Skip to main content

Advertisement

SpringerLink
Log in

Maternal Self-confidence Postpartum and at Pre-school Age: The Role of Depression, Anxiety Disorders, Maternal Attachment Insecurity

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

The aim of this study was to analyze the impact of maternal postpartum depression and/or anxiety disorders according to DMS-IV on maternal self-confidence throughout infancy and early childhood. Exploratively, associations between maternal attachment insecurity and maternal self-confidence at pre-school age were examined. The sample (N = 54) of this prospective longitudinal study was comprised of n = 27 women with postpartum depression and/or anxiety disorders according to DSM-IV criteria and n = 27 healthy women without present or history of mental health disorders or psychotherapy. Data was collected in the postpartum period (M = 60.08 days) and at pre-school age (M = 4.7 years). Subjects were recruited between 2004 and 2011 in South Germany. Data revealed a significant difference in maternal self-confidence between clinical and control group at child′s pre-school age: Women with postpartum depression and/or anxiety disorder scored lower on maternal self-confidence than healthy controls, but only if they had current SCID-diagnoses or partly remitted symptoms. According to explorative analyses maternal attachment insecurity turned out to be the strongest predictor of maternal self-confidence at pre-school age besides maternal mental health status. The results emphasize the impact of attachment insecurity and maternal mental health regarding maternal self-confidence leading to potential adverse long-term consequences for the mother–child relationship. Attachment based interventions taking maternal self-confidence into account are needed.

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

Similar content being viewed by others

References

  1. Britton, J. R. (2008). Maternal anxiety: Course and antecedents during the early postpartum period. Depression and Anxiety, 25(9), 793–800. doi:10.1002/da.20325.

    Article  PubMed  Google Scholar 

  2. Reck, C., Struben, K., Backenstrass, M., et al. (2008). Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatrica Scandinavica, 118(6), 459–468. doi:10.1111/j.1600-0447.2008.01264.x.

    Article  PubMed  CAS  Google Scholar 

  3. Cooper, P. J., & Murray, L. (1998). Postnatal depression. Clinical review. British Journal of Medicine, 316, 1884–1886.

    Article  CAS  Google Scholar 

  4. Brown, S., & Lumley, J. (2000). Physical health problems after childbirth and maternal depression at six to seven months postpartum. British Journal of Obstetrics and Gynaecology, 107, 1194–1201.

    Article  PubMed  CAS  Google Scholar 

  5. Wenzel, A., Haugen, E., Jackson, L., & Robinson, K. (2003). Prevalence of generalized anxiety at 8 weeks postpartum. Archives Of Women’s Mental Health (serial online). 6(1):43–49. Available from: PsycINFO, Ipswich, MA. Accessed Nov 24, 2013.

  6. Andrews, G., Sanderson, K., Slade, T., et al. (2000). Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment. Bulletin of the World Health Organization, 78(4), 446–454.

    PubMed  CAS  PubMed Central  Google Scholar 

  7. Masi, G., Millepiedi, S., Mucci, M., et al. (2004). Generalized anxiety disorder in referred children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(6), 752–760.

    Article  PubMed  Google Scholar 

  8. Andrews, G., Hall, W., & Teesson, M., et al. (1999). The mental health of Australians. Mental Health Branch, Commonwealth Department of Health and Aged Care, Canberra.

  9. Field, T., Hernandez-Reif, M., & Diego, M. A. (2007). Still-face and separation effects on depressed mother–infant interactions. Infant Mental Health Journal, 28(3), 314–323.

    Article  Google Scholar 

  10. Moehler, E., Brunner, R., Wiebel, A., et al. (2006). Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Archives of Women’s Mental Health, 9(5), 273–278. doi:10.1007/s00737-006-0149-5.

    Article  PubMed  CAS  Google Scholar 

  11. Reck, C., Hunt, A., Fuchs, T., et al. (2004). Interactive regulation of affect in postpartum depressed mothers and their infants: An overview. Psychopathology, 37, 272–280.

    Article  PubMed  Google Scholar 

  12. Tronick, E., & Reck, C. (2009). Infants of depressed mothers. Harvard Review of Psychiatry, 17(2), 147–156. doi:10.1080/10673220902899714.

