Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour

Abstract

Hardly any research has examined the link between postpartum anxiety disorder and maternal bonding. This study examined if postpartum anxiety disorder and maternal bonding are related in the postpartum period. Thereby, subclinical depressive symptoms and specific aspects of an anxious symptomatology were also taken into consideration. The German sample of N = 78 mother–infant dyads is composed of n = 30 mothers with postpartum anxiety disorders but without major or minor depression according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and n = 48 healthy mothers. Subjects were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months. Moreover, mothers filled out the Postpartum Bonding Questionnaire-16. The Anxiety Cognitions Questionnaire, the Body Sensations Questionnaire and the Mobility Inventory were chosen to assess different aspects of anxious symptomatology. To control for concurrent subclinical depressive symptoms, we used the German Edinburgh-Postnatal-Depression Scale. Mothers with postpartum anxiety disorder reported significantly lower bonding than healthy mothers. However, in a linear regression analysis, concurrent subclinical depressive symptoms and avoidance of anxiety-related situations in company explained 27 % of the overall variance in maternal bonding. The perceived lower bonding of mothers with anxiety disorder could be due to aspects of a concurrent subclinical depressive symptomatology. This notion emphasizes the need to target even mild depressive symptoms in the treatment of postpartum anxiety disorders. The outcomes also underline that the severity of anxious symptomatology, reflected by avoidance behaviour in company, puts the mother–infant bond at risk.

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References

  1. Arteche A, Joormann J, Harvey A, Craske M, Gotlib IH, Lehtonen A, Stein A (2011) The effects of postnatal maternal depression and anxiety on the processing of infant faces. J Affect Disord 133(1–2):197–203. doi:10.1016/j.jad.2011.04.015

    PubMed  Article  PubMed Central  Google Scholar 

  2. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    PubMed  Article  CAS  Google Scholar 

  3. Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O (1998) Deutschsprachige Fassung und Validierung der "Edinburgh Postnatal Depression Scale". Deutsche Medizinische Wochenzeitschrift 123(3):35–40

    Article  CAS  Google Scholar 

  4. Bortz J (2005) Statistik für Sozialwissenschaftler, 6th edn. Springer, Berlin

    Google Scholar 

  5. Brockington I (2004) Postpartum psychiatric disorders. Lancet 363(9405):303–310

    PubMed  Article  Google Scholar 

  6. Brockington IF, Oates J, George S, Turner D, Vostanis P, Sullivan M, Murdoch C (2001) A screening questionnaire for mother–infant bonding disorders. Arch Women's Mental Health 3(4):133–140

    Article  Google Scholar 

  7. Brown TA, Barlow DH (1995) Comorbidity among anxiety and mood disorders: implications for treatment and DSM-IV. J Consult Clin Psychol 63:408–441

    Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum, Hillsdale

    Google Scholar 

  9. Cohn JF, Matias R, Tronick E, Connell D, Lyons-Ruth K (1986) Face-to-face interactions of depressed mothers and their infants. In: Tronick EZ, Field T (eds) Maternal depression and infant disturbance, vol 34. Fossey-Bass, San Francisco, pp 31–45

  10. Creswell C, Apetroaia A, Murray L, Cooper P (2013) Cognitive, affective, and behavioral characteristics of mothers with anxiety disorders in the context of child anxiety disorder. J Abnorm Psychol 122(1):26–38. doi:10.1037/a0029516

    PubMed  Article  Google Scholar 

  11. Edhborg M, Nasreen HE, Kabir ZN (2011) 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 Women's Mental Health 14(4):307–316. doi:10.1007/s00737-011-0221-7

    Article  Google Scholar 

  12. Ehlers A, Margraf J, Chambless D (2001) Fragebogen zu körperbezogenen Ängsten, Kognitionen und Vermeidung (AKV). Beltz Test, Göttingen

    Google Scholar 

  13. Everaert J, Tierens M, Uzieblo K, Koster EHW (2013) The indirect effect of attention bias on memory via interpretation bias: evidence for the combined cognitive bias hypothesis in subclinical depression. Cogn Emot 27(8):1450–1458. doi:10.1080/ 02699931.2013.787972

