Abstract
The purpose of this study was to investigate the impact of depressive and anxiety symptoms on maternal bonding to the infant 2–3 months postpartum and the influence of the mother’s bonding to the infant during pregnancy and to her own caregiver during her childhood on maternal bonding 2–3 months postpartum. This study originated from a community-based cohort study carried out in rural Bangladesh. Trained staff collected data and administrated the questionnaires during the third trimester of pregnancy, at childbirth and 2–3 months postpartum. Maternal depressive and anxiety symptoms were assessed with the Edinburgh Postnatal Depression Scale and the State Anxiety Inventory and the mother’s emotional bonding to the infant with the Postpartum Bonding Questionnaire. The results showed that 11% of the women reported depressive symptoms, 35% anxiety symptoms, 3.4% both depressive and anxiety symptoms and 51% neither depressive nor anxiety symptoms. Mothers with depressive symptoms were older, were poorer, fewer were literate, reported more intimate partner violence and showed lower emotional bonding to their infants 2–3 months postpartum compared to mentally well and anxious mothers. Approximately 11% of the mothers reported mild bonding disturbances and nearly one third of them showed depressive symptoms. Depressive symptoms and giving birth to a girl were negatively associated to a mother’s emotional bonding to her infant, while maternal anxiety symptoms and high bonding to the foetus during pregnancy were positively associated to the mother's emotional bonding to the infant 2–3 months postpartum.
Similar content being viewed by others
References
Adewuya AO, Ola BA, Aloba OO, Mapayi BM (2006) Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Arch Womens’ Ment Health 9:325–328
Ainsworth MD, Blehar MC, Waters E, Wall S (1978) Patterns of attachment. A psychological study of the strange situation. Erlbaum, Hilldale
Austin MP, Hadzi-Pavlovic D, Leader L, Saint K, Parker G (2005) Maternal trait anxiety, depression and life event stress in pregnancy: relationship with infant temperament. Early Hum Dev 81(2):183–190
Bowlby J (1997) Attachment and loss, volume 1. Pimlico, London (original work published 1969)
Britton J (2005) Pre-discharge anxiety among mothers of well newborns: prevalence and correlates. Acta Paediatr 94(12):1771–1776
Brockington IF (2004) Postpartum psychiatric disorders. Lancet 364:303–310
Brockington IF, Oates J, George S, Turner D, Vostanis M, Murdoch C (2001) A screening questionnaire for mother–infant bonding disorders. Arch Womens’ Ment Health 3:133–140
Brockington IF, Fraser C, Wilson D (2006) The postpartum bonding questionnaire: a validation. Arch Womens’ Ment Health 9:233–242
Campbell S, Cohn JF, Meyers T (1995) Depression in first-time mothers: mother–infant interaction and depression chronicity. Dev Psychol 31(3):349–357
Cassidy J (2008) The nature of the child’s ties. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 2nd edn. Guilford, New York, pp 3–23
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
Damato EG (2004) Prenatal attachment and other correlates of postnatal maternal attachment in twins. Adv Neonatal Care 4:274–291
DiPietro JA, Hilton SC, Hawkins M (2002) Maternal stress and affect influence fetal neurobehavioral development. Dev Psychol 38(5):659–668
Edhborg M, Mathiesen A-S, Lundh W, Widström A-M (2005) Some early indicators for depressive symptoms and bonding 2 months postpartum—a study of new mothers and fathers. Arch Womens’ Ment Health 8(4):221–231
Feldman R, Greenbaum CW, Mayes LC, Erlich HS (1997) Change in mother–infant interactive behavior: relations to change in the mother, the infant, and social context. J Child Psychol Psychiatry 20:153–165