    Article  PubMed  Google Scholar 

  13. Nicol-Harper, R., Harvey, A., & Stein, A. (2007). Interactions between mothers and infants: Impact of maternal anxiety. Infant Behavior & Development, 30(1), 161–167.

    Article  Google Scholar 

  14. Goodman, S. H., Rouse, M. H., Connell, A. M., et al. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1–27. doi:10.1007/s10567-010-0080-1.

    Article  PubMed  Google Scholar 

  15. Feldman, R., Granat, A., Pariente, C., et al. (2009). Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9), 919–927. doi:10.1097/CHI.0b013e3181b21651.

    Article  PubMed  Google Scholar 

  16. Kötter, C., Stemmler, M., Bühler, A., et al. (2010). Mütterliche depressivität, Erziehung und kindliche Erlebens- und Verhaltensprobleme. Kindheit und Entwicklung, 19(2), 109–118. doi:10.1026/0942-5403/a000006.

    Article  Google Scholar 

  17. Luoma, I., Tamminen, T., Kaukonen, P., et al. (2001). Longitudinal study of maternal depressive symptoms and child well-being. Journal of the American Academy of Child and Adolescent Psychiatry, 40(12), 1367–1374. doi:10.1097/00004583-200112000-00006.

    Article  PubMed  CAS  Google Scholar 

  18. Murray, L., Woolgar, M., Cooper, P., et al. (2001). Cognitive vulnerability to depression in 5-year-old children of depressed mothers. Journal of Child Psychology and Psychiatry, 42(7), 891–899. doi:10.1111/1469-7610.00785.

    Article  PubMed  CAS  Google Scholar 

  19. Righetti-Veltema, M., Bousquet, A., & Manzano, J. (2003). Impact of postpartum depressive symptoms on mother and her 18-month-old infant. European Child and Adolescent Psychiatry, 12(2), 75–83. doi:10.1007/s00787-003-0311-9.

    Article  PubMed  Google Scholar 

  20. Weinberg, M. K., & Tronick, E. Z. (1998). The impact of maternal psychiatric illness on infant development. Journal of Clinical Psychiatry, 59(Suppl 2), 53–61.

    PubMed  Google Scholar 

  21. Van den Bergh, B. R. H., Mulder, E. J. H., Mennes, M., et al. (2005). Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: Links and possible mechanisms. A review. Neuroscience and Biobehavioral Reviews, 29(2), 237–258. doi:10.1016/j.neubiorev.2004.10.007.

    Article  PubMed  Google Scholar 

  22. Woodruff-Borden, J., Morrow, C., Bourland, S., et al. (2002). The behavior of anxious parents: Examining mechanisms of transmission of anxiety from parent to child. Journal of Clinical Child and Adolescent Psychology, 31(3), 364–374. doi:10.1207/153744202760082621.

    Article  PubMed  Google Scholar 

  23. Teti, D. M., & Gelfand, D. M. (1991). Behavioral competence among mothers of infants in the first year: The mediational role of maternal self-efficacy. Child Development, 62(5), 918–929. doi:10.2307/1131143.

    Article  PubMed  CAS  Google Scholar 

  24. Coleman, P. K., & Karraker, K. H. (2003). Maternal self-efficacy beliefs, competence in parenting, and toddlers’ behavior and developmental status. Infant Mental Health Journal, 24(2), 126–148. doi:10.1002/imhj.10048.

    Article  Google Scholar 

  25. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215. doi:10.1037/0033-295x.84.2.191.

    Article  PubMed  CAS  Google Scholar 

  26. Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W H Freeman/Times Books/Henry Holt & Co.

  27. Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental Psychology, 25(5), 729–735. doi:10.1037/0012-1649.25.5.729.

    Article  Google Scholar 

  28. Janicke, D. M., & Finney, J. W. (2003). Children’s primary health care services: Social-cognitive factors related to utilization. Journal of Pediatric Psychology, 28(8), 547–557.