    PubMed  Article  Google Scholar 

  14. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191

    PubMed  Article  Google Scholar 

  15. Faul F, Erdfelder E, Buchner A, Lang A-G (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160. doi:10.3758/BRM.41.4.1149

    PubMed  Article  Google Scholar 

  16. Feldman R, Greenbaum CW, Mayes LC, Erlich SH (1997) Change in mother–infant interactive behavior: relations to change in the mother, the infant, and the social context. Infant Behav Dev 20(2):151–163. doi:10.1016/s0163-6383(97)90018-7

    Article  Google Scholar 

  17. Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E (2009) Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry 48(9):919–927. doi:10.1097/CHI.0b013e3181b21651

    PubMed  Article  Google Scholar 

  18. Field T, Healy BT, Goldstein S, Guthertz M (1990) Behavior-state matching and synchrony in mother–infant interactions of nondepressed versus depressed dyads. Dev Psychol 26(1):7–14. doi:10.1037/0012-1649.26.1.7

    Article  Google Scholar 

  19. Field T, Morrow C, Adlestein D (1993) Depressed mothers’ perceptions of infant behavior. Infant Behav Dev 16:99–108

    Article  Google Scholar 

  20. Forman DR, O'Hara MW, Stuart S, Gorman LL, Larsen KE, Coy KC (2007) Effective treatment for postpartum depression is not sufficient to improve the developing mother–child relationship. Dev Psychopathol 19(2):585–602

    PubMed  Article  Google Scholar 

  21. Gotlib IH, Joormann J (2010) Cognition and depression: current status and future directions. Annu Rev Clin Psychol 6(285):312

    Google Scholar 

  22. Hofmeijer-Sevink MK, Batelaan NM, van Megen HJGM, Penninx BW, Cath DC, van den Hout MA, van Balkom AJLM (2012) Clinical relevance of comorbidity in anxiety disorders: a report from the Netherlands study of depression and anxiety. J Affect Disord 137(1–3):106–112

    PubMed  Article  Google Scholar 

  23. Hornstein C, Hohm E, Trautmann-Villalba P (2009) Die postpartale Bindungsstörung: Eine Risikokonstellation für den Infantizid? Forensische Psychiatrie, Psychologie, Kriminologie 3(1):1–8. doi:10.1007/s11757-008-0111-7

    Article  Google Scholar 

  24. Kaitz M, Maytal HR, Devor N, Bergman L, Mankuta D (2010) Maternal anxiety, mother–infant interactions, and infants’ response to challenge. Infant Behav Dev 33(2):136–148. doi:10.1016/j.infbeh.2009.12.003

    PubMed  Article  Google Scholar 

  25. Klaus MH, Kennell JH (1982) Parent–infant bonding, 2nd edn. Mosby, St. Louis, MO

    Google Scholar 

  26. Klaus MH, Kennel JH, Klaus P (1995) Bonding: building the foundations of secure attachment and independence. Addison-Wesley, Reading, MA

    Google Scholar 

  27. Kumar R (1997) "Anybody's child": severe disorders of mother-to-infant bonding. Br J Psychiatry 171:175–181. doi:10.1192/bjp.171.2.175

    PubMed  Article  CAS  Google Scholar 

  28. Loh C–C, Vostanis P (2004) Perceived mother–infant relationship difficulties in postnatal depression. Infant Child Dev 13(2):159–171

    Article  Google Scholar 

  29. Matthey S, Fisher J, Rowe H (2012) Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders: Conceptual and methodological considerations. Journal of affective disorders. doi:10.1016/j.jad.2012.09.009

    Google Scholar 

  30. 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. ArchWomen's Mental Health 9(5):273–278

    Article  CAS  Google Scholar 

  31. Murray L, Cooper P, Hipwell A (2003) Mental health of parents caring for infants. Arch Women's Mental Health 6(2):71–77

    Article  Google Scholar 

  32. Murray L, Cooper P, Creswell C, Schofield E, Sack C (2007) The effects of maternal social phobia on mother-infant interactions and infant social responsiveness. J Child Psychol Psychiat 48(1):45–52

