Investigating the under-recognition of childbirth-related post-traumatic stress disorder among the public and mental health professionals.

BACKGROUND: Childbirth posttraumatic stress disorder (PTSD) poses significant challenges, impacting both mothers and infants. This work investigates whether childbirth PTSD is less recognized than PTSD caused by other index events. METHODS: In two preregistered experimens we investigated the public and professional perception of PTSD resulting from childbirth compared to other traumatic events (i.e., sexual assault, car accident, terror attack, and an earthquake). FINDINGS: Study 1, conducted among the general population in the U.S. revealed that a woman depicted as experiencing PTSD symptoms due to childbirth, was less likely to be recognized as suffering from PTSD than a woman with the same symptoms resulting from other traumatic events. Study 2 demonstrated that mental health professionals worldwide are also less inclined to diagnose PTSD when childbirth is the index event in comparison to other index events. DISCUSSION: Due to the importance of social recognition in the treatment of PTSD, the findings underscore the urgent need for heightened awareness and education regarding childbirth PTSD to bridge the recognition gap among the general population and mental health professionals.

Postpartum acute stress disorder symptoms, social support, and quality of couple's relationship associations with childbirth PTSD.

Background: We aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple's relationship quality at 8-12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables. Methods: Participants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1-4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8-12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS). Results: In partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (ß = .33, p <.001) and the total score (ß = .29, p <.001), but not to birth-related symptoms. Social support (ß = -.21, p = .003) and the quality of the couple's relationship (ß=-.20, p = .003) showed negative associations with the BiTS general symptoms. Conclusion: Our study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple's relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health.

BACKGROUND: Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far. METHODS: Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively. RESULTS: Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers. LIMITATIONS: Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small. CONCLUSIONS: Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

Social support as a differential moderator of the association between optimism, birth satisfaction, and postpartum acute stress symptoms of fathers and mothers.

OBJECTIVE: Childbirth can be a stressful event that leads to the development of acute stress. However, little is known about postpartum acute stress among mothers and even less among fathers. The current study aims to expand the understanding of postpartum acute stress symptoms by examining associations with dispositional optimism, subjective birth satisfaction, and social support in a moderated-mediation model. METHOD: Participants comprised 567 mothers and 109 fathers who gave/were present at birth, sampled at the maternity ward of a tertiary healthcare center. Self-report questionnaires were distributed a few days postpartum: demographic and obstetric information, dispositional optimism (Life Orientation Test-Revised), birth satisfaction (Birth Satisfaction Scale-Revised), social support (the Multidimensional Scale of Perceived Social Support), and acute stress symptoms (National Stressful Events Survey Acute Stress Disorder Short Scale). RESULTS: For mothers, birth satisfaction mediated the association between dispositional optimism and acute stress, and social support moderated the association between birth satisfaction and acute stress for all levels of social support (B = .14, SE = .05, CI [.05 to .23]). For fathers, a similar moderated-mediation occurred; however, at high levels of social support, the association between birth satisfaction and acute stress became insignificant (B = .17, SE = .08, CI [.02 to .32]; index of moderated-mediation = .08, [-.07 to .22]). CONCLUSIONS: Optimism through birth satisfaction may reduce acute stress levels following childbirth among parents, while different effects of social support for fathers and mothers were discovered. For fathers, high levels of social support were found to eliminate the association between birth satisfaction and acute stress and therefore buffer the development of postpartum acute stress symptoms. This study took place in one healthcare center with mostly Jewish participants; further studies are thus needed for better generalization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Hebrew validation of the postpartum bonding questionnaire: a study of mothers and fathers.