    Article  PubMed  Google Scholar 

  29. Eaton, M. M. (2008). Self-efficacy in first-time mothers. US: ProQuest Information & Learning.

    Google Scholar 

  30. O’Neil, J., Wilson, M. N., Shaw, D. S., et al. (2009). The relationship between parental efficacy and depressive symptoms in a diverse sample of low income mothers. Journal of Child and Family Studies, 18(6), 643–652. doi:10.1007/s10826-009-9265-y.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Porter, C. L., & Hsu, H.-C. (2003). First-time mothers’ perceptions of efficacy during the transition to motherhood: Links to infant temperament. Journal of Family Psychology, 17(1), 54–64. doi:10.1037/0893-3200.17.1.54.

    Article  PubMed  Google Scholar 

  32. Sevigny, P. R., & Loutzenhiser, L. (2010). Predictors of parenting self-efficacy in mothers and fathers of toddlers. 36(2):179–89. doi:10.1111/j.1365-2214.2009.00980.x.

  33. Reck, C., Noe, D., Gerstenlauer, J., et al. (2012). Effects of postpartum anxiety disorders and depression on maternal self-confidence. Infant Behavior & Development. doi:10.1016/j.infbeh.2011.12.005.

  34. Haslam, D. M., Pakenham, K. I., & Smith, A. (2006). Social support and postpartum depressive symptomatology: The mediating role of maternal self-efficacy. Infant Mental Health Journal, 27(3), 276–291. doi:10.1002/imhj.20092.

    Article  Google Scholar 

  35. Howell, E. A., Mora, P. A., DiBonaventura, M. D., et al. (2009). Modifiable factors associated with changes in postpartum depressive symptoms. Archives of Women’s Mental Health, 12(2), 113–120. doi:10.1007/s00737-009-0056-7.

    Article  PubMed  Google Scholar 

  36. Leerkes, E. M., & Burney, R. V. (2007). The development of parenting efficacy among new mothers and fathers. Infancy, 12(1), 45–67. doi:10.1111/j.1532-7078.2007.tb00233.x.

    Article  Google Scholar 

  37. Froman, R. D., & Owen, S. V. (1990). Mothers’ and nurses’ perceptions of infant care skills. Research in Nursing & Health, 13(4), 247–253. doi:10.1002/nur.4770130407.

    Article  CAS  Google Scholar 

  38. Seo, S.-J. (2004). Maternal self-efficacy, quality of parenting, and child developmental outcome among mothers with young children from early head start. USA: ProQuest Information & Learning.

    Google Scholar 

  39. Gustave-Bochner, B. (2008). Changes in depression, anxiety and subjective well-being among new mothers in an professionally facilitated support group. New York, NY: New York University.

  40. Logsdon, M. C., Wisner, K., & Hanusa, B. H. (2009). Does maternal role functioning improve with antidepressant treatment in women with postpartum depression? Journal of Women’s Health, 18(1), 85–90. doi:10.1089/jwh.2007.0635.

    Article  PubMed  Google Scholar 

  41. Bifulco, A., Figueiredo, B., Henshaw, C., et al. (2004). Maternal attachment style and depression associated with childbirth: Preliminary results from a European and US cross-cultural study. The British Journal Of Psychiatry, 184(Suppl46), s31–s37.

    Article  Google Scholar 

  42. Murphy, B., & Bates, G. (1997). Adult attachment style and vulnerability to depression. Personality and Individual Differences, 22(6), 835–844.

    Article  Google Scholar 

  43. Xue, Y., & Yang, Y. (2013). Study on the adult attachment styles of the outpatients with anxiety disorder. Chinese Journal of Clinical Psychology, 21(1), 81–84.

    Google Scholar 

  44. Eng, W., Heimberg, R., Hart, T., Schneier, F., & Liebowitz, M. (2001). Attachment in individuals with social anxiety disorder: The relationship among adult attachment styles, social anxiety, and depression. Emotion, 1(4), 365–380.

    Article  PubMed  CAS  Google Scholar 

  45. Mickelson, K., Kessler, R., & Shaver, P. (1997). Adult attachment in a nationally representative sample. Journal of Personality & Social Psychology, 73(5), 1092–1106.

    Article  CAS  Google Scholar 

  46. Diehl, M., Elnick, A., Bourbeau, L., & Labouvie-Vief, G. (1998). Adult attachment styles: Their relations to family context and personality. Journal of Personality and Social Psychology, 74(6), 1656–1669.

