Emotional Rejection of the Infant: Status of the Concept

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.

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.

Towards Preventative Psychiatry: Concurrent and Longitudinal Predictors of Postnatal Maternal-Infant Bonding

Maternal-infant bonding is important for children's positive development. Poor maternal-infant bonding is a risk factor for negative mother and infant outcomes. Although researchers have examined individual predictors of maternal-infant bonding, studies typically do not examine several concurrent and longitudinal predictors within the same model. This study aimed to evaluate the unique and combined predictive power of cross-sectional and longitudinal predictors of maternal-infant bonding. Participants were 372 pregnant women recruited from an Australian hospital. Data were collected from mothers at antenatal appointments (T0), following their child's birth (T1), and at a laboratory assessment when their child was 5-11-months-old (T2). Poorer bonding at T2 was predicted at T0 by younger maternal age, higher education, and higher antenatal depressive symptoms. Poorer bonding at T2 was predicted at T1 by younger maternal age, higher education, and higher postnatal depressive symptoms. Poorer bonding at T2 was predicted at T2 by younger maternal age, higher education, higher postnatal depression symptoms, higher concurrent perceived social support, and more difficult infant temperament, when controlling for child age at T2. To promote positive maternal-infant bonding, global and targeted interventions in the perinatal period may benefit from targeting maternal psychopathology, perceived lack of social support, and coping with difficult infant temperament.

Identification of Bonding Difficulties in the Peripartum Period Using the Mother-to-Infant Bonding Scale-Japanese Version and Its Tentative Cutoff Points

PURPOSE

Identification of pregnant women with bonding difficulties is important to provide early intervention. However, few studies have examined the utility of self-report questionnaires that assess mother-infant bonding as screening tools for bonding difficulties. This longitudinal study aimed to identify pregnant women with bonding difficulties using the Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) and to estimate its optimal cutoff points in the peripartum period.

PATIENTS AND METHODS

A total of 1301 pregnant women completed the MIBS-J and Hospital Anxiety and Depression Scale (HADS) at three time points: first trimester (T1; approximately 12-15 weeks gestation), third trimester (T2; approximately 30-34 weeks gestation), and postpartum (T3; approximately 4 weeks postpartum). A two-step cluster analysis was conducted to classify pregnant women based on their MIBS-J subscale scores at the three time points. Based on the cluster analysis results, receiver operating characteristic curve analysis was performed to estimate the optimal cutoff scores for the MIBS-J total score at each time point.

RESULTS

The two-step cluster analysis produced two clusters: Cluster 1 (n = 824) and Cluster 2 (n = 477). Both the MIBS-J and HADS scores were significantly higher in Cluster 2 than in Cluster 1 at all time points. The MIBS-J tentative cutoff points were 3/4, 3/4, and 2/3 at T1, T2, and T3, respectively.

CONCLUSION

We identified two distinct groups across the perinatal period: pregnant women with bonding difficulties and pregnant women with normal bonding. Our findings suggest the usefulness of the MIBS-J as a screening tool to identify bonding difficulties during pregnancy.

Use of the Stafford Interview for assessing perinatal bonding disorders

Perinatal bonding disorders have been advocated by Brockington and he developed the semistructured Stafford Interview which contains a specific section to assess these disorders. To our knowledge, this is the first report on a fully described clinical case by using the interview. A 29-year-old primiparous mother gave birth to a healthy girl, but visited our clinic because of depression at one month postnatally and received pharmacotherapy. Despite improvement of her depression, at around 7 months postnatally, she felt distressed by childcare. The Stafford Interview was conducted and it manifested evidences of anger and rejection to her infant: she screamed at her infant because of anger towards her infant, and had desire to escape from the baby care and then temporally transferred the care to her mother (grandmother of the baby). The evidence of maternal feelings by using the Stafford Interview is practically useful for treating mothers with bonding disorders.