The anxious aspects of insecure attachment styles are associated with depression either in pregnancy or in the postpartum period

Abstract

Background Perinatal depression (PND) is a major complication of pregnancy and many risk factors have been associated with its development both during pregnancy and postpartum. The transition to motherhood activates the attachment system. The aim of our study was to investigate the relationship between women’s attachment style (AS) and PND in pregnancy, and 1 month after childbirth, in a large cohort of women. We hypothesized that different patterns of AS were associated with either antenatal or postnatal depression. We, further, explored the role of other possible risk factors such as life-stress events. Methods A final sample of 572 women was enrolled. At the third trimester of pregnancy, clinical data sheet and self-report questionnaires (ASQ, PSS, LTE-Q, and EPDS) were administered. One month after delivery, EPDS was administered by telephone interview. Results We found 10.1% of the women with depression during pregnancy and 11.1% in the postpartum period. The first logistic regression showed that ASQ-CONF subscale (OR = 0.876, p < 0.0001), ASQ-NFA subscale (OR = 1.097, p = 0.002), foreign nationality (OR = 2.29, p = 0.040), low education levels (OR = 0.185, p = 0.012), PSS total score (OR = 1.376, p = 0.010), and recent life adversities (OR = 3.250, p = 0.012) were related to EPDS ≥ 14 during pregnancy. The second logistic regression showed that ASQ-PRE subscale (OR = 1.077, p < 0.001) and foreign nationality (OR = 2.88, p = 0.010) were related to EPDS ≥ 12 in the postpartum period. Conclusions Different dimensions of anxious insecure AS were, respectively, associated with either antenatal or postnatal depression. These findings support the literature investigating subtypes of perinatal depression. The PND may be heterogeneous in nature, and the comprehension of psychopathological trajectories may improve screening, prevention, and treatment of a disorder which has a long-lasting disabling impact on the mental health of mother and child. We provided a rationale for targeting an attachment-based intervention in this group of women.

Psychological Characteristics of Women with Perinatal Depression Who Require Psychiatric Support during Pregnancy or Postpartum: A Cross-Sectional Study

“…Consistent with our previous findings, stressful life events in the preceding 12 months were the strongest risk factor for perinatal depression [ 24 ]. Pregnancy itself is a stressful time with many potential changes and challenges.…”

“…An insecure attachment style is a stronger predictor of postpartum depression than prenatal depression and a history of mood disorder [ 22 ]. In a previous large study, we found that several subtypes of insecure attachment were associated with the onset of depression during pregnancy or after delivery [ 24 ]. The “need for approval” dimension, characterized by low self-confidence and excessive dependence on others, increases the risk of depression in pregnancy.…”

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

“…The Edinburgh Postnatal Depression Scale (EPDS) by Cox et al (17) is a validated tool for the clinical detection of PD and depressive symptoms during pregnancy (see description in the "Materials and methods" section). The insecure attachment is also considered to be a psychological factor associated with a higher risk of PD since it is related to internal working models based on a negative self-representation (18,19). Finally, the subjective vulnerability to develop PD is associated with dysfunctional coping strategies as well as protective factors for PD, which are related to personal psychological factors of resilience (20, 21).…”

The Mother-Baby Bond: Role of Past and Current Relationships

“…The secure attachment style supports women’s interpersonal functioning, protects them from depression, and is associated with more effective emotional regulation strategies that improve the relationship with the child. Conversely, the insecure attachment style increased the risk of mood disorders, as bonding with the child can be perceived as a source of stress [ 43 ]. Furthermore, for the first time, we demonstrated that the relationship that the women in this study had with their parents in the first 15 years of their lives influenced their relationship with the newborn and breastfeeding.…”