OBJECTIVE: The Postpartum Bonding Questionnaire (PBQ) is a self-report questionnaire designed to screen disorders of the mother-infant relationship. The PBQ was adapted to several countries, though there is no agreement on the accepted number of items and factors. This study aimed to assess the validity and reliability of the Hebrew version for both mothers and fathers. METHODS: Participants (602 mothers and 144 fathers) from two separate samples were randomly recruited in the maternity ward of a large tertiary health centre. The mothers' samples were combined and redivided to form subsamples A and B. At T1 (1-4 days postpartum), the participants completed demographic questionnaire in person the PBQ and the Edinburgh Postpartum Depression Scale (EPDS) were administered online at T2 (8-12 weeks postpartum). The PBQ was also administrated at T3 (six-months). RESULTS: EFA on subsample A resulted in a two-factor structure, which was tested using CFA on subsample B. The model's fit was very good; χ(35)2 = 83.68, p < .001, CFI = .97, TLI = .91, RMSEA = .07, SRMR = .03. Additional reliability and validity analyses showed a very good fit for mothers. Scalar measurement invariance across mothers and fathers yielded satisfactory results. CFA among fathers, revealed adequate goodness of fit; χ2/df = 87.65/46, p < .001, CFI = .95, TLI = .89, RMSEA = .08, SRMR = .05. CONCLUSIONS: The Hebrew version of the PBQ demonstrated satisfactory validity for both mothers and fathers. The revised version, with 14 items, measures bonding as a continuum rather than measuring bonding disorders like the original version. These findings emphasise the importance of validating the scale in different cultural contexts.

Effects of 3D-Printed Models and 3D Printed Pictures on Maternal- and Paternal-Fetal Attachment, Anxiety, and Depression.

OBJECTIVE: To compare the effect of a 3D-printed model versus 3D printed pictures on maternal- and paternal-fetal attachment, pregnancy-related anxiety, and depression in parents in the third trimester. DESIGN: Randomized controlled trial. SETTING: University- and clinic-affiliated hospital system. PARTICIPANTS: Between August 2020 and July 2021, we screened 419 women for eligibility. A total of 184 participants (n = 95 women and n = 89 men) were included in the intention-to-treat analysis, of whom 47 women and 44 men received the 3D-printed model, whereas 48 women and 45 men received the 3D printed picture. METHODS: Participants completed a set of questionnaires before they received third trimester 3D ultrasonography and a second set of questionnaires approximately 14 days after the study ultrasonography. The primary outcome was the global Maternal and Paternal Antenatal Attachment scale scores. Secondary outcomes included the Maternal and Paternal Antenatal Attachment subscale scores, global Generalized Anxiety Disorder-7 scores, global Patient Health Questionnaire-9 scores, and global Pregnancy-Related Anxiety Questionnaire-Revised (second version) scores. We used multilevel models to estimate the effect of the intervention. RESULTS: We found a statistically significant increase in mean attachment scores after the 3D printed picture and 3D-printed model intervention of 0.26, 95% confidence interval (CI) [0.22, 0.31], p < .001. Additionally, we found statistically significant improvement in depression (mean change = -1.08, 95% CI [-1.54, -0.62], p < .001), generalized anxiety (mean change = -1.38, 95% CI [-1.87, -0.89], p < .001), and pregnancy-related anxiety (mean change = -2.92, 95% CI [-4.11, -1.72], p < .001) scores. We found no statistically significant between-group differences related to maternal or paternal attachment, anxiety, depression, or pregnancy-related anxiety. CONCLUSIONS: Our findings support the use of 3D printed pictures and 3D-printed models to improve prenatal attachment, anxiety, depression, and pregnancy-related anxiety.

COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum.

BACKGROUND: The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase. METHODS: Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4. RESULTS: Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12). DISCUSSION: The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD.

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1-4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8-10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Epidural analgesia associations with depression, PTSD, and bonding at 2 months postpartum.

