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The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

This prospective study investigated associations between prenatal attachment of adult first-time mothers to the unborn child, perinatal factors and levels of depression before and up to 18 months after delivery.

Method

Primiparas (N = 161) without specific risk factors answered the following questionnaires during the last term of pregnancy (t1): Edinburgh Postnatal Depression Scale (EPDS), Maternal Antenatal Attachment Scale (MAAS), questionnaire on the schema of the unborn child, and a questionnaire about the pregnancy. Perinatal data were taken from the patients’ files. The EPDS was answered 3 weeks (t2, N = 157), 6 months (t3, N = 159), and 18 months (t4, N = 132) postpartum.

Results

During pregnancy, 16.9 % of the women indicated mild depressive symptoms, and 7.5 %, medium to severe symptoms of depression. Mild symptoms of depression were found in 25.5 % at t2, 10.1 % at t3, and 12.2 % at t4; medium to severe symptoms were reported by 7.6, 1.9 and 5.6 %, respectively. Women with low control during delivery (emergency Caesarean) showed a tendency for higher levels (p = 0.067) of depression at t3 than women with elective Caesarean did. The quality of prenatal attachment to the unborn child correlated negatively with depressive symptoms at t1–t4.

Conclusions

The closer the prenatal attachment of a mother to her unborn child, the less symptoms of depression she reports during the last term of pregnancy and postpartum. Therefore, promoting good mother–child attachment during pregnancy might influence the level of postpartum depression.

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References

  1. Fowles E (1998) The relationship between maternal role attainment and postpartum depression. Health Care Women Int 19(1):83–94

    Article  PubMed  CAS  Google Scholar 

  2. Association AP (2000) Diagnostic and statistical manual of mental disorders (DSM-IV-TR). American Psychiatric Association, Washington

    Google Scholar 

  3. World Health Organization (1994) The ICD-10 classification of mental and behavioral disorders. Clinical description and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  4. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. The Lancet 370(9590):851–858

    Article  Google Scholar 

  5. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WAM (2004) Prevalence of mental disorders in Europe: results from the European Study of the epidemiology of mental disorders (ESEMeD) project. Acta Psychiatr Scand 109:21–27. doi:10.1111/j.1600-0047.2004.00327.x

    Article  Google Scholar 

  6. Kringlen E, Torgersen S, Cramer V (2001) A Norwegian psychiatric epidemiological study. Am J Psychiatry 158(7):1091–1098

    Article  PubMed  CAS  Google Scholar 

  7. Fryers T, Melzer D, Jenkins R, Brugha T (2005) The distribution of the common mental disorders: social inequalities in Europe. Clin Pract Epidemiol Mental Health 1:14

    Article  Google Scholar 

  8. Andrews G, Poulton R, Skoog I (2005) Lifetime risk of depression: restricted to a minority or waiting for most? Br J Psychiatry 187(6):495–496. doi:10.1192/bjp.187.6.495

    Article  PubMed  Google Scholar 

  9. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 301(5631):386–389. doi:10.1126/science.1083968

    Article  PubMed  CAS  Google Scholar 

  10. Kendler KS, Kuhn JW, Vittum J, Prescott CA, Riley B (2005) The interaction of stressful life events and a serotonin transporter polymorphism in the prediction of episodes of major depression: a replication. Arch Gen Psychiatry 62(5):529–535. doi:10.1001/archpsyc.62.5.529

    Article  PubMed  CAS  Google Scholar 

  11. Monroe S, Reid M (2009) Life stress and major depression. Curr Directions Psychol Sci 18(2):68–72

    Article  Google Scholar 

  12. Muscatell KA, Slavich GM, Monroe SM, Gotlib IH (2009) Stressful life events, chronic difficulties, and the symptoms of clinical depression. J Nerv Ment Dis 197(3):154–160. doi:110.1097/NMD.1090b1013e318199f318177b

    Article  PubMed  Google Scholar 

  13. Brown GW, Harris TO (2008) Depression and the serotonin transporter 5-HTTLPR polymorphism: A review and a hypothesis concerning gene–environment interaction. J Affect Disord 111(1):1–12. doi:10.1016/j.jad.2008.04.009

    Article  PubMed  CAS  Google Scholar 

  14. Holma J, Holma I, Melartin T, Rytsala H, Isometsa E (2008) Long-term outcome of major depressive disorder in psychiatric patients is variable. J Clin Psychiatry 69(2):196–205

