Psychometric properties of 13-item versions of the maternal and paternal antenatal attachment scales in German

Reliability and validity of the original and brief German version of the Maternal Antenatal Attachment Scale (MAAS): Longitudinal study findings

BACKGROUND

Maternal-foetal attachment (MFA) seems essential for adapting to motherhood and the healthy development of the child, with direct implications for clinical practice. It is often assessed using the Maternal Antenatal Attachment Scale (MAAS), which covers two dimensions: quality and intensity of attachment. However, studies including the MAAS presented missing or inadequate psychometric properties. Therefore, the current study aimed to investigate the reliability and validity of both the original and the recently introduced brief German version of the MAAS.

MATERIALS AND METHODS

Data from 184 pregnant women from a longitudinal study were used. Women (≥ 18 years old) were recruited between the 18th and 22nd weeks of gestation while waiting for routine prenatal diagnostic appointments. Participants answered the MAAS, together with other questionnaires measuring maternal mental health, self-esteem, and social support. For both versions of the MAAS (19 items vs. 13 items), item characteristics, confirmatory factor analysis, internal consistency, and test-retest reliability were calculated and compared. Moreover, associations between the brief German MAAS and theoretically related constructs were analysed using correlation coefficients.

RESULTS

In this study, item analyses revealed better psychometric properties for the brief German MAAS than for the original MAAS, with a significant reduction in items with inadequate discriminatory power. The internal consistency (α ≥ .69) and test-retest reliability (ICC ≥ .62) were acceptable to good for both MAAS versions. With regard to structural validity, factor analysis of the German MAAS presented acceptable to good global model fit indices for the model with correlated factors (GFI > .90; RMSEA ≤ .08; SRMR < .10) in the current sample. In contrast, most global model fit indices of the original MAAS were not acceptable. The construct validity of the German MAAS was demonstrated on the basis of small-to-moderate correlations with a variety of constructs (e.g., measures of depression, anxiety, stress).

CONCLUSIONS

According to the present results, the brief German version of the MAAS represents a reliable and valid measurement instrument of MFA for use in clinical practice. Further studies examining possible cut-off values are needed to identify pregnant women with significant attachment difficulties who may benefit from additional support.

Engaging fathers(to-be): a pilot study on the adaptation and programme experience of SMS4baba intervention in Kenya's informal settlements

BACKGROUND

Engaging fathers(to-be) can improve maternal, newborn, and child health outcomes. However, father-focused interventions in low-resource settings are under-researched. As part of an integrated early childhood development pilot cluster randomised trial in Nairobi's informal settlements, this study aimed to test the feasibility of a text-only intervention for fathers (SMS4baba) adapted from one developed in Australia (SMS4dads).

METHODS

A multi-phased mixed-methods study, which included an exploratory qualitative phase and pre-post evaluation of the adapted SMS4baba text-only intervention was conducted between 2019 and 2022. Three focus-group discussions (FGDs) with 19 fathers were conducted at inception to inform SMS4baba content development; two post-pilot FGDs with 12 fathers explored the acceptability and feasibility of SMS4baba implementation; and 4 post-intervention FGDs with 22 fathers evaluated SMS4baba programme experiences. In the intervention phase, 72 fathers were recruited to receive SMS4baba messages thrice weekly from late pregnancy until over six months postpartum. A pre-enrolment questionnaire captured fathers' socio-demographic characteristics. Pre-post surveys were administered telephonically, and outcome measures evaluated using a paternal antenatal attachment scale, generalised anxiety disorder scale (GAD-7), patient health questionnaire (PHQ-9), and researcher-developed questionnaire items assessing paternal involvement, childcare and parenting practices. Qualitative data were analysed using a thematic approach. Statistical analysis performed included descriptive statistics, tests of association, and mixed model regression to evaluate outcomes.

