War trauma and maternal–fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families

Abstract

Optimal maternal-fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother-infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant's sensorimotor and language development, and mother-infant interaction (emotional availability) at T3. Results revealed, first, that war trauma was not directly associated with MFA but that it was mediated through a low level of social support and high level of maternal prenatal mental health problems. Second, intensive MFA predicted optimal mother-reported infant's sensorimotor and language development and mother-infant emotional availability but not newborn health or maternal postpartum mental health.

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

“…The EA‐SR Brief is based on the observational Emotional Availability Scales (Biringen & Easterbrooks, ) and has been shown to correlate significantly with them (Vliegen, Luyten, & Biringen, ). However, instead of the proposed three‐dimensional structure, two factors (positive and negative dimensions of emotional availability) emerged in the earlier analysis based on the same data as ours (Punamäki, Isosävi, Qouta, Kuittinen, & Diab, ). In the current study, a sum score was calculated by subtracting the mean score of the negative dimension from the mean score of the positive dimension; the final score presents the positive mother–infant interaction.…”

Health-related publications on people living in fragile states in the alert zone: a bibliometric analysis

“…Poverty, substance abuse, and violence against women are associated with fragile states and vulnerable settings [50]. A recent systematic review suggested that both depression and posttraumatic stress disorder were highly prevalent in war survivors who stayed in areas of con ict [51][52][53]. Even refugees who live abroad continue to suffer mental health problems due to the horri c sciences and scary journey to safe places [54].…”

WAIMH position paper: Infants’ rights in wartime

“…An additional study, done at the same period but by a different team (Wainstock, Lerner‐Geva, Glasser, Shoham‐Vardi, & Anteby, ), has found a significant increase in stillbirth rate. On the other side of the conflict border, 511 Palestinian women from the Gaza Strip had been followed from the second trimester of pregnancy to 1 year after delivery (Punamäki, Isosavi, & Diab, ). Poor maternal–fetal attachment was not directly correlated with war trauma but mediated by poor maternal mental health (posttraumatic stress disorder [PTSD], depression, anxiety) and a low level of social support.…”