    Article  PubMed  Google Scholar 

  15. Sit DWK (2009) Identification of postpartum depression. Clin Obstet Gynecol 52(3):456–468

    Article  PubMed  Google Scholar 

  16. Martini J, Winkel S, Knappe S, Hoyer J (2010) Psychische Störungen in den reproduktiven Phasen der Frau. Geburtsh Frauenheilk 70:R46–R62

    Article  Google Scholar 

  17. O`Hara M, Schlechte J, Lewis D, Wright E (1991) Prospective study of postpartum blues. Biologic and psychosocial factors. Arch Gen Psychiatry 48(9):801–806

    Article  CAS  Google Scholar 

  18. Binder EB, Jeffrey Newport D, Zach EB, Smith AK, Deveau TC, Altshuler LL, Cohen LS, Stowe ZN, Cubells JF (2010) A serotonin transporter gene polymorphism predicts peripartum depressive symptoms in an at-risk psychiatric cohort. J Psychiatr Res 44(10):640–646. doi:10.1016/j.jpsychires.2009.12.001

    Article  PubMed  Google Scholar 

  19. Bifulco A, Figueiredo B, Guedeney N, Gorman LL, Hayes S, Muzik M, Glatigny-Dallay E, Valoriani V, Kammerer MH, Henshaw CA, Group TP (2004) Maternal attachment style and depression associated with childbirth: preliminary results from a European and US cross-cultural study. Br J Psychiatry 184(46):s31–s37. doi:10.1192/03-335

    Article  Google Scholar 

  20. McMahon C, Barnett B, Kowalenko N, Tennant C (2005) Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style. J Affect Disord 84(1):15–24. doi:10.1016/j.jad.2004.05.005

    Article  PubMed  Google Scholar 

  21. McMahon C, Barnett B, Kowalenko N, Tennant C (2006) Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment. J Child Psychol Psychiatry 47(7):660–669

    Article  PubMed  Google Scholar 

  22. Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295. doi:10.1016/j.genhosppsych.2004.02.006

    Article  PubMed  Google Scholar 

  23. Bergant A, Nguyen T, Moser R, Ulmer H (1998) Prävalenz depressiver Störungen im frühen Wochenbett. Gynäkologisch-geburtshilfliche Rundschau 38(4):232–237

    Article  PubMed  CAS  Google Scholar 

  24. Hayes B, Muller R (2004) Prenatal depression: a randomized controlled trial in the emotional health of primiparous women. Res Theory Nurs Pract 18(2–3):165–183

    Article  PubMed  Google Scholar 

  25. Reulbach U, Bleich S, Knörr J, Burger P, Fasching P, Kornhuber J, Beckmann M, Goecke T (2009) Pre-, peri- and postpartal depression: FRAMES. Fortschr Neurol Psychiatr 77(12):708–713

    Article  PubMed  CAS  Google Scholar 

  26. Bonari LPN, Ahn E, Einarson A, Steiner M, Koren G (2004) Perinatal risks of untreated depression during pregnancy. Can J Psychiatry 49(11):726–735

    PubMed  Google Scholar 

  27. Gawlik S, Reck C, Kuelkens S, Waldeier L, Sohn C, Schlehe B, Maul H (2010) Prenatal depression and anxiety—what is important for the obstetrician? Geburtsh Frauenheilk 70:268–361

    Google Scholar 

  28. Parcells D (2010) Women’s mental health nursing: depression, anxiety and stress during pregnancy. J Psychiatr Ment Health Nurs 17(9):813–820

    Article  PubMed  CAS  Google Scholar 

  29. Carter AS, Garrity-Rokous FE, Chazan-Cohen R, Little C, Briggs-Gowan MJ (2001) Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 40(1):18–26

    Article  PubMed  CAS  Google Scholar 

  30. Bowlby J (ed) (1969) Attachmend and loss, vol 1. Basic Books, New York

    Google Scholar 

  31. Laxton-Kane M, Slade P (2002) The role of maternal prenatal attachment in a woman’s experience of pregnancy and implications for the process of care. J Reprod Infant Psychol 20:253–266

    Article  Google Scholar 

  32. Cranley M (1981) Development of a tool for the measurement of maternal attachment during pregnancy. Nurs Res 30:281–284

    Article  PubMed  CAS  Google Scholar 

  33. Condon J (1993) The assessment of antenatal emotional attachment: development of a questionnaire instrument. Br J Med Psychol 66(2):167–183

    Article  PubMed  Google Scholar 

  34. Condon JT, Corkindale C (1997) The correlates of antenatal attachment in pregnant women. Br J Med Psychol 70(4):359–372