RESULTS

Fathers perceived SMS4baba messages as educational, instilling new knowledge and reinforcing positive parenting, and helped fathers cope with fatherhood transition. High levels of engagement by reading and sharing the texts was reported, and fathers expressed strong approval of the SMS4baba messages. SMS4baba's acceptability was attributed to modest message frequency and utilising familiar language. Fathers reported examples of behaviour change in their parenting and spousal support, which challenged gendered parenting norms. Pre-post measures showed increased father involvement in childcare (Cohen's d = 2.17, 95%CI [1.7, 2.62]), infant/child attachment (Cohen's d = 0.33, 95%CI [-0.03, 0.69]), and partner support (Cohen's d = 0.5, 95%CI [0.13, 0.87]).

CONCLUSION

Our findings provide support for father-specific interventions utilising digital technologies to reach and engage fathers from low-resource settings such as urban informal settlements. Exploration of text messaging channels targeting fathers, to address family wellbeing in the perinatal period is warranted.

TRIAL REGISTRATION

This study was part of the integrated early childhood development pilot cluster randomised trial, registered in the Pan African Clinical Trial Registry on 26/03/2021, registration number PACTR202103514565914.

Psychometric properties of the Maternal Postnatal Attachment Scale and the Postpartum Bonding Questionnaire in three German samples

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.

Translation and Testing the Reliability and Validity of a Japanese Version of the Paternal Antenatal Attachment Scale (PAAS-J)

Background and Purpose: This study aimed to translate and validate a Japanese version of the Paternal Antenatal Attachment Scale (PAAS-J). Methods: The PAAS-J was translated through a pilot study and a survey of fathers with pregnant partners. Results: The survey involved 189 fathers. A confirmatory factor analysis was performed, but the model fit was poor. Therefore, an exploratory factor analysis (EFA) was performed. Based on the results of the EFA, three items with low interitem correlations and factor loadings were deleted, and a 13-item scale consisting of 2 domains was created. Coefficient alpha was .80. The intraclass correlation coefficient of the retest method was .80, confirming its reliability. Conclusions: The PAAS-J was found to be reliable and valid.

Manifest anxiety and maternal-fetal attachment in pregnant women with previous fetal losses

AIM

To explore associations between manifest anxiety (Taylor's Manifest Anxiety Scale, TMAS), major obstetric and demographic features and maternal-fetal attachment (MFA) (Maternal Antenatal Attachment Scale, MAAS) in women with previous miscarriages.

SUBJECTS AND METHODS

One hundred pregnant women with previous miscarriages, having uncomplicated singleton pregnancy, not receiving any medications, and conceived in a natural manner . Ages ranged between 19 and 47 years, gestational age between 4 and 35 weeks. Hierarchical multiple linear regression, Kruskal-Wallis test, and ANCOVA were used in data analysis.

RESULTS

Maternal age, gestational age, previous abortions, parity, maternal education, and marital status in combination contributed significantly to the regression model in prediction of the MAAS quality and intensity scores. Adding the TMAS score accounted for an additional 17% of variation in the MAAS quality score, and the change in R2 was significant. There was a negative relationship between the TMAS and the MAAS quality scores. The TMAS score did not contribute to prediction of the MAAS intensity. The highest TMAS values were in the women having anxious, ambivalent or affectless preoccupation.

CONCLUSION

Prevention of negative consequences of poor quality of MFA in women with previous miscarriages should include early screening for manifest anxiety.

Factors Affecting Intrauterine Paternal-Foetal Attachment and the Responsibility Status of Fathers Concerning Mothers and Babies

AIM

This study aims to determine the sociodemographic and paternal factors affecting intrauterine paternal-fetal attachment.

METHODS

The descriptive and cross-sectional study was conducted with fathers whose partners were over the 24th week of their pregnancies (n=174). The fathers were applied a form regarding responsibility-taking for mother and baby and the Intrauterine Father Attachment Scale.