The research aim was to study the possible effect of epidural analgesia, as well as other possible demographic/obstetric variables and subjective birth experience on postpartum depression, PTSD, and impaired bonding. This was a longitudinal study of 254 women who gave birth at the maternity wards of a large tertiary health center and responded to questionnaires at T1 (Childbirth Experience Questionnaire and level of fatigue question; in person, 1-4 days postpartum) and at T2 (Postnatal Depression Scale, Postpartum Bonding Questionnaire, and the City Birth Trauma Scale; online-two months postpartum). Obstetric and demographic data were taken from medical files. Having a previous psychiatric diagnosis and higher levels of fatigue significantly predicted worse outcomes in all measures (level of fatigue was not associated with the City Birth Trauma birth-related symptoms factor). Having higher education, being primiparous, worse birth experience, and longer second stage of birth predicted worse outcomes in some measures. Although epidural administration had no effect on any of the outcome variables, special attention should be devoted to women who had long second-stage births and/or suffering from postpartum fatigue to prevent postpartum psychopathology. In addition, demographic variables, such as primiparity, education, and prior psychopathology diagnosis should be considered to treat women and prevent postpartum psychopathology.

The effect of stillbirth and late termination of pregnancy on the emergence of post-traumatic symptoms among attending medical personnel.

The purpose of this paper was to assess the impact and the post-traumatic potential of late termination of pregnancy (TOP) and stillbirth on medical staff and characterise personal attributes that modulate these possible outcomes. Fifty-one participants involved in the treatment of women undergoing late TOPs and stillbirths answered questionnaires including demographics, Neuroticism subscale of the Big Five Inventory (BFI), Life Orientation Test-Revised (LOT-R), Posttraumatic Diagnostic Scale (PDS), Brief Symptom Inventory (BSI-18) and questions regarding exposure to stillbirths and late TOPs. None of the participants met the full post-traumatic stress disorder (PTSD) criteria. A correlation with a marginal significance was found between the number of TOP's/stillbirths attended during the past year and traumatic symptoms. Neuroticism moderated the association between presence in TOP's/stillbirths and post-traumatic symptoms among those who attended this event over the past month. According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths. Impact StatementWhat is already known on this subject? There is a very little research on the ways in which medical personnel respond to Stillbirths, late miscarriages and terminations of pregnancy (TOP) of their patients and on the possible effect of their personality traits in this response.What do the results of this study add? According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP's/stillbirths.What are the implications of these findings for clinical practice and/or further research? Further studies are warranted to better assess the impact of exposure to traumatic events in general and on the effect of late TOP and stillbirths in particular, on medical personnel and to identify interventions that may prevent posttraumatic symptoms among staff members when they happen.

COVID-19 related worry moderates the association between postpartum depression and mother-infant bonding.

The aim of this study was to ask whether a substantial external stressor, such as the COVID-19 pandemic, affects the association between postpartum depression (PPD) and mother-infant bonding. Specifically, we aimed to determine whether worry regarding such an external threat differentially affected PPD and bonding by analyzing a longitudinal sample of postpartum women assessed before and during the pandemic. One-hundred forty women responded to online questionnaires at (T1) Pre-COVID-19: Six months postpartum (February 2018 to December 2019), and (T2) During COVID-19: Twenty-one months postpartum (April 2020 to January 2021). The strength of correlation between mother-infant bonding and PPD significantly declined from before (T1: R = 0.64, p < 0.00) to during the pandemic (T2: R = 0.44, p < 0.001; Difference = 0.20, p = 0.05). Furthermore, only PPD correlated with the worry due to the pandemic; thus the PPD-bonding association was weaker among women who were less concerned about the pandemic (F(3, 136) = 15.4, R2 = 0.25). The study suggests that emotions and cognitions related to motherhood, such as mother-infant bonding, may be more resilient to external pressures such as a pandemic than affective states such as PPD. (174 words).

Attachment insecurity moderates the link between maternal childhood neglect and postpartum bonding to the infant.

Mothers who experienced childhood neglect are at increased risk of parenting difficulties in adulthood, but adult attachment relationships may be protective. Eighty-eight postpartum women seeking outpatient psychiatric care completed self-report measures on adverse childhood experiences, adult attachment, mental health symptoms, and bonding. Beyond the effects of maternal mental health on bonding, childhood neglect predicted bonding difficulties only in mothers with more insecure attachments, suggesting adult attachment as a potential point of intervention to reduce the intergenerational transmission of risk.

