Factors affecting mother-infant bonding in a Polish group of mothers.

AIM: The study aimed to identify the factors affecting the mother-infant bond. METHODS: This cross-sectional study included 117 mothers of infants up to 12 months of age. The participants completed online versions of the Postpartum Depression Screening Scale - Short Form, the Postpartum Bonding Questionnaire, the Parenting Sense of Competence Scale, the Perception of Stress Questionnaire, and the Prenatal Expectations Scale, which included expectations toward the child, social functioning, and the partner. The results were analyzed using independent t-tests, one-way ANOVA, and multivariate linear regression. RESULTS: Mothers who experienced symptoms of postpartum depression reported lower satisfaction with motherhood, higher stress levels, and greater discrepancies between prenatal expectations and postpartum reality. Regression analysis revealed that postpartum depression symptoms did not significantly influence the three dimensions of bonding difficulties. However, stress, discrepancies between expectations toward the partner and child, and maternal sense of competence were found to potentially intensify bonding disorders. The study also found that greater disappointment with the partner was generally associated with a weaker bond with the child. However, in cases where caring for a child was more challenging than expected during pregnancy, high emotional tension was present, or the mother had lower parental competencies, having a partner who functioned better than expected may exacerbate the disruption of the bond between the mother and child. CONCLUSIONS: Prenatal expectations, perceived stress levels, and maternal sense of competence are significant factors in bonding difficulties, with postpartum depression symptoms being an important as single variable. However, the role of postpartum depression symptoms in shaping the mother-infant bond diminishes when the overall functioning of the mother is considered.

Trastornos del vínculo con origen en la etapa perinatal. Contribuciones del psicoanálisis y la neurociencia / Bonding disorders starting in the perinatal stage. Contributions of psychoanalysis and neuroscience

Sepresentan en este artículo dos casos atendidos en un centro de salud mental infanto-juvenil (CSMIJ) en los cuales elvínculo materno filial está gravemente comprometido desde etapas prenatales. Tanto desde aportes psicoanalíticoscomo de estudios neurocientíficos actuales, se expone cómo el periodo perinatal es clave para que el bebé puedaconstruir una base emocional sana que repercutirá en su desarrollo posterior. Se subraya la importancia de destinarrecursos a la intervención precoz en mujeres gestantes o en periodo de puerperio que puedan presentar dificultadesemocionales, para fortalecer el vínculo con sus hijos e hijas y prevenir una mayor tendencia a problemas de saludmental en estos.(AU)

Thisarticle presents two cases attended in a child and adolescent mental health center (CSMIJ) in which thematernal-filial bond is severely compromised since prenatal stages. Both psychoanalytical contributions andcurrent neuroscientific studies show how the perinatal period is key for the baby to build a healthy emotionalbase that will have repercussions on its later development. The importance of allocating resources to earlyintervention in pregnant or postpartum women who may present emotional difficulties is emphasized, in orderto strengthen the bond with their children and prevent a greater tendency to mental health problems in them.(AU)

Espresenten en aquest article dos casos atesos en un centre de salut mental infantil i juvenil (CSMIJ) en què el vinclematernofilial està greument compromès des d’etapes prenatals. Tant des d’aportacions psicoanalítiques comd’estudis neurocientífics actuals, s’exposa com el període perinatal és clau perquè el nadó pugui construir unabase emocional sana que repercutirà en el desenvolupament posterior. Se subratlla la importància de destinarrecursos a la intervenció precoç en dones gestants o en període de puerperi que puguin presentar dificultatsemocionals, per enfortir el vincle amb els seus fills i filles i prevenir una tendència més gran a problemes de salutmental en aquests.(AU)

Postpartum Mental Health Status & Role Transition to Mother in Primigravid Women: A Cross-Sectional Study.

OBJECTIVE: : To assess the incidence of postpartum depression, maternal confidence about parenting and maternal-infant bonding characteristics in first-time mothers. BACKGROUND: : First-time mothers are usually unprepared for the transition into motherhood and may find it difficult to cope-up with this challenge leading to parenting stress, maternal-infant bonding disorders, and mental health problems. METHODS: : This cross-sectional study was conducted in a tertiary centre in South India, on 151 primigravid mothers who delivered a live-born healthy infant after 37 weeks' gestation. Assessment was done using Patient Health Questionnaire scale, Tamil version of the Postpartum Bonding Questionnaire and Maternal Confidence Questionnaire on the 2nd or 3rd postpartum day. RESULTS: : Incidence of postpartum depression was found to be 18.5%, with 6% having features of severe depression. All mothers had good perceived maternal confidence. Nearly one-third had one or more of the maternal-infant bonding disorders. Those who had a vaginal delivery were associated with bonding disorders (OR = 10.3; 95% CI 2.13-47.21) whereas moderate to severe postpartum depression was not associated with it on multivariate analysis. CONCLUSION: : First-time mothers were found to have good confidence in the transition to motherhood. However, the high incidence of maternal-infant bonding difficulty, especially in those with moderate to severe depression, suggests the need for initiating systematic and routine screening for postpartum mental health problems.