RESULTS

Fathers who are young, university graduates, have spouse working, planned the pregnancy, have no other children, and state that they had a good relationship with their father, were found to have significantly higher levels of attachment to the intrauterine fetus. Fathers who are attended the prenatal classes with their spouse, state that their spouse is supportive towards them, want to accompany their spouse during childbirth, and state that the baby is both the mother and the father's responsibility after birth, were found to have significantly higher levels of attachment to the intrauterine fetus. Also, it was found that fathers who responsibility-taking for both mother and baby have a high level of attachment to the fetus (P <0.05).

CONCLUSION

Considering that planned pregnancy and fathers' participation in antenatal care increases the level of attachment, health professionals have a great responsibility in terms of planning pregnancies and encouraging fathers to participate in antenatal care.

[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.

Associations of Partnership Quality and Father-to-Child Attachment During the Peripartum Period. A Prospective-Longitudinal Study in Expectant Fathers

Background: During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention. Methods: Data were derived from the Maternal Anxiety and it's Relation to Infants' Development (MARI) study. N = 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in N = 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses. Results: Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment. Conclusions: Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy-both with the mother and the unborn child.

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.

Prenatal bonds among Polish expectant couples: a brief version of the parental antenatal attachment scales

OBJECTIVE

To examine the psychometric properties of the Maternal and Paternal Attachment Scales (MAAS/PAAS) in a Polish sample of expectant couples.

BACKGROUND

A parental prenatal bond is important for the psychological and health outcomes of children and parents. The MAAS/PAAS is one of the well-established measures for parental prenatal bonding. However, there is a lack of Polish investigations of the factor structure and construct validity of these scales.

METHODS

The sample consisted of 341 Polish expectant couples who were surveyed about their prenatal bond, closeness with their unborn child, relationship satisfaction, and gender-role attitudes towards parenthood. The reliability and construct validity of the MAAS/PAAS were evaluated. A Confirmatory Factor Analysis (CFA) and a Principal Axis Factoring (PAF) were conducted.

RESULTS

The obtained results did not confirm the original factor structures of the MAAS/PAAS. However, in the proposed  single 11-item version for the MAAS/PAAS, two factors equivalent to the original structure were extracted. The scale reliability for the brief MAAS/PAAS version was good. The construct validity was confirmed.

CONCLUSION

The single Polish brief version for the MAAS/PAAS is a reliable and valid measure to use in Polish context. The obtained results support the importance of couple functioning for the MAAS/PAAS.

Couples' prenatal bonding to the fetus and the association with one's own and partner's emotional well-being and adult romantic attachment style

OBJECTIVE

Developing an emotional bond to the fetus is a highly relevant task for both parents. However, research on the influence of emotional well-being and relationship dynamics on parental-fetal bonding is limited, especially regarding the paternal experience. Additionally, the roles of prenatal anxiety and hostility in parental bonding need further investigation. The aim of this study was to investigate the importance of one's own anxiety and hostility, adult romantic attachment style and one's partner's anxiety and hostility for parental-fetal bonding quality and intensity.

DESIGN

Data were assessed cross-sectionally and analyzed using linear regression models.

SETTING

The study took place at the University Medical Center Hamburg-Eppendorf, Germany.

PARTICIPANTS

Ninety-three pregnant women and their partners (total n = 186).

MEASUREMENTS AND FINDINGS

Participants completed questionnaires in mid to late pregnancy. For mothers, higher levels of hostility and attachment-related avoidance were associated with lower bonding quality. Unexpectedly, higher levels of partner hostility were associated with higher bonding quality. Fathers with higher attachment-related avoidance reported lower bonding intensity. Neither maternal bonding intensity nor paternal bonding quality was associated with the predictor variables.

KEY CONCLUSION

Prenatal bonding is individually influenced by emotional well-being and romantic attachment styles, with different effects in mothers and fathers.

IMPLICATIONS FOR PRACTICE

Potential negative emotional states and couple dynamics in the peripartum period should be addressed in prenatal care. Birth preparation classes might be an ideal context to generally inform parents about these topics. Distressed parents might benefit from interdisciplinary support focusing on perinatal mental health and parental-fetal bonding.