Mood state and psychological adjustment to pregnancy
First Online: 10 July 2006 Received: 28 October 2005 Accepted: 06 June 2006 DOI:
Cite this article as: Hart, R. & McMahon, C. Arch Womens Ment Health (2006) 9: 329. doi:10.1007/s00737-006-0141-0 Summary
The aim of this study was to investigate whether there is an association between antenatal mood state (depression and anxiety) and psychological adjustment to pregnancy. Participants were first-time, low obstetric risk mothers at a Sydney teaching hospital who completed self-report questionnaires measuring depression, anxiety, thoughts about motherhood and self as mother and relationship with the fetus. Higher symptom levels of antenatal anxiety were related to less optimal maternal-fetal quality of attachment, more negative attitudes towards motherhood and the self as mother. Similar trends were found for symptoms of depression, however depression was not significantly related to psychological adjustment to pregnancy variables. The significance of anxiety in the current study highlights the importance of considering anxiety in the psychological adjustment to pregnancy, as well as the in the context of perinatal mental health more generally. Implications of these findings for intervention are also briefly discussed.
Keywords: Antenatal depression; antenatal anxiety; psychological adjustment to pregnancy; self as mother; maternal-fetal attachment. References Altshuler, LL, Hendrick, V, Cohen, LS 1998 Course of mood and anxiety disorders during pregnancy and the postpartum period J Clin Psychiatry 59 29 33 PubMed Google Scholar Anderson, VN, Fleming, AS, Steiner, M 1994 Mood and the transition to motherhood J Reprod Infant Psychol 12 69 77 Google Scholar Armstrong, D, Hutti, M 1997 Pregnancy after perinatal loss: the relationship between anxiety and prenatal attachment J Obstet Gynecol Neonat Nurs 27 183 189 CrossRef Google Scholar Austin, M-P 2003 Perinatal mental health: opportunities and challenges for psychiatry Australas Psychiatry 11 399 403 CrossRef Google Scholar Austin, M-P 2004 Antenatal screening and early intervention for “perinatal” distress, depression and anxiety: where to from here? Arch Womens Ment Health 7 1 6 PubMed CrossRef Google Scholar Austin, M-P, Lumley, J 2003 Antenatal screening for postnatal depression: a systematic review Acta Psychiatr Scand 107 10 17 PubMed CrossRef Google Scholar Barnett, B, Parker, G 1985 Professional and non-professional intervention for highly anxious primiparous mothers Br J Psychiatry 146 287 293 PubMed Google Scholar Barnett, B, Parker, G 1986 Possible determinants, correlates and consequences of high levels of anxiety in primiparous mothers Psychol Med 16 177 185 PubMed Google Scholar Barnett, B, Schaafsma, MF, Guzman, A-M, Parker, GB 1991 Maternal anxiety: a 5 year review of an intervention study J Child Psychiatry 32 423 438 Google Scholar Benedeck, T 1959 Parenthood as a developmental phase Am Psychoanal Assoc 78 389 417 CrossRef Google Scholar Benoit, D, Parker, KCH, Zeanah, CH 1997 Mother’s representations of their infants assessed prenatally: stability and association with infants’ attachment classifications J Child Psychol Psychiatry 38 307 313 PubMed Google Scholar Berryman, JC, Windridge, KC 1996 Pregnancy after 35 and attachment to the fetus J Reprod Infant Psychol 14 133 143 Google Scholar Bibring, GL, Dwyer, TF, Huntington, DC, Valenstein, AF 1961 A study of the psychological processes in pregnancy and the earliest mother-child relationship Psychoanal Study Child 16 9 44 Google Scholar Bloom, KC 1995 The development of attachment behaviours in pregnant adolescents Nurs Res 44 284 288 PubMed CrossRef Google Scholar Bosquet, M, Egeland, B 2001 Associations among maternal depressive symptomatology, state of mind and parent child behaviours: Implications for attachment-based interventions Attach Hum Dev 3 173 199 PubMed CrossRef Google Scholar Buist, A 2002 Mental health in pregnancy: the sleeping giant Australas Psychiatry 10 203 206 CrossRef Google Scholar Condon, JT 1993 The assessment of antenatal emotional attachment: Development of a questionnaire