Postpartum Bonding Difficulties and Adult Attachment Styles: The Mediating Role of Postpartum Depression and Childbirth‐related PTSD

Abstract

Despite decades of research demonstrating the role of adult attachment styles and early mother-infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth-related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks' postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant-focused anxiety, mediated by postpartum depression but not childbirth-related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth-related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth-related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.

Adult attachment style and maternal-infant bonding: the indirect path of parenting stress

“…Our findings show that attachment avoidance and anxiety correlated negatively and significantly with maternal-infant bonding and positively with overall parenting stress and the stress subscales experience of competence in the parenting role, relationship with spouse, isolation, symptoms of depression and role restriction. This is in line with some previous studies that showed a relationship between adult attachment and different aspects of parenting [14], including parenting stress [32] and maternal-infant bonding [18], but contrary to one study that failed to find a significant association between adult attachment and maternal-infant bonding [16]. Further, in the hierarchical regression analysis, attachment anxiety and avoidance alone explained 16% of the variance in mother-infant bonding.…”

“…Chrzan-Detkos and Lockiewics [16] found a relationship between adult attachment and maternal bonding during pregnancy, but not with maternal bonding after birth. However, two studies [17,18] found a relationship between adult attachment style and maternal bonding postpartum, and this relationship was mediated by depression. The variability in the results of the studies investigating the association between adult attachment style and maternal bonding makes evident the need for more research on this relationship and on the potential mediators of this link.…”

“…Adult attachment styles have been studied in relation to diverse aspects of parenting (for a review see: [14]), and the relationship between adult attachment styles and maternal bonding has received some attention [15][16][17][18]. Van Bussel, Spitz and Demuttenaere [15] found weak associations between adult attachment patterns and maternal bonding.…”

Construct Validity and Psychometric Properties of the Hebrew Version of the City Birth Trauma Scale

“…In general, PTSD is known to have comorbidity with depression and anxiety disorders (e.g., Grekin and O’Hara, 2014 ; Horesh et al, 2017 ), increasing the risk for postpartum psychiatric morbidity among women with PPTSD. Further, maternal PTSD may negatively impact maternal and spousal relationships ( Ayers et al, 2006 ; Parfitt and Ayers, 2009 ; Hairston et al, 2018 ), and may even have long-term negative effects on infant behavior and development ( Hairston et al, 2011 ); all of which underscore the importance of understanding and minimizing the risk of PPTSD.…”

Doğum Sonrası Depresyonda Bağlanma Örüntüleri ve Partner Desteğinin Rolü

“…In a more recent study (Hairstone et al 2018), the mediator role of postpartum depression in the relationship between new mothers' adult romantic attachment styles and mother-infant attachment difficulties was investigated. The results yielded that postpartum depression mediated the relationship between only the anxious/ambivalent attachment style and infant-focused anxiety.…”