The association of attachment style, postpartum PTSD and depression with bonding- A longitudinal path analysis model, from childbirth to six months

• Published in: Journal of affective disorders Vol. 280; no. Pt A; pp. 17 - 25
• Main Authors: Handelzalts, Jonathan E., Levy, Sigal, Molmen-Lichter, Maayan, Ayers, Susan, Krissi, Haim, Wiznitzer, Arnon, Peled, Yoav
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2021
• Subjects: Adult; Attachment; Bonding; Depression; Depression, Postpartum; Female; Humans; Infant; Mother-Child Relations; Mothers; Object Attachment; Postpartum; Postpartum Period; Pregnancy; Psychiatric/Mental Health; PTSD; Stress Disorders, Post-Traumatic - epidemiology; Surveys and Questionnaires; PTSD; Depression; Attachment; Bonding; Postpartum
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2020.10.068

•Avoidant and anxious attachment styles were indirectly associated with poorer bonding•Attachment-bonding associations were mediated by PPD and general PTSD symptoms•Attachment-bonding associations were not mediated by birth-related PTSD symptoms•Implications for interventions aimed at improving bonding are suggested There is substantial evidence that postpartum depression (PPD) is associated with a poor mother-infant bond, however, fewer studies have examined the role of other postpartum psychopathologies such as birth-related PTSD or relevant trait variables such as adult attachment styles in the quality of the mother-infant bond. 210 postpartum women were sampled in a maternity ward of a tertiary health care center. Participants completed questionnaires at three-time points. Demographics questionnaire and the Adult Attachment style scale were administrated at 1-4 days postpartum, the City Birth Trauma Scale and the Edinburgh Postpartum Depression Scale two months postpartum and the Postpartum Bonding questionnaire at six months postpartum. The associations between adult attachment styles and postpartum bonding were fully mediated by postpartum psychopathology. Avoidant attachment had indirect effects on bonding through general PTSD symptoms (Beta=0.05, p=.019) and PPD (Beta=0.06, p=.010). Anxious attachment also had indirect effects on bonding through general PTSD symptoms (Beta=0.04, p=.044) and PPD (Beta=0.10, p=.001). In contrast, birth-related PTSD symptoms were not associated with bonding. The model presented a good fit. Women sampled from one health-care center and self-report measures used. Our results suggest that although birth-related PTSD symptoms may cause difficulties, importantly they may not be associated with bonding difficulties six months postpartum. Therefore, women could be reassured that their birth-related PTSD symptoms, may not impact on bonding. Consequently, if interventions are specifically aimed at improving the mother-infant bond, the general-related PTSD, PPD symptoms and insecure attachment styles should be the focus of treatment.