instrument Br J Med Psychol 66 167 183 PubMed Google Scholar Condon, JT, Corkindale, C 1997 The correlates of antenatal attachment in pregnant women Br J Med Psychol 70 359 372 PubMed Google Scholar Cooper, PJ, Murray, L, Hooper, R, West, A 1996 The development and validation of a predictive index for postpartum depression Psychol Med 26 627 634 PubMed CrossRef Google Scholar Cox, JL, Holden, JM, Sagovsky, R 1987 Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale Br J Psychiatry 150 782 786 PubMed Google Scholar Cranley, M 1981 Development of a tool for the measurement of maternal attachment during pregnancy Nurs Res 30 281 284 PubMed CrossRef Google Scholar Cranley, MS 1993 The origins of the mother-child relationship – A review Phys Occupat Ther Pediatr 12 39 51 CrossRef Google Scholar Deutsch, FM, Ruble, DN, Fleming, A, Brooks-Gunn, J, Stangor, C 1988 Information seeking and maternal self-definition during the transition to motherhood J Personal Soc Psychol 55 420 431 CrossRef Google Scholar Evans, J, Heron, J, Francomb, H, Oke, S, Golding, J 2001 Cohort study of depressed mood during pregnancy and after childbirth Br Med J 323 257 260 CrossRef Google Scholar Fleming, AS, Ruble, DN, Flett, GL, Shaul, DL 1988 Postpartum adjustment in first time mothers: effects of mood on maternal responsiveness Dev Psychol 24 71 81 CrossRef Google Scholar Fowles, ER 1996 Relationships among prenatal maternal attachment, presence of postnatal depressive symptoms, and maternal role attainment J Soc Ped Nurs 1 75 82 CrossRef Google Scholar Fuller, JR 1990 Early patterns of maternal attachment Health Care Women Int 11 433 446 PubMed CrossRef Google Scholar Gaffney, KF 1986 Maternal-fetal attachment in relation to self-concept and anxiety Matern Child Nurs J 15 91 101 PubMed Google Scholar Gloger-Tippelt, G 1983 A process model of the pregnancy course Hum Dev 26 134 148 PubMed CrossRef Google Scholar Gotlib, IH, Whiffen, V, Wallace, PM, Mount, JH 1989 Prospective investigation of postpartum depression: factors involved in onset and recovery J Abnorm Psychol 100 122 132 CrossRef Google Scholar Grace, JT 1989 Development of maternal-fetal attachment during pregnancy Nurs Res 38 228 232 PubMed CrossRef Google Scholar Green, JM 1998 Postnatal depression or perinatal dysphoria? Findings from a longitudinal community-based study using the Edinburgh Postnatal Depression Scale J Reprod Infant Psychol 16 143 155 Google Scholar Heidrich, SM, Cranley, MS 1989 Effect of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment Nurs Res 38 81 84 PubMed CrossRef Google Scholar Heron, J, O’Connor, TG, Evans, J, Golding, J, Glover, V 2004 The course of anxiety and depression through pregnancy and the postpartum in a community sample J Affect Disord 80 65 73 PubMed CrossRef Google Scholar Honjo, S, Arai, S, Kaneko, H, Ujiie, T, Murase, S, Sechiyama, H, Sasaki, Y, Hatagaki, C, Inagaki, E, Usui, M, Miwa, K, Ishihara, M, Hashimoto, O, Nomura, K, Itakura, A, Inoko, K 2003 Antenatal depression and maternal-fetal attachment Psychopathology 36 304 311 PubMed CrossRef Google Scholar Kumar, R, Robson, K 1984 A prospective study of emotional disorders in childbearing women Br J Psychiatry 144 35 47 PubMed CrossRef Google Scholar Kunkel, GF, Doan, HMcK 2003 Fetal attachment and depression: measurement matters J Prenat Perinat Psychol Health 18 149 166 Google Scholar Leifer, M 1977 Psychological changes accompanying pregnancy and motherhood Gen Psychol Monogr 95 55 96 Google Scholar Leifer, M 1980Psychological effects of motherhood: A study of first pregnancy Praeger New York Google Scholar Lerum, CW, Major, RN, LoBiondo-Wood, G 1989 The relationship of maternal age, quickening, and physical symptoms of pregnancy to the development of maternal-fetal attachment Birth 16 13 17 PubMed Google Scholar Lindgren, K 2001 Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy Res Nurs Health 24 203 217 PubMed CrossRef Google Scholar
McMahon C, Barnett B, Kowalenko N, Tennant C (in press) Maternal attachment state of mind moderates the impact of maternal depression on child attachment security. J Child Psychol Psychiatry.
