancy before week 25 (T1), during late pregnancy around week 36 (T2), and at 5 days after delivery (T3). We created a structural regression model to clarify the relationships between depressive mood and bonding failure during pregnancy and at 5 days after delivery. The model was tested with structural equation modeling.

RESULTS

Our non-recursive model fit the data well, and we found that: (i) during T2, bonding failure predicted depressive mood (P < 0.01, r = 0.23); (ii) at T3, bonding failure predicted depressive mood (P < 0.05, r = 0.31); (iii) during T1, depressive mood was correlated with bonding failure (P < 0.01, r = 0.45); (iv) depressive mood during T1 predicted depressive mood during T2 (P < 0.01, r = 0.58); (v) depressive mood during T2 predicted depressive mood at T3 (P < 0.01, r = 0.45); (vi) bonding failure during T1 predicted bonding failure during T2 (P < 0.01, r = 0.84); and (vii) bonding failure during T2 predicted bonding failure at T3 (P < 0.01, r = 0.44). The determinant coefficients of depressive mood and bonding failure at T3 were 0.41 and 0.28, respectively.

CONCLUSION

Our large-scale cohort study indicates that bonding failure predicts depressive mood during pregnancy and 5 days after delivery. These findings suggest that protection and support for pregnant women with depressive mood and bonding failure may prevent both issues during pregnancy and the early stage after delivery.

Discrete category of mother-to-infant bonding disorder and its identification by the Mother-to-Infant Bonding Scale: A study in Japanese mothers of a 1-month-old

BACKGROUND

Difficulty of maternal bonding towards a baby is widely recognised. It is unclear whether this phenomenon is dimensional or categorical. If categorical, an optimal cut-off score of a screening instrument is needed in clinical settings.

AIMS

In this study, we investigated whether maternal bonding is dimensional or categorical phenomenon and try to set optimal cut-off score of screening instruments.

METHODS

Self-report questionnaire studies were conducted in a general hospital and four antenatal clinics. Two-step cluster analysis was conducted for the Mother-to-Infant Bonding Scale (MIBS) subscale scores in 723 mothers of neonates. ROC curves and optimal cut-off points of the MIBS scores were calculated based on cluster-analysis derived groups.

RESULTS

A 2-cluster structure appeared: "normal" (n=619) vs. "pathological maternal bonding" (n=104). Mothers of the latter category scored significantly higher in terms of postnatal depression and neonatal abuse than those of the former category. AUC of the ROC curve by the total MIBS scores both 5days and 1month after childbirth were >0.9. The optimal cut off scores were 3/4 at 5days, and 4/5 at 1month, after childbirth.

CONCLUSIONS

There was a group of mothers with high MIBS scores discretely different from those with low MIBS scores. MIBS may be a useful tool to identify mothers with a severe bonding disorder that needs clinical intervention.