    Article  PubMed  CAS  Google Scholar 

  47. McMahon, C., Trapolini, T., & Barnett, B. (2008). Maternal state of mind regarding attachment predicts persistence of postnatal depression in the preschool years. Journal of Affective Disorders, 107(1–3), 199–203.

    Article  PubMed  Google Scholar 

  48. Bifulco, A., Kwon, J., Jacobs, C., Moran, P., Bunn, A., & Beer, N. (2006). Adult attachment style as mediator between childhood neglect/abuse and adult depression and anxiety. Social Psychiatry & Psychiatric Epidemiology, 41(10), 796–805.

    Article  Google Scholar 

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

  50. Bloom, K., & Lips, H. M. (1988, April). New scale of maternal selfconfidence. Poster session presented at the International Conference on Infant Studies, Washington, DC.

  51. Bifulco, A., Mahon, J., Kwon, J., Moran, P., & Jacobs, C. (2003). The Vulnerable Attachment Style Questionnaire (VASQ): An interview-based measure of attachment styles that predict depressive disorder. Psychological Medicine, 33(6), 1099–1110.

    Article  PubMed  CAS  Google Scholar 

  52. Bifulco, A., Moran, P., Ball, C., & Bernazzani, O. (2002). Adult attachment style. I: Its relationship to clinical depression. Social Psychiatry and Psychiatric Epidemiology, 37(2), 50–59.

    Article  PubMed  CAS  Google Scholar 

  53. Saß, H., Wittchen, H.-U., & Zaudig, M. (1994). Diagnostic and statistical manual of mental disorders-DSM-IV. Göttingen: Hogrefe.

    Google Scholar 

  54. Conrad, B. (1991). Using self-efficacy theory to explain maternal confidence during toddlerhood. US: ProQuest Information & Learning.

    Google Scholar 

  55. Coleman, P. K., & Karraker, K. H. (2000). Parenting self-efficacy among mothers of school-age children. Family Relations, 49(1), 13–24.

    Article  Google Scholar 

  56. Cohen, J. (1977). Statistical power analysis for the behavioral sciences (Rev. Ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

  57. Hopkins, J., Campbell, S., & Marcus, M. (1987). Role of infant-related stressors in postpartum depression. Journal of Abnormal Psychology, 96(3), 237–241.

    Article  PubMed  CAS  Google Scholar 

  58. Roberts, J., Gotlib, I., & Kassel, J. (1996). Adult attachment security and symptoms of depression: The mediating roles of dysfunctional attitudes and low self-esteem. Journal of Personality and Social Psychology, 70(2), 310–320.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

First and foremost, we would like to express our thanks to the mothers participating in the study. Also, we would like to thank the maternity clinics and their staff in Heidelberg (St. Josef’s Hospital, Saint Elisabeth’s Hospital, Salem Hospital, and the Gynecological Clinic at the University of Heidelberg) as well as participating clinics in Darmstadt (Alice-Hospital and Darmstadt Hospital) for their willingness to cooperate and their support in recruiting patients. The study was supported by a grant from the Program of Research Support at the University Medical Faculty, Heidelberg (funding period: 2003–2004) as well as by Köhler and Jung Foundation.

Author information

Authors and Affiliations

  1. Centre for Psychosocial Medicine, General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany

    Anna-Lena Zietlow, Myriam Kim Schlüter, Nora Nonnenmacher, Mitho Müller & Corinna Reck

  2. Department of Psychology and Pedagogy, Ludwig Maximilians University, Munich, Germany

    Corinna Reck

Authors
  1. Anna-Lena Zietlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Myriam Kim Schlüter
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nora Nonnenmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mitho Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Corinna Reck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Corinna Reck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zietlow, AL., Schlüter, M.K., Nonnenmacher, N. et al. Maternal Self-confidence Postpartum and at Pre-school Age: The Role of Depression, Anxiety Disorders, Maternal Attachment Insecurity. Matern Child Health J 18, 1873–1880 (2014). https://doi.org/10.1007/s10995-014-1431-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-014-1431-1

Keywords

Search

Navigation