Skip to main content

Advertisement

SpringerLink
Log in

The relationship between women’s attachment style and perinatal mood disturbance: implications for screening and treatment

  • Original Contribution
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

To investigate women’s attachment style in relation to risk for pregnancy-specific distress and perinatal depression. During the 2nd trimester, 186 women were evaluated for Axis I psychiatric disorders. In the 3rd trimester they self-reported: attachment style, pregnancy experience, current life stress, and symptoms of depression and anxiety. At 4 months post partum, a sub-sample of them (n = 56) repeated the self-report questionnaires. Wariness of attachments (high on fear dimension) was associated with greater ‘hassles’ compared to ‘uplifts’ in the assessment of pregnancy (r = 0.31, p ≤ 0.001) while attachment security was negatively related to this ratio (r = −0.31, p ≤ 0.001). Healthy women, versus women with a psychiatric diagnosis, scored higher on security (t = (150) −3.47, p ≤ 0.001) and lower on attachment fear (t = (150) −2.32, p ≤ 0.05). Using multiple regression models, there was a significant main effect of fearful attachment style on prenatal depressive symptoms (ß = 1.7, p ≤ 0.05), and of fearful and secure attachment styles for postpartum depression (ß = −2.88, p ≤ 0.05, ß = −3.78, p ≤ 0.05, respectively), even in the context of other known risk factors (in the two models, F(8, 106) =  29.33, p ≤ 0.0001, F(3, 33) = 10.85, p ≤ 0.0001, respectively). A hierarchical regression showed that attachment security uniquely contributed to the risk for postpartum depression, beyond depression during pregnancy (R 2 change from 0.25 to 0.35). An approach to perinatal psychiatric disorders that includes psychological factors such as attachment could improve screening, and provide pregnant women with specifically-tailored psychosocial interventions focused on modifying attachment schemas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Thirty-seven subjects are missing data on birth weight and gestational age. However, because this study is not specifically concerned with infant outcome, we did not exclude subjects missing these data. We ran all analyses only with subjects with gestational age (none of whom were born prior to 37 weeks). In no instance did the results differ from analyses with all subjects.

  2. Five babies weighed <2,500 g at birth. Eighteen hundred and fifteen grams (1,815 g) was the lowest weight.

  3. The prediction of postpartum depressive symptoms based on women who were less depressed during pregnancy biases the data against our hypothesis. We lose power and, given that prior research indicates that depression during pregnancy predicts postpartum depression, likely constrict our range in the outcome variable.

  4. The distribution of CES-D scores during pregnancy and at 4 months postpartum were skewed somewhat to the right. Using the square root transformation, both distributions were normal. We conducted regression analyses using the square root transformation and found similar results.

References

  • Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM (2007) Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med 356:2684–2692

    Article  PubMed  CAS  Google Scholar 

  • Andersen SM, Chen S (2002) The relational self: an interpersonal social-cognitive theory. Psychol Rev 109:619–645

    Article  PubMed  Google Scholar 

  • Austin MP, Lumley J (2003) Antenatal screening for postnatal depression: a systematic review. Acta Psychiatr Scand 107:10–17

    Article  PubMed  Google Scholar 

  • Austin MP, Tully L, Parker G (2006) Examining the relationship between antenatal anxiety and postnatal depression. J Affect Disord 101(1–3):169–174

    PubMed  Google Scholar 

  • Beck CT (1996) A meta-analysis of predictors of postpartum depression. Nurs Res 45:297–303

    Article  PubMed  CAS  Google Scholar 

  • Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50:275–285

    Article  PubMed  CAS  Google Scholar 

  • Beck AT, Rush AJ, Shaw BF, Emeny G (1979) Cognitive therapy of depression. Guilford, New York

    Google Scholar 

  • Berard A, Ramos E, Rey E, Blais L, St-Andre M, Oraichi D (2007) First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage. Birth Defects Res B Dev Reprod Toxicol 80:18–27