McNair, LM, Droppleman, LF 1981Manual: Profile of Mood States EDITS San Diego, CA Google Scholar Marcus, SM, Flynn, HA, Blow, FC, Barry, KL 2003 Depressive symptoms among pregnant women screened in obstetrics settings J Womens Health 12 373 380 CrossRef Google Scholar Martins, C, Gaffan, EA 2000 Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation J Child Psychol Psychiatry 41 737 746 PubMed CrossRef Google Scholar Matthey, S 2004 Detection and treatment of postnatal depression (perinatal depression or anxiety) Curr Opin Psychiatry 17 21 29 CrossRef Google Scholar Matthey, S, Barnett, B, Howie, P, Kavanagh, DJ 2003 Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 74 139 147 PubMed CrossRef Google Scholar Mercer, R 1985 The process of maternal role attainment over the first year Nurs Res 34 198 204 PubMed CrossRef Google Scholar Muller, ME 1996 Prenatal and postnatal attachment: A modest correlation J Obstet Gynecol Neonat Nurs 25 161 166 CrossRef Google Scholar Murray, D, Cox, JL 1990 Screening for depression during depression with the Edinburgh Depression Scale (EPDS) J Reprod Infant Psychol 8 99 107 Google Scholar O’Leary, J 2004 Grief and its impact on prenatal attachment in the subsequent pregnancy Arch Womens Ment Health 7 7 18 PubMed CrossRef Google Scholar Pollock, PH, Percy, A 1999 Maternal antenatal attachment style and potential fetal abuse Child Abuse Neglect 23 1345 1357 PubMed CrossRef Google Scholar Raphael-Leff, J 1983 Facilitators and regulators: Two approaches to mothering Br J Med Psychol 56 379 390 PubMed Google Scholar Raphael-Leff, J 1986 Facilitators and regulators: Conscious and unconscious processes in pregnancy and early motherhood Br J Med Psychol 59 43 55 PubMed Google Scholar Rubin, R 1975 Maternal tasks of pregnancy Matern Child Nurs J 4 143 153 PubMed Google Scholar Rubin, R 1984Maternal identity and the maternal experience Springer Berlin Heidelberg New York Google Scholar Ruble, DN, Fleming, AS, Stangor, C, Brooks-Gunn, J, Fitzmaurice, G, Deutsch, F 1990 Transition to motherhood and the self: measurement, stability, and change J Personal Soc Psychol 58 450 463 CrossRef Google Scholar Salisbury, A, Law, K, La Gasse, L, Lester, B 2003 Maternal-fetal attachment J Am Med Assoc 289 1701 CrossRef Google Scholar Sedgmen, B, McMahon, C, Cairns, D, Benzie, R, Woodfield, R 2006 The impact of two-dimensional versus three-dimensional ultrasound exposure on maternal-fetal attachment and maternal health behaviour in pregnancy Ultrasound Obstet Gynecol 27 245 251 PubMed CrossRef Google Scholar Shereshefsky, PM, Yarrow, LJ 1973Psychological aspects of a first pregnancy and early postnatal adaptation Raven New York Google Scholar Siddiqui, A, Hagglof, B 2000 Does maternal prenatal attachment predict postnatal mother-infant interaction? Early Hum Dev 59 13 25 PubMed CrossRef Google Scholar Siddiqui, A, Haggloff, B, Eisemann, M 2000 Own memories of upbringing as a determinant of prenatal attachment in expectant women J Reprod Inf Psychol 18 67 74 CrossRef Google Scholar Spielberger, CD, Gorsuch, RL, Lushene, RE 1970Manual for the State-Trait Anxiety Inventory (Self-evaluation Questionnaire) Consulting Psychologists Press Palo Alto, CA Google Scholar Warner, R, Appleby, L, Whitton, A, Faragher, B 1997 Attitudes toward motherhood in postnatal depression: Development of the maternal attitudes questionnaire J Psychosom Res 43 351 358 PubMed CrossRef Google Scholar
Waters A-M, Dean JH, Sullivan EA (2006) Assisted reproductive technology in Australia and New Zealand 2003 AIHW Cat. No. PER 31. AIHW National Perinatal Statistics Unit (Assisted Reproductive Technology Series No 9), Sydney.
Zigmond, AS, Snaith, RP 1983 The Hospital Anxiety and Depression Scale Acta Psychiatr Scand 67 361 370 PubMed Google Scholar