A paradoxical role of childbirth-related posttraumatic stress disorder (PTSD) symptoms in the association between personality factors and mother-infant bonding: A cross-sectional study.

OBJECTIVE: As mother-infant bonding difficulties are potentially detrimental to child development, it is of importance to study its etiology and associated factors. Only a minority of studies have focused on the role of personality and postpartum depression and posttraumatic stress disorder (PTSD) in the etiology of bonding difficulties. The present article attempted to ascertain the association of vulnerability (Neuroticism) and resilience (Dispositional Optimism) with bonding, wherein postpartum depression and PTSD symptoms were possible mediators. METHOD: There were 504 mothers of infants, 0-13 months, who were sampled cross-sectionally using social media. Respondents completed an online survey consisting of the following questionnaires: demographic details, Neuroticism (subscale of the Big Five Inventory, BFI), Dispositional Optimism (Life Orientation Test-Revised), postpartum PTSD symptoms (City Birth Trauma Scale, BiTS), postpartum depression symptoms (Edinburgh Postpartum Depression Scale, EPDS), and mother-infant bonding difficulties (Postpartum Bonding Questionnaire, PBQ). RESULTS: Path analysis revealed 5 significant indirect paths: Dispositional Optimism affected bonding through EPDS (ß = -0.04, p = .010) and through BiTS general symptoms (ß = -.02, p = .019), and BFI-Neuroticism affected bonding through EPDS (ß = 0.14, p = .001), BiTS birth-related symptoms (ß = -0.03, p = .013), and BiTS general symptoms (ß = 0.11, p = .001). CONCLUSIONS: Both Dispositional Optimism and Neuroticism correlated with bonding difficulties, mediated by postpartum depression and PTSD symptoms. When all variables were measured in a single model, postpartum PTSD birth-related symptoms predicted fewer bonding difficulties while general postpartum PTSD symptoms were associated with more bonding difficulties. Taken together, these results can promote better understanding of postpartum psychopathology and mother-infant bonding to allow for better treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD.

Childbirth-related PTSD is generally believed to result from multiple factors, including negative objective and subjective experiences and patient predisposing factors. There is conflicting evidence regarding whether severe childbirth pain affects development of PTSD. We hypothesize that a woman's retrospective subjective appraisal of birth pain is a greater predictor of postpartum-onset PTSD than medically documented measures of pain, and that a positive subjective experience communicating with medical providers during labor also reduces risk for postpartum-onset PTSD. A sample of 112 women, who screened positive for psychopathology within a year postpartum, were interviewed probing for their subjective labor experiences. Interviews were coded for subjective labor pain perception and quality of provider communication. Regression analyses tested associations between subjective labor pain perception and quality of provider communication with postpartum PTSD. Pain scores recorded during labor were not significantly associated to probable PTSD at any recorded time point up to 12 months postpartum. Positive perception of birth pain was associated with reduced risk of probable PTSD at 6 weeks postpartum (aOR = 0.34, p = 0.03). Positive provider communication was associated with reduced risk of probable PTSD at 6 months (aOR = 0.29, p = 0.02) and 12 months (aOR = 0.2, p = 0.03) postpartum. Pain recorded during childbirth is not necessarily a negative experience leading to trauma. For some women, even severe pain may be seen positively, and lacks traumatizing elements. Interventions to positively shift women's childbirth pain appraisal and educate medical workforce in patient-provider communication may reduce rates of postpartum PTSD. ClinicalTrials.gov Indentifier: NCT03004872.

Anxious Attachment Mediates the Associations Between Early Recollections of Mother's Own Parental Bonding and Mother-Infant Bonding: A 2-Month Path Analysis Model.

