Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis

Abstract

Purpose Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. Methods We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. Results We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression (r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety (r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress (r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression (r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety (r = .16 [95% CI 0.10, 0.22]), and stress (r = .15 [95% CI − 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems (r = − 0.17 [95% CI − 0.22, − 0.11]). Conclusion Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying

“…Parents reporting high‐level of infant carrying had fewer bonding impairments than parents reporting low levels of infant carrying. Parental bonding, the emotional connection from parent to child, has been shown to play an important role in postpartum mental health (Badr et al., 2018; Behrendt et al., 2016; Eitenmüller et al., 2022; Nakano et al., 2019; O'Dea et al., 2023) and to affect a child's socio‐emotional development (Fuchs et al., 2016; Joas & Möhler, 2021; Le Bas et al., 2022). The association between parental reflective functioning and parental bonding is in line with previous findings (Pazzagli et al., 2022) suggesting that parental reflective functioning may have an important (mediating) role in the developing parent‐infant bond.…”

Two babies, two bonds: Frequency and correlates of differential maternal‐infant bonding in mothers of twins

“…Finally, we had 99.99% power to observe large correlations of r = .50 and 89.95% power to observe medium correlations of r = .30, but only 17.89% power to observe small correlations of r = .10. Prior work examining links between maternalinfant bonding and maternal mental health suggests that effect sizes for our hypotheses would range from medium to large (O'Dea et al, 2023).…”

“…Although no research has explicitly tested potential mechanisms, there are many possible reasons for lower average maternal-infant bonding in mothers of twins. Higher levels of stress (Wenze et al, 2023), resulting from increased caregiving burden, time demands, sleep disruption, medical complications (Wenze et al, 2020), and the unique challenge of attempting to connect simultaneously with both babies (Bryan, 2003) could contribute; links between maternal parenting stress and poor maternal-infant bonding are well-established (Lutkiewicz et al, 2020;O'Dea et al, 2023). Parents of twins often express concern that the need to be highly task-focused interferes with opportunities to bond with their babies (Gowling et al, 2021;Holditch-Davis et al, 1999).…”

“…It is possible that factors associated with poor maternalinfant bonding generally (i.e., in singletons) are also associated with differential bonding with twins. In particular, symptoms of postpartum depression (Liu et al, 2022;Lutkiewicz et al, 2020;O'Dea et al, 2023;Rusanen et al, 2021;Sockol et al, 2014;Tichelman et al, 2019), stress (Lutkiewicz et al, 2020;O'Dea et al, 2023;Rusanen et al, 2021), and anxiety (Doster et al, 2018;Lutkiewicz et al, 2020;O'Dea et al, 2023) have been linked with poor maternal-infant bonding, as has maternal postpartum sleep disruption (Kalmbach et al, 2022). Such symptomsall of which are more common in mothers of multiples than in mothers of singletons (Wenze et al, 2015(Wenze et al, , 2023)might make it harder to build a bond with two babies at once.…”

Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States

“…Additional studies revealed that substantial impairment of maternal bonding is evident in the presence of antenatal depression (Hildingsson & Rubertsson, 2022) and postpartum depression (PPD) (Lutkiewicz et al, 2020;Moehler et al, 2006). Three prior narrative reviews (Edwards et al, 2017;McNamara et al, 2019;Tichelman et al, 2019) reported that maternal depression and stress symptoms were associated with maternal bonding problems; additionally, one recent meta-analysis (O'Dea et al, 2023) concluded that maternal symptoms of depression and stress are associated with an increased risk of poorer mother-child bonding that will likely persist beyond the first year postpartum. As could be expected, the prevalence of maternal bonding problems in mothers with psychiatric disorders and depression is generally higher than in community samples (O'Higgins et al, 2013;Vengadavaradan et al, 2019).…”