The association of attachment style, postpartum PTSD and depression with bonding- A longitudinal path analysis model, from childbirth to six months

Background: There is substantial evidence that postpartum depression (PPD) is associated with a poor mother-infant bond, however, fewer studies have examined the role of other postpartum psychopathologies such as birth-related PTSD or relevant trait variables such as adult attachment styles in the quality of the mother-infant bond. Methods: 210 postpartum women were sampled in a maternity ward of a tertiary health care center. Participants completed questionnaires at three-time points. Demographics questionnaire and the Adult Attachment style scale were administrated at 1-4 days postpartum, the City Birth Trauma Scale and the Edinburgh Postpartum Depression Scale two months postpartum and the Postpartum Bonding questionnaire at six months postpartum. Results: The associations between adult attachment styles and postpartum bonding were fully mediated by postpartum psychopathology. Avoidant attachment had indirect effects on bonding through general PTSD symptoms (Beta=0.05, p=.019) and PPD (Beta=0.06, p=.010). Anxious attachment also had indirect effects on bonding through general PTSD symptoms (Beta=0.04, p=.044) and PPD (Beta=0.10, p=.001). In contrast, birth-related PTSD symptoms were not associated with bonding. The model presented a good fit. Limitations: Women sampled from one health-care center and self-report measures used. Conclusions: Our results suggest that although birth-related PTSD symptoms may cause difficulties, importantly they may not be associated with bonding difficulties six months postpartum. Therefore, women could be reassured that their birth-related PTSD symptoms, may not impact on bonding. Consequently, if interventions are specifically aimed at improving the mother-infant bond, the general-related PTSD, PPD symptoms and insecure attachment styles should be the focus of treatment.