    Article  PubMed  CAS  Google Scholar 

  • Bergman K, Sarkar P, O'Connor TG, Modi N, Glover V (2007) Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry 46:1454–1463

    Article  PubMed  Google Scholar 

  • Bifulco A, Moran PM, Ball C, Bernazzani O (2002a) Adult attachment style. I: its relationship to clinical depression. Soc Psychiatry Psychiatr Epidemiol 37:50–59

    Article  CAS  Google Scholar 

  • Bifulco A, Moran PM, Ball C, Lillie A (2002b) Adult attachment style. II: its relationship to psychosocial depressive-vulnerability. Soc Psychiatry Psychiatr Epidemiol 37:60–67

    Article  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Blackmore ER, Carroll J, Reid A, Biringer A, Glazier RH, Midmer D, Permaul JA, Stewart DE (2006) The use of the Antenatal Psychosocial Health Assessment (ALPHA) tool in the detection of psychosocial risk factors for postpartum depression: a randomized controlled trial. J Obstet Gynaecol Can 28:873–878

    PubMed  Google Scholar 

  • Bowlby J (1988) A secure base: parent–child attachment and healthy human development. Routledge, London

    Google Scholar 

  • Boyce P, Hickie I, Parker G (1991) Parents, partners or personality? Risk factors for post-natal depression. J Affect Disord 21:245–255

    Article  PubMed  CAS  Google Scholar 

  • Boyd JH, Weissman MM, Thompson WD, Myers JK (1982) Screening for depression in a community sample. Understanding the discrepancies between depression symptom and diagnostic scales. Arch Gen Psychiatry 39:1195–1200

    PubMed  CAS  Google Scholar 

  • Brown GW, Harris TO (1978) Social origins of depression: a study of psychiatric disorder in women. Tavistock, London

    Google Scholar 

  • 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 301:386–389

    Article  PubMed  CAS  Google Scholar 

  • Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, Mitchell AA (2006) Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med 354:579–587

    Article  PubMed  CAS  Google Scholar 

  • Cohen S (1986) Contrasting the hassles scale and the perceived stress scale: who's really measuring appraised stress? Am Psychol 41:716–718

    Article  Google Scholar 

  • Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396

    Article  PubMed  CAS  Google Scholar 

  • Cooper PJ, Murray L, Hooper R, West A (1996) The development and validation of a predictive index for postpartum depression. Psychol Med 26:627–634

    PubMed  CAS  Google Scholar 

  • Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C (1999) Post-partum depression and the mother–infant relationship in a South African peri-urban settlement. Br J Psychiatry 175:554–558

    PubMed  CAS  Google Scholar 

  • Da Costa D, Larouche J, Dritsa M, Brender W (2000) Psychosocial correlates of prepartum and postpartum depressed mood. J Affect Disord 59:31–40

    Article  PubMed  Google Scholar 

  • DiPietro JA, Ghera MM, Costigan K, Hawkins M (2004) Measuring the ups and downs of pregnancy stress. J Psychosom Obstet Gynaecol 25:189–201

    Article  PubMed  CAS  Google Scholar 

  • Downey G, Coyne JC (1990) Children of depressed parents: an integrative review. Psychol Bull 108:50–76

    Article  PubMed  CAS  Google Scholar 

  • Feeney J, Alexander R, Noller P, Hohaus L (2003) Attachment insecurity, depression, and the transition to parenthood. Pers Relatsh 10:475–493

    Article  Google Scholar 

  • Field T (1995) Infants of depressed mothers. Infant Behav Dev 18:1–13

    Article  Google Scholar 

  • Field T (1998) Maternal depression effects on infants and early interventions. Prev Med 27:200–203

    Article  PubMed  CAS  Google Scholar 

  • Field T, Diego M, Dieter J, Hernandez-Reif M, Schanberg S, Kuhn C, Yando R, Bendell D (2004) Prenatal depression effects on the fetus and the newborn. Infant Behav Dev 27:216–229