Development of Social Life Impact for Mother (SLIM) scale at first trimester to identify mothers who need social support postpartum: a hospital-based prospective study in Japan.

OBJECTIVE: To develop and validate the Social Life Impact for Mother (SLIM) scale to identify mothers in Japan who need social support postpartum. METHODS: Hospital-based prospective study was implemented nationwide in Japan. A total of 7462 pregnant women completed the SLIM scale in their first trimester, and postpartum social problems (postpartum depression and bonding disorders) were assessed at 1 month after delivery (N = 5768, follow-up rate 77.3%). Multivariate logistic regression was applied to investigate the association between SLIM scale and postpartum social problems. RESULTS: The SLIM scale is made up of nine risk factors for postpartum social problems, including relationship problems, lower financial status, and lack of social support. The SLIM scale predicted postpartum social problems with moderate accuracy (area under the curve 0.63, 95% confidence interval 0.60-0.65). Further stratification by local clinic and tertiary hospital did not affect the estimates. CONCLUSION: The SLIM scale at prenatal check-up may be useful for obstetricians to detect mothers with postpartum social problems. Further intervention studies using the SLIM score are warranted.

Postpartum Depressive Symptoms and Their Selected Psychological Predictors in Breast-, Mixed and Formula-Feeding Mothers.

BACKGROUND: Although breastfeeding is recommended by WHO and professionals as the most beneficial for newborn babies, many women find it challenging. Previous research yielded ambiguous results concerning the role of breastfeeding in the development of postpartum depression. The study aimed to identify the best predictors of depressive symptoms for each of these feeding method. METHODS: The participants were 151 women (mean age 29.4 yrs; SD = 4.5) who gave birth within the last 6 months and included 82 women classified as breastfeeding, 38 classified as mixed-feeding (breast and bottle), and 31 as formula-feeding. The study had a cross-sectional design using a web-based survey for data collection. The following measures were administered: The Edinburgh Postnatal Depression Scale; Sense of Stress Questionnaire; The Postpartum Bonding Questionnaire; Parenting Sense of Competence Scale; Infant Feeding Questionnaire. RESULTS: Women in study groups differed in stress, bonding difficulties, and beliefs related to feeding practices and infancy. There were no significant differences in the severity of depressive symptoms, but all mean EPDS scores were above 12. Maternal satisfaction, intrapsychic stress, and concerns about feeding on a schedule were the best predictors of EPDS scores for breastfeeding women. For mixed-feeding - emotional tension, concern about infant's hunger, overeating, and awareness of infant's hunger and satiety cues; while for the formula-feeding group, predictors included emotional tension, bonding difficulties, and such maternal feeding practices and beliefs as concern about undereating, awareness of infant's hunger and satiety cues, concerns about feeding on a schedule and social interaction with the infant during feeding. CONCLUSION: Differences in predictors of postpartum depression for study groups suggest that breastfeeding itself may not be a risk for postpartum depression. However, the specificity of maternal experiences with the various types of feeding is related to difficulties promoting postpartum depression. Providing emotional and educational support appropriate for different types of feeding may be an essential protective factor for postnatal depression.

Frequency and correlates of mother-infant bonding disorders among postpartum women in India.

PURPOSE: Disorders of mother-infant bonding have been described since early 20th Century. Previous studies have looked at the prevalence of bonding disorders among mothers with postpartum psychiatric disorders. However, its frequency among healthy postpartum mothers is less studied. METHODS: Two hundred and fifty mother-infant dyads were studied using the Mini International Neuropsychiatric Interview (MINI), the Stafford Interview, Bangalore Maternal Behaviour Scale (BMBS) and Tamil versions of the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire (PBQ). The mothers were interviewed between 4 weeks to six months postpartum. In addition, thirty one mothers with a lifetime history of psychiatric disorders were interviewed using the above scales. RESULTS: The frequency of bonding disorders was found to be 24% among healthy postpartum mothers as against 45.2% in mothers with psychiatric disorder. However, the frequency of mild disorders of bonding was relatively lower at 5.6% among healthy mothers and 6.5% among mothers with psychiatric disorders. We found that mothers in India had a clinging / over-involved subtype of anxiety that prevented them from leaving their baby under care of another competent adult. While infant-related anxiety was seen in 10% of healthy mothers, about 20% of mothers with psychiatric diagnoses had anxiety. The presence of bonding disorders was not correlated with any maternal or infant related factors except difficulty in breastfeeding. CONCLUSIONS: Disorders of mother infant bonding are seen in healthy postpartum mothers. The frequency of mild disorders of bonding appears to be similar across countries and this condition warrants further attention.

Translation, validation and factor structure of the Tamil version of the Postpartum Bonding Questionnaire (PBQ-T).