Field T (1995) Infants of depressed mothers. Infant Behav Dev 18:1–13
Field T, Diego M, Dieter J (2004) Prenatal depression effects on the foetus and neonate. Infant Behav Dev 27:216–229
Field T, Diego M, Hernandez-Reiff M, Figueiredo B, Deeds O, Ascencio A et al (2010) Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behav Dev 33:23–29
Figueireda B, Costa R (2009) Mother’s stress, mood and emotional involvement with the infant 3 months before and 3 months after childbirth. Arch Womens’ Ment Health 12:143–153
Fleming AS, Ruble D, Krieger H (1997) Hormonal and experiential correlates of maternal responsiveness during pregnancy and puerperium in human mothers. Horm Behav 31(2):145–158
Frankel KA, Harmon RJ (1996) Depressed mothers: they don’t always look as bad as they feel. J Acad Child Adolesc Psychiatry 35(3):289–298
Gausia K, Hamadani JD, Islam MM, Ali M, Algin S, Yunus M, Fisher C, Oosthuizen J (2007) Bangla translation, adaptation and piloting of Edinburgh Postnatal Depression Scale. Bangladesh Med Res Counc Bull 33(3):81–87
Gausia K, Fisher C, Ali M, Oosthuizen J (2009) Magnitude and contributory factors of postnatal depression: a community-based cohort study from a rural sub district of Bangladesh. Psychol Med 39:999–1007. doi:10.1017/S00033291708004455
Georg C, Solomon J (2008) Handbook of attachment: theory, research and clinical applications. In: Cassidy J, Shaver PR (eds) Handbook of attachment: theory, research and clinical applications, 2nd edn. Guilford, New York, pp 833–856
Giardino J, Gonzales A, Steiner M, Fleming AS (2008) Effects of motherhood on physiological and subjective responses to infant cries in teenage mothers: a comparison with non-mothers and adult mothers. Horm Behav 53(1):149–158
Hay FH, Pawlby S, Sharp D, Asten P, Mills A, Kumar R (2001) Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiaty 42(7):871–889
Heron J, O’Connor TG, Evans J, Golding J, Glover V, ALSPAC Study Team (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73
Hornstein CH, Trautman-Villaba P, Hohn E, Rave E, Wortmann-Fleischer S, Schwarz M (2006) Maternal bond and mother–child interaction in severe postpartum psychiatric disorders: is there a link? Arch Womens’ Ment Health 9:279–284
Huizink AC, Robles de Medina PG, Mulder EJH, Visser GHA, Buitelaar JK (2003) Stress during pregnancy is associated with developmental outcome in infancy. J Child Psychol Psychiatry 44(6):810–818
Klainin P, Arthur DG (2009) Postpartum depression in Asian cultures: a literature review. Int J Nurs Stud 46:1355–1373
Klaus MH, Kennell JH, Klaus PH (1995) Bonding: building the foundations of secure attachment and independence. Addison-Wesley, New York
Kumar RC (1997) Anybody’s child: severe disorders of mother-to-infant bonding. Br J Psychiatry 171:175–181
Luoma I, Tamminen T, Kaukonen P et al (2001) Longitudinal study of maternal depressive symptoms and child well-being. J Am Child Adolesc Psych 40(12):1367–1374
Mc Farland JA, Smith DM, Garrow DH (1978) The relationship between mother and neonate. In: Kitzinger S, Davis JA (eds) The place of birth. Oxford University Press, New York
Moehler E, Brunner R, Wiebel A, Reck C, Resch F (2006) Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Arch Womens’ Ment Health 9:273–278
Müller ME (1993) Development of the prenatal attachment inventory. West J Nursing Res 15(2):199–215
Müller ME (1996) Prenatal and postnatal attachment: a modest correlation. J Obstet Gynecol Neonatal Nurs 25:161–166
Murray L (1992) The impact of postnatal depression on infant development. J Child Psychol Psychiatry 33(3):543–561
Murray L, Fiori-Cowley A, Hooper R, Cooper P (1996) The impact of postnatal depression on early mother–infant interaction and later infant outcome. Child Dev 67(5):2512–2526