    Google Scholar 

  33. Murray L, Lau PY, Arteche A, Creswell C, Russ S, Zoppa LD, Cooper P (2012) Parenting by anxious mothers: effects of disorder subtype, context and child characteristics. J Child Psychol Psychiatry 53(2):188–196. doi:10.1111/j.1469-7610.2011.02473.x

    PubMed  Article  Google Scholar 

  34. Nicol-Harper R, Harvey AG, Stein A (2007) Interactions between mothers and infants: impact of maternal anxiety. Infant Behav Dev 30(1):161–167

    PubMed  Article  PubMed Central  Google Scholar 

  35. Noorlander Y, Bergink V, van den Berg MO (2008) Perceived and observed mother–child interaction at time of hospitalization and release in postpartum depression and psychosis. Arch Women's Mental Health 11(1):49–56

    Article  CAS  Google Scholar 

  36. Ramchandani P, Stein A, Evans J, O'Connor TG (2005) Paternal depression in the postnatal period and child development: a prospective population study. Lancet 365(9478):2201–2205. doi:10.1016/S0140-6736(05)66778-5

    PubMed  Article  Google Scholar 

  37. Reck C (2008) Depressionen und Angststörungen im Peripartalzeitraum. Epidemiologie, Mutter-Kind-Beziehung und Behandlungskonzept. Nervenheilkunde 27:499–505

    Google Scholar 

  38. Reck C, Backenstrass M, Möhler E, Hunt A, Resch F, Mundt C (2001) Mutter-Kind-Interaktion und postpartale Depression Theorie und Empirie im Überblick. Psychotherapie 6(2):171–185

    Google Scholar 

  39. 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 Women's Mental Health 9(5):265–271

    Article  CAS  Google Scholar 

  40. Reck C, Noe D, Gerstenlauer J, Stehle E (2012) Effects of postpartum anxiety disorders and depression on maternal self-confidence. Infant Behav Dev 35(2):264–272. doi:10.1016/j.infbeh.2011.12.005

    PubMed  Article  Google Scholar 

  41. Sartorius N, Üstün TB, Lecrubier Y, Wittchen H-U (1996) Depression comorbid with anxiety: results from the WHO study on 'psychological disorders in primary health care'. Br J Psychiatry 168(30):38–43

    Google Scholar 

  42. Saß H, Wittchen H-U, Zaudig M (1994) Diagnostisches und Statistisches Manual Psychischer Störungen–DSM-IV [Diagnostic and Statistical Manual of Mental Disorders–DSM-IV]. Hogrefe, Göttingen

    Google Scholar 

  43. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA (1983) Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press, Palo Alto, CA

    Google Scholar 

  44. West AE, Newman DL (2003) Worried and blue: mild parental anxiety and depression in relation to the development of young children’s temperament and behavior problems. Parenting:Sci Pract 3:133–154. doi:10.1207/S15327922PAR0302_02

    Article  Google Scholar 

  45. Whaley SE, Pinto A, Sigman M (1999) Characterizing interactions between anxious mothers and their children. J Consult Clin Psychol 67(6):826–836. doi:10.1037/0022-006x.67.6.826

    PubMed  Article  CAS  Google Scholar 

  46. Wittchen H-U, Wunderlich U, Gruschwitz S, Zaudig M (1997) SKID-I: Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen. Hogrefe, Göttingen

    Google Scholar 

  47. Zietlow AL, Schlüter MK, Nonnenmacher N, Müller M, Reck C (2014) Maternal self-confidence postpartum and at pre-school age: the role of depression, anxiety disorders and maternal attachment insecurity. Maternal and Child Health. doi:10.1007/s10995-014-1431-1

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Acknowledgements

This research was supported by the German Research Foundation (Deutsche Forschungsgemeinschaft (DFG)). We would also like to take the opportunity to thank the participants of the study who made this research undertaking possible.

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Tietz, A., Zietlow, AL. & Reck, C. Maternal bonding in mothers with postpartum anxiety disorder: the crucial role of subclinical depressive symptoms and maternal avoidance behaviour. Arch Womens Ment Health 17, 433–442 (2014). https://doi.org/10.1007/s00737-014-0423-x

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Keywords

  • Maternal bonding
  • Postpartum anxiety disorder
  • Depressive symptoms
  • Maternal avoidance behaviour