Abstract
BackgroundPostnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The extra community care cost for women with PND living in the UK was found to be £35.7 million per year.MethodWe carried out a systematic search to the literature to investigate the associations between attachment style and PND, using meta-narrative analysis methods, reporting statistical data and life narratives. The following databases were searched: PsycInfo, PsycExtra Web of Science, The Cochrane Library and Pubmed. We focused on research papers that examined adult attachment styles and PND, and published between 1991 and 2013. We included any papers showing relationship between maternal adult attachment and PND. Out of 353 papers, 20 met the study inclusion criteria, representing a total of 2306 participants. Data from these 20 studies was extracted by means of a data extraction table.ResultsWe found that attachment and PND share a common aetiology and that ‘insecure adult attachment style’ is an additional risk factor for PND. Of the insecure adult attachment styles, anxious styles were found to be associated with PND symptoms more frequently than avoidant or dismissing styles of attachment.ConclusionMore comprehensive longitudinal research would be crucial to examine possible cause-effect associations between adult attachment style (as an intergenerational construct and risk factor) and PND (as an important maternal mental health), with new screening and interventions being essential for alleviating the suffering and consequences of PND. If more is understood about the risk profile of a new or prospective mother, more can be done to prevent the illness trajectory (PND); as well as making existing screening measures and treatment options more widely available.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-014-0056-x) contains supplementary material, which is available to authorized users.
Highlights
Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course
Every paper in this review found adult attachment style to be significantly linked to PND symptoms, with the exception to Flykt et al 2010
Several authors illustrate how the infant bonding process can be threatened by maternal PND, which in turn leads to less secure infant attachment experience and more disorganised, as well as avoidant infant attachment styles (Alhusen 2013; Kohlhoff 2013). 19 out of 20 studies included in this review found PND to be statistically associated with insecure adult attachment style
Summary
Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The ICD-10 classifies it as a “Mild mental and behavioural disorder associated with the peurperium, not elsewhere classified”. These different definitions refer PND development from four weeks to one year. The epidemiology of PND is fairly well researched with many empirically supported risk factors giving rise to a complex bio-psychosocial model for its development. The strongest psychosocial predictors of depression are depression and/or anxiety in pregnancy, stressful life events, low social support
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