    Article  PubMed  Google Scholar 

  35. Rubin R (1975) Maternal tasks in pregnancy. Matern Child Nurse J 6:67–75

    Google Scholar 

  36. Caccia N, Johnson J, Robinson G, Barna T (1991) Impact of prenatal testing on maternal-fetal bonding: chorionic villus sampling versus amniocentesis. Am J Obstet Gynecol 165(4):1122–1125

    PubMed  CAS  Google Scholar 

  37. Grace J (1989) Development of maternal-fetal attachment during pregnancy. Nurs Res 38:228–232

    Article  PubMed  CAS  Google Scholar 

  38. Lindgren K (2001) Relationships among maternal fetal attachment, prenatal depression and health practices in pregnancy. Res Nurs Health 24:203–217

    Article  PubMed  CAS  Google Scholar 

  39. Condon J (1989) The spectrum of fetal abuse in pregnant women. J Nerv Ment Dis 174(9):509–516

    Google Scholar 

  40. Priel B, Besser A (1999) Vulnerability to postpartum depressive symptomatology: dependency, self-criticism and the moderating role of antenatal attachment. J Soc Clin Psychol 19(2):240–253

    Article  Google Scholar 

  41. Fowles ER (1996) Relationships among prenatal maternal attachment, presence of postnatal depressive symptoms and maternal role attainment. J Specialists Pediatr Nurs 1:75–83

    Google Scholar 

  42. Bergant A, Nguyen T, Heim K, Ulmer H, Dapunt O (1998) Deutschsprachige Fassung und Validierung der EPDS. DtschMed Wochenrundschau 123(3):35–40

    Article  CAS  Google Scholar 

  43. Murray D, Cox J (1990) Screening for depression during pregnancy with the edinburgh depression scale (EPDS). J Reproduct Infant Psychol 8:99–107

    Article  Google Scholar 

  44. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150(6):782–786. doi:10.1192/bjp.150.6.782

    Article  PubMed  CAS  Google Scholar 

  45. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571. doi:10.1001/archpsyc.1961.01710120031004

    Article  PubMed  CAS  Google Scholar 

  46. Harris B, Huckle P, Thomas R, Johns S, Fung H (1989) The use of rating scales to identify postnatal depression. Br J Psychiatry 154:813–817

    Article  PubMed  CAS  Google Scholar 

  47. Cox JL, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord 39(3):185–189. doi:10.1016/0165-0327(96)00008-0

    Article  PubMed  CAS  Google Scholar 

  48. Campbell S, Cohn J (1991) Prevalence and correlates of postpartum depression in first-time mothers. J Abnormal Psychol 100(4):594–599

    Article  CAS  Google Scholar 

  49. Gotlib I, Whiffen V, Mount J, Milne K, Cordy N (1998) Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 57(2):269–274

    Google Scholar 

  50. Spinelli M, Endicott J (2003) Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 160:555–562

    Article  PubMed  Google Scholar 

  51. Hayes B, Muller R, Bradley B (2001) Perinatal depression: a randomized controlled trial of an antenatal education intervention for primiparas. Birth 28(1):28–35

    Article  PubMed  CAS  Google Scholar 

  52. Siedentopf F, Rauchfuß M, Kentenich H (2011) Ist eine Weiterbildung „Psychosomatische Grundversorgung in der Frauenheilkunde“zwingend notwendig? Geburtsh Frauenheilk 71:312–313

    Article  Google Scholar 

  53. Lermann J, Schott S, Dörr A, Grupe C, Lattrich C (2011) Ist eine Weiterbildung in Kursform "Psychosomatische Grundversorgung in der Frauenheilkunde" zwingend notwendig? Geburtsh Frauenheilk 71:350–551

    Article  Google Scholar 

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Conflict of interesrt

No conflict of interest to be declared.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Erlangen, Universitätsstr. 21−23, Erlangen, Germany

    T. W. Goecke, F. Voigt, F. Faschingbauer & M. W. Beckmann

  2. Department of Psychology, University of Erlangen-Nuermberg, Neagelsbachstr. 49a, Erlangen, Germany

    G. Spangler & A. Beetz

  3. Institute for Special Education and Development and Rehabilitation, University of Rostock, August-Bebel-Str.10, Rostock, Germany

    A. Beetz

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  1. T. W. Goecke
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Correspondence to T. W. Goecke.

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Goecke, T.W., Voigt, F., Faschingbauer, F. et al. The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers. Arch Gynecol Obstet 286, 309–316 (2012). https://doi.org/10.1007/s00404-012-2286-6

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  • DOI: https://doi.org/10.1007/s00404-012-2286-6

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