    Article  Google Scholar 

  • First MB, Spitzer RL, Gibbon M, Williams JBW (1997) Structured clinical interview for DSM-IV axis I disorders—non-patient edition. Biometrics Research Department, NYSPI, New York

    Google Scholar 

  • Fonagy P, Steele M, Moran G, Steele H, Higgitt A (1993) Measuring the ghost in the nursery: an empirical study of the relation between parents’ mental representations of childhood experiences and their infants’ security of attachment. J Am Psychol Assoc 41:957–989

    CAS  Google Scholar 

  • Fraiberg S (1995) Ghosts in the nursery: a psychoanalytic approach to the problems of impaired mother–infant relationships. Assessment and therapy of disturbances in infancy. Aronson, Northvale, pp 164–221

    Google Scholar 

  • Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083

    PubMed  Google Scholar 

  • Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment (Summ). Agency for Healthcare Research and Quality, Rockville, pp 1–8

    Google Scholar 

  • George C, Kaplan N, Main M (1985) An adult attachment interview. University of California at Berkeley, Berkeley

    Google Scholar 

  • Gerlsma C, Luteijn F (2000) Attachment style in the context of clinical and health psychology: a proposal for the assessment of valence, incongruence, and accessibility of attachment representations in various working models. Br J Med Psychol 73(Pt 1):15–34

    Article  PubMed  Google Scholar 

  • Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI (1989) Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 57:269–274

    Article  PubMed  CAS  Google Scholar 

  • Griffin D, Bartholomew K (1994a) Models of self and other: fundamental dimensions underlying measures of adult attachment. J Pers Soc Psychol 67:430–445

    Article  Google Scholar 

  • Griffin D, Bartholomew K (1994b) The metaphysics of measurement: the case of adult attachment. In: Bartholomew K, Perlman D (eds) Advances in personal relationships. Jessica Kingsley, London, pp 17–52

    Google Scholar 

  • Hart R, McMahon CA (2006) Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health 9:329–337

    Article  PubMed  CAS  Google Scholar 

  • Hart S, Jones NA, Field T (2003) Atypical expressions of jealousy in infants of intrusive- and withdrawn-depressed mothers. Child Psychiatry Hum Dev 33:193–207

    Article  PubMed  Google Scholar 

  • Hazan C, Shaver P (1987) Romantic love conceptualized as an attachment process. J Pers Soc Psychol 52:511–524

    Article  PubMed  CAS  Google Scholar 

  • Heron J, O'Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80:65–73

    Article  PubMed  Google Scholar 

  • Kammerer M, Taylor A, Glover V (2006) The HPA axis and perinatal depression: a hypothesis. Arch Womens Ment Health 9:187–196

    Article  PubMed  CAS  Google Scholar 

  • Kaplan LA, Evans L, Monk C (2007) Effects of mothers’ prenatal psychiatric status and postnatal caregiving on infant biobehavioral regulation: can prenatal programming be modified. Early Hum Dev 84(4):249–256

    Article  PubMed  Google Scholar 

  • Kurdek LA (2002) On being insecure about the assessment of attachment styles. J Soc Pers Relatsh 19:811–834

    Article  Google Scholar 

  • Louik C, Lin AE, Werler MM, Hernandez-Diaz S, Mitchell AA (2007) First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med 356:2675–2683

    Article  PubMed  CAS  Google Scholar 

  • Lyons-Ruth K, Wolfe R, Lyubchik A (2000) Depression and the parenting of young children: making the case for early preventive mental health services. Harv Rev Psychiatry 8:148–153

    Article  PubMed  CAS  Google Scholar 

  • Matthey S, Barnett B, Ungerer J, Waters B (2000) Paternal and maternal depressed mood during the transition to parenthood. J Affect Disord 60:75–85

    Article  PubMed  CAS  Google Scholar 

  • 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 84:15–24

    Article  PubMed  Google Scholar 

  • Meredith P, Noller P (2003) Attachment and infant difficultness in postnatal depression. J Fam Issues 24:668–686

