Mother-to-Infant Bonding in Women with Postpartum Psychosis and Severe Postpartum Depression: A Clinical Cohort Study.

Janneke Gilden,Astrid M Kamperman,Anna-Sophie Rommel,Veerle Bergink,Anne K Smit,Witte J G Hoogendijk,Nina M Molenaar

doi:10.3390/jcm9072291

Janneke Gilden, Astrid M Kamperman + Show 5 more

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https://doi.org/10.3390/jcm9072291

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Abstract

Mother-to-infant bonding is important for long-term child development. The aim of this study was to investigate bonding in women admitted to a Mother and Baby Unit with postpartum depression (PD, n = 64) and postpartum psychosis (PP, n = 91). Participants completed the Postpartum Bonding Questionnaire (PBQ), the Edinburgh Postnatal Depression Scale (EPDS) and the Young Mania Rating Scale (YMRS) weekly during admission. At admission, 57.1% of women with PD had impaired bonding, compared to only 17.6% of women with PP (p-value < 0.001). At discharge, only 18.2% of women with PD and 5.9% of women with PP still experienced impaired bonding (p-value = 0.02). There was a strong association between decrease of depressive and manic symptoms and improved bonding over an eight-week admission period. In a small group of women (5.7%) impaired bonding persisted despite being in remission of their psychiatric disorder. The results from our study show that impaired bonding is a more present and evidently severe problem in postpartum depression but not so much in postpartum psychosis. Treatment of depressive symptoms will improve bonding in almost all women, but clinicians should assess if impaired bonding is still present after remission because for a small group special care and treatment focused on bonding might be required.

Highlights

Affective and protective feelings towards the child usually begin during the