Parental bonding (recollection of own parents' parenting), adult attachment, and mother-infant bonding are all closely related yet distinct concepts of the parent-child relationship, sometimes used interchangeably in the literature. This study aimed to examine the associations between these concepts in a longitudinal path analysis design. A total of 262 postpartum women who gave birth at the maternity ward of a large tertiary health center in Israel completed a demographic questionnaire, the Experiences in Close Relationships Scale (ECR), the Parental Bonding Instrument (PBI) at 1-4 days postpartum, and the Postpartum Bonding Questionnaire (PBQ) at 2 months postpartum. Parental care factor (PBI) was found to be associated with mother-infant bonding (PBQ), directly and indirectly through insecure anxious attachment (ECR). Denial of autonomy factor (PBI) was found to be associated with mother-infant bonding (PBQ) only through insecure anxious attachment (ECR). Encouragement of behavioral freedom factor (PBI) was found to be associated with mother-infant bonding (PBQ) in a simple correlation but not in the complete model. The results highlight the intergenerational aspects of parenting and suggest that early childhood interventions with parents may have a long-term impact on child-rearing though generations, and by that on children's development.

Associations of rooming-in with maternal postpartum bonding: the impact of mothers' pre-delivery intentions.

OBJECTIVE: Full rooming-in, that is, mother and baby staying together for 24 hours per day after birth in the hospital, has been suggested as beneficial for positive maternal bonding. However, it has never been studied directly. We aimed to examine the association of full versus partial rooming-in and maternal bonding to her infant during the post-childbirth hospital stay. STUDY DESIGN: Longitudinal questionnaire study. SETTING: Maternity ward of a large tertiary health care center in Israel. PARTICIPANTS: The sample consisted of postpartum women (N = 293) in a maternity ward of a tertiary health care center who were fully or partially rooming-in. MEASUREMENTS AND FINDINGS: Questionnaires were administered at two time points, immediately after childbirth (T1; days 1-4) and 2 months postpartum (T2). The Childbirth Experience Questionnaire (CEQ), breastfeeding questions, and the Postpartum Bonding Questionnaire (PBQ) were administered at T1; the PBQ was repeated at T2. Regression analysis revealed that the rooming-in mode did not significantly predict bonding at 1-4 days postpartum. However, the rooming-in mode was a significant predictor of bonding at two months postpartum only for women who practiced the rooming-in mode they had initially planned (Beta = 0.12, p < .05), while controlling for other demographic as well as obstetric variables. Women who chose and practiced partial rooming-in manifested more bonding difficulties than those who chose and practiced full rooming-in. These distinctions in bonding were not manifested when including in the analysis women who partially rooming-in, but not in accordance with their intentions. CONCLUSIONS: Mother-infant bonding may be optimally supported when women's pre-labor desires to participate in full rooming-in are fulfilled. IMPLICATIONS FOR PRACTICE: Hospital staff should be aware of the mothers' intentions regarding full rooming-in requests and make sincere efforts to accommodate and support their wishes.

The associations between insecure attachment, rooming-in, and postpartum depression: A 2 months' longitudinal study.

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming-in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming-in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1-4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming-in conditions. In addition, women in partial rooming-in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming-in women. A situational factor such as full rooming-in, which occurs at a critical time point for the mother-infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming-in, can be personalized and thus beneficial in moderating personal risk factors for PPD.