BACKGROUND: The Postpartum Bonding Questionnaire was developed in English for the purpose of screening for bonding disorders among postpartum mothers. There was a felt need for a Tamil translation of the self-rated instrument. METHODS: The Postpartum Bonding Questionnaire was translated into Tamil (PBQ-T). Two hundred and fifty mother-infant dyads were administered the PBQ-T along with the Stafford Interview. The Stafford Interview was studied by two independent psychiatrists to arrive at a diagnosis of bonding disorders in the mothers. The Edinburgh Postnatal Depression Scale (EPDS) and Bangalore Maternal Behaviour Scale (BMBS) were used for rating depressive symptoms and caregiver reported behaviour of the mother towards the infant. We also did a factor analysis to find the factor structure of the PBQ-T. RESULTS: A 19-item PBQ-T that has five factors grouped into three subscales. The five factors are General Bonding (F1A), Frustration (F1B), Anxiety (F2), Feeling trapped (F3A) and Aggression/ Rejection dimensions (F3B) loading onto three subscales 1, 2 and 3. Total PBQ-T scores were best used to detect 'any disorder of bonding' (cut-off 5/6). Subscale 1 (cut-off 2/3) was useful in detection of mild disorders of bonding, subscale 2 (cut-off 2/3) for infant-focused anxiety and subscale 3 (cut-off 0/1) for Anger/ Rejection. Mothers with bonding disorders had greater psychological distress. Caregiver report of mother's behaviour (BMBS) could detect anxiety and anger/ rejection but not the lack of emotional bond. CONCLUSION: A 19-item Tamil version of the PBQ is useful in screening for disorders of mother-infant bonding among healthy postpartum mothers.

Psychometric properties of the Postpartum Bonding Questionnaire and correlates of mother-infant bonding impairment in Italian new mothers.

OBJECTIVE: impaired maternal bonding is a risk factor for problems with infant well-being and development. The investigation of perinatal variables related to disorders of the mother-infant relationship as well as the administration of reliable and valid screening tools to new mothers in the postpartum can help identify early signs of a disturbed mother-child relationship. The Postpartum Bonding Questionnaire (PBQ) has been shown to be a valid screening instrument, but its dimensional structure is still controversial. An analysis of the literature demonstrated the need for research into the perinatal correlates of the quality of mother-newborn bonding as measured by the PBQ, and for information about the reliability and validity of the Italian version of the questionnaire. AIM: to (a) carry out preliminary analysis of the psychometric properties of an Italian version of the PBQ and (b) explore how mother-infant disturbances are related to relevant perinatal psychological variables. DESIGN: the research design consisted of a prenatal and a postnatal phase. SETTING: prenatal education classes delivered in public and private institutions. PARTICIPANTS: 123 pregnant Italian women were recruited from prenatal education classes. MEASUREMENTS: in the prenatal period participants completed a questionnaire measuring maternal-fetal attachment; at the postnatal assessment (3 months postpartum) participants completed the Italian PBQ together with measures of mother-infant attachment, the couple's adjustment and maternal psychological well-being. Exploratory factor analysis was used to investigate the factor structure of the PBQ. Internal consistencies were evaluated using Cronbach's alpha. Nomological validity was assessed via Pearson correlations. FINDINGS: a three-factor model provided the most meaningful representation of the PBQ data, with one factor reflecting annoyance and anger towards the infant, another reflecting detachment and rejection and the third reflecting anxiety about infant care. Internal consistencies were good. Impaired mother-infant bonding was negatively correlated with prenatal and postnatal mother-infant attachment and couple adjustment, as well as being positively correlated with maternal depressive symptoms. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the Italian PBQ is a reliable, valid screening instrument and can be used for research, including transcultural comparisons in perinatal psychiatry. It can also be used clinically to detect signs of a disordered mother-child relationship. Knowledge of the variables generally associated with mother-infant bonding problems combined with data from postpartum administration of the PBQ could be used in midwifery to develop preventive programmes based on the specific needs of new mothers.

The maternal infant dyadic relationship-looking beyond postpartum depression

Postpartum mental illness arises from a culmination of factors at the time of the motherhood transition, and bears impact on maternal wellbeing, as well as the infant. Whilst traditional psychiatric approach focuses primarily on symptomatology, diagnostic assessment, and treatment aimed largely at symptoms relief, the infant’s wellbeing and development is of key concern. And thus follows the need to address the space between mother and infant – the dyadic experience. Understanding the world of the infant, the nature of mother-infant bonding, and possible disorders allows us to care better for mothers with perinatal mental illness. Methods: Literature review of the evidence and possible approaches to addressing the mother-infant relational disorder will be discussed based on case reports. In particular, the Watch Wait and Wonder technique, an infant/child-led psychotherapy will be demonstrated with case studies. Results: The case studies demonstrate important themes of mother-infant bonding difficulties common to mothers with postpartum mental illness. Therapy specifically addressing these issues can enable mothers to process feelings of ambivalence and conflicts that hamper the development of the dyadic relationship. Conclusion: The maternal-infant dyadic relationship is a key focus in postpartum mental illness, and mental healthcare for postpartum depression and other illness should consider interventions as needed.