    Article  Google Scholar 

  • Monk C, Fifer WP, Sloan RP, Myers MM, Trien L, Hurtado A (2000) Maternal stress responses and anxiety during pregnancy: effects on fetal heart rate. Dev Psychobiol 36:67–77

    Article  PubMed  CAS  Google Scholar 

  • Monk C, Myers MM, Sloan RP, Werner L, Jeon J, Tager F, Fifer WP (2004) Fetal heart rate reactivity differs by women's psychiatric status: an early marker for developmental risk? J Am Acad Child Adolesc Psych 43:283–290

    Article  Google Scholar 

  • Murray L, Fiori-Cowley A, Hooper R, Cooper PJ (1996) The impact of postnatal depression and associated adversity on early mother infant interactions and later infant outcomes. Child Dev 67:2512–2526

    Article  PubMed  CAS  Google Scholar 

  • Newport DJ, Wilcox MM, Stowe ZN (2002) Maternal depression: a child's first adverse life event. Semin Clin Neuropsychiatry 7:113–119

    Article  PubMed  Google Scholar 

  • Oberlander TF, Grunau RE, Fitzgerald C, Ellwood A-L, Misri S, Rurak D, Riggs KW (2002) Prolonged prenatal psychotropic medication exposure alters neonatal acute pain response. Pediatr Res 51:443–453

    Article  PubMed  CAS  Google Scholar 

  • Oberlander TF, Grunau RE, Fitzgerald C, Papsdorf M, Rurak D, Riggs W (2005) Pain reactivity in 2-month-old infants after prenatal and postnatal serotonin reuptake inhibitor medication exposure. Pediatrics 115:411–425

    Article  PubMed  Google Scholar 

  • Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C (2006) Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 63:898–906

    Article  PubMed  Google Scholar 

  • O'Connor TG, Heron J, Golding J, Beveridge M, Glover V (2002) Maternal antenatal anxiety and children's behavioral/emotional problems at 4 years: report from the Avon longitudinal study of parents and children. Br J Psychiatry 180:502–508

    Article  PubMed  Google Scholar 

  • O'Connor TG, Ben-Shlomo Y, Heron J, Golding J, Adams D, Glover V (2005) Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry 58:211–217

    Article  PubMed  CAS  Google Scholar 

  • O'Hara MW (1986) Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry 43:569–573

    PubMed  Google Scholar 

  • O'Hara MW, Gorman LL (2004) Can postpartum depression be predicted? Prim Psychiatry 11:42–47

    Google Scholar 

  • O'Hara MW, Rehm LP, Campbell SB (1983) Postpartum depression. A role for social network and life stress variables. J Nerv Ment Dis 171:336–341

    PubMed  Google Scholar 

  • O'Hara MW, Schlechte JA, Lewis DA, Varner MW (1991) Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables. Journal of Abnormal Psychology 100:63–73

    Article  PubMed  Google Scholar 

  • Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401

    Article  Google Scholar 

  • Roberts RE (1980) Reliability of the CES-D Scale in different ethnic contexts. Psychiatry Res 2:125–134

    Article  PubMed  CAS  Google Scholar 

  • Rooney E, Gaudette M, Pergament E (2006) Neonatal complications associated with late pregnancy use of selective serotonin reuptake inhibitors. ITIS Newsletter vol. 13, no. 2, April 2006

  • Rosenbaum JF, Biederman J, Gersten M, Hirshfeld DR, Meminger SR, Herman JB, Kagan J, Reznick JS, Snidman N (1988) Behavioral inhibition in children of parents with panic disorder and agoraphobia. A controlled study. Arch Gen Psychiatry 45:463–470

    PubMed  CAS  Google Scholar 

  • Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67:1285–1298

    Article  PubMed  Google Scholar 

  • Sandman CA, Wadhwa P, Glynn L, Chicz-Demet A, Porto M, Garite TJ (1999) Corticotrophin-releasing hormone and fetal responses in human pregnancy. Ann N Y Acad Sci 897:66–75