Murray L, Cooper P, Hipwell A (2003) Mental health of parents caring for infants. Arch Womens’ Ment Health. doi:10.1007/s00737-003-0007-7
O’Connor TG, Heron J, Glover V, the Alspac study team (2002) Antenatal anxiety predicts child behavioural/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 41(12):1470–1477
Oates MR (2002) Adverse effects of maternal anxiety on children: causal effect or developmental continuum? Br J Psychiatry 180:478–479
Parker G, Tupling H, Brown LB (1979) A parental bonding instrument. Br J Med Psychol 52:1–10
Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry 159:43–47
Rahman A, Iqbal Z, Harrington R (2003) Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med 23:1161–1167
Raphael-Leff J (2005) Psychological processes of childbearing. Centre for Psychoanalytic Studies, Colchester
Reck C, Hunt A, Fuchs T, Weiss R, Noon A, Moehler E, Downing G, Tronick EZ, Mundt C (2004) Interactive regulation of affect in postpartum depressed mothers and their infants: an overview. Psychopathology 37:272–280
Reck C, Klier CM, Pabst K, Stehle E, Steffenelli U, Struben K, Backenstrass M (2006) The German version of the Postpartum Bonding Instrument: psychometric properties and association with postpartum depression. Arch Womens’ Ment Health 9:265–271
Righetti-Veltema M, Conne-Perrèard E, Bousquet A, Manzano J (2002) Postpartum depression and mother–infant relationship at 3 months old. J Affect Disord 70:291–306
Robson KS, Kumar R (1980) Delayed onset of maternal affection after childbirth. Br J Psychiatry 136:347–353
Siddique A, Hägglöf B (2000) Does maternal prenatal attachment predict postnatal mother–infant interaction? Early Hum Dev 59:13–25
Siddiqui A, Hägglöf B, Eisemann M (2000) Own memories of upbringing as a determinant of prenatal attachment in expectant women. J Reprod Infant Psychol 18(1):67–74
Spielberger CD (1983) Manual for the state–trait anxiety inventory. Consulting Psychologists Press, Palo Alto
Teti DM, Gelfand DM, Isabella R (1995) Maternal depression and the quality of early attachment: an examination of infants, preschoolers, and their mothers. Dev Psychol 31:53–61
UNICEF (2009) The state of the world’s children. Special edition. Available at http://www.unicef.org/rightsite/sowc/pdfs/statistics/SOWC_Spec_Ed_CRC_TABLE%201.%20BASIC%20INDICATORS_EN_111309.pdf. Accessed on 11 December 2010
van Bussel JCH, Spitz B, Demyttenaere K (2010) Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health. doi:10.1007/s00737-009-0140
Van den Bergh BRH, Marcoen A (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems and anxiety in 8/9-year-olds. Child Dev 75:1085–1097
Winnicott DW (1956) Through pediatrics to psycho-analysis. Hogarth, London
Wittkowski A, Wieck A, Mann S (2007) An evaluation of two bonding questionnaires: a comparison of the Mother-to-Infant Bonding Scale with the Postpartum Bonding Questionnaire in a sample of primiparous mothers. Arch Womens’ Ment Health 10:171–175
Acknowledgement
The study was supported by grants from the Swedish Research Link (2007-25292-51983-33) to the Karolinska Institute and the School of Public Health at BRAC University. We appreciate the help of BRAC in Bangladesh in carrying out the study. We would also like to thank all the women who participated in the study with their infants for generously giving their time and energy.
Declarations of interests
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Edhborg, M., Nasreen, HE. & Kabir, Z.N. Impact of postpartum depressive and anxiety symptoms on mothers’ emotional tie to their infants 2–3 months postpartum: a population-based study from rural Bangladesh. Arch Womens Ment Health 14, 307–316 (2011). https://doi.org/10.1007/s00737-011-0221-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-011-0221-7