La depresión posterior al parto (PPD) es la complicación más común de dar a luz y estudios recientes han intentado examinar los factores de riesgo asociados con el parto. La hipótesis del principal estudio fue que un factor situacional de protección en un período temporal sensible (permitirle a la madre mantener a su bebé con ella en el mismo cuarto después del parto) moderaría las asociaciones entre las dimensiones de afectividad insegura y PPD. Trescientas doce mujeres, en situación completa o parcial de tener a su bebé en el mismo cuarto, participaron en un estudio longitudinal en la sala de partos de un centro terciario de cuidado de salud. Del primer al cuarto día después del parto, se administró un cuestionario demográfico y la Escala de Experiencias en Relaciones Cercanas; la Escala de Edimburgo de Depresión Postnatal se administró a los dos meses posteriores al parto. Significativamente se asoció la PPD tanto con las dimensiones de afectividad de tipo ansiosas como las evasivas, pero no con las condiciones de compartir el mismo cuarto. Adicionalmente, las mujeres en situaciones parciales de compartir el mismo cuarto mostraron una correlación positiva entre las dimensiones de afectividad insegura y PPD, mientras que tal correlación no se encontró en el caso de las mujeres en situaciones de compartir el cuarto completamente. Un factor situacional tal como el compartir el cuarto completamente, lo cual ocurre en un punto temporal crítico para la relación madre-infante, puede moderar la asociación entre las dimensiones de afectividad maternas evasivas o ansiosas y los niveles de PPD de la madre. Las prácticas del período posterior al parto, tales como el compartir el cuarto, pueden ser personalizadas y por tanto beneficiosas en cuanto a moderar los factores personales de riesgo de PPD.

La dépression postpartum (DPP) est la complication la plus commune de la maternité et les études récentes ont essayé d'examiner les facteurs de risque qui y sont liés. L'hypothèse principale de cette étude était qu'un facteur protecteur situationnel à une période sensible (rooming-in total postpartum) modérerait les liens entre les dimensions d'attachement insécure et la DPP. Trois cent douze femmes, soit en rooming-in partiel ou total, ont participé à une étude longitudinale à la maternité d'un centre de santé tertiaire. Un questionnaire démographique et l'Echelle d'Expériences dans les Relations Proches ont été donnés à 1-4 jours postpartum, l'Echelle de Dépression Postnatale d'Edinbourg à deux mois postpartum. La DPP a été liée de manière importante à des dimensions d'attachement à la fois anxieux et évitant, mais pas avec les conditions de rooming-in. De plus, les femmes en rooming-in partiel ont fait preuve d'une corrélation positive entre les dimensions de l'attachement insécure et la DPP, alors qu'aucune corrélation n'a été trouvée pour les femmes du groupe rooming-in. Un facteur situationnel telle que le rooming-in total, qui se passe à un moment critique pour la relation mère-bébé, peut modérer le lien entre les dimensions d'attachement évitant maternel et de l'attachement anxieux et les niveaux de DPP de la mère. Les pratiques postpartum, tel que le rooming-in, peuvent être personnalisées et donc s'avérer être un bénéfice pour la modération de facteurs de risque personnel pour la DPP.

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.

The Association of Religion and Spirituality with Postpartum Mental Health in Women with Childhood Maltreatment Histories.

OBJECTIVES: Although the associations between religion and spirituality and mental health and trauma have been studied extensively across various populations, relatively few studies have focused on the postpartum period. This study aimed to shed light on specific domains of religiosity and spirituality that may be resiliency factors for positive postpartum adjustment defined as low depression and high quality of life in mothers oversampled for childhood trauma histories. METHODS: We examined several religion and spirituality variables among 108 women at 6 months postpartum as well as prospective relations from religion and spirituality to postpartum depression and quality of life at 12 and 15 months postpartum. RESULTS: We found that the personal aspects of self-forgiveness and forgiveness for others were most relevant as resiliency factors predicting lower postpartum depression and better quality of life even when controlling for other risks (trauma and demographics). Surprisingly, no other religion and spirituality domain had associations with postpartum depression or quality of life, with the exception of a significant negative association for organizational religiousness with quality of life at 12 months postpartum. CONCLUSIONS: Our findings suggest that forgiveness, especially to self and to others, in women who have been physically and mentally hurt as children may be associated with mental wellness and quality of life in the late postpartum period. Further, our results point to the need to study specific religion and spirituality aspects in the context of specific populations and conditions instead of generally studying religion and spirituality as a common marker for coping.