    Article  PubMed  CAS  Google Scholar 

  • Simpson JA, Rholes WS, Campbell L, Tran S, Wilson CL (2003) Adult attachment, the transition to parenthood, and depressive symptoms. J Pers Soc Psychol 84:1172–1187

    Article  PubMed  Google Scholar 

  • Sinclair D, Murray L (1998) Effects of postnatal depression on children's adjustment to school. Teacher's reports. Br J Psychiatry 172:58–63

    Article  PubMed  CAS  Google Scholar 

  • Spielberger CD (1983) Manual for the state—trait anxiety inventory. Consulting Psychologists, Palo Alto

    Google Scholar 

  • Sroufe LA (2005) Attachment and development: a prospective, longitudinal study from birth to adulthood. Attach Hum Dev 7:349–367

    Article  PubMed  Google Scholar 

  • Sugawara M, Toda MA, Shima S, Mukai T, Sakakura K, Kitamura T (1997) Premenstrual mood changes and maternal mental health in pregnancy and the postpartum period. J Clin Psychol 53:225–232

    Article  PubMed  CAS  Google Scholar 

  • Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J (2007) Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry 164:1206–1213

    Article  PubMed  Google Scholar 

  • Van den Bergh BR, 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

    Article  PubMed  Google Scholar 

  • Warren SL, Gunnar MR, Kagan J, Anders TF, Simmens SJ, Rones M, Wease S, Aron E, Dahl RE, Sroufe LA (2003) Maternal panic disorder: infant temperament, neurophysiology, and parenting behaviors. J Am Acad Child Adolesc Psychiatry 42:814–825

    Article  PubMed  Google Scholar 

  • Way CM (2007) Safety of newer antidepressants in pregnancy. Pharmacotherapy 27:546–552

    Article  PubMed  CAS  Google Scholar 

  • Weissman MM, Prusoff BA, Thompson WD, Harding PS, Myers JK (1978) Social adjustment by self-report in a community sample and in psychiatric outpatients. J Nerv Ment Dis 166:317–326

    Article  PubMed  CAS  Google Scholar 

  • Weissman MM, Prusoff BA, Gammon GD, Merikangas KR, Leckman JF, Kidd KK (1984) Psychopathology in the children (ages 6–18) of depressed and normal parents. J Am Acad Child Psychiatry 23:78–84

    Article  PubMed  CAS  Google Scholar 

  • Werner A, Myers MM, Fifer WP, Cheng B, Fang Y, Allen R, Monk C (2007) Prenatal predictors of infant temperament. Dev Psychobiol 49:474–484

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This research was supported by the March of Dimes, the National Alliance for Research on Schizophrenia and Depression, the Sackler Institute, and by a Career Development Award MH01928 to Catherine Monk. We would like to thank the many women who participated in this research, as well as Liz Werner, Lynn M. Evans, Ph.D., and Anuja Kriplani for their contributions in the collection and management of these data. We also extend thanks to Michael Myers, Ph.D. for commenting on an earlier draft of this manuscript.

Author information

Authors and Affiliations

  1. Behavioral Medicine Program, Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, 1150 St. Nicholas Avenue, Suite 1-121, New York, NY, 10032, USA

    Catherine Monk

  2. Columbia Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Box 106, New York, NY, 10032, USA

    Kristin L. Leight

  3. Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA

    Catherine Monk

  4. Department of Mathematics and Statistics, Georgia State University, Atlanta, GA, USA

    Yixin Fang

Authors
  1. Catherine Monk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristin L. Leight
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yixin Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine Monk.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Monk, C., Leight, K.L. & Fang, Y. The relationship between women’s attachment style and perinatal mood disturbance: implications for screening and treatment. Arch Womens Ment Health 11, 117–129 (2008). https://doi.org/10.1007/s00737-008-0005-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-008-0005-x

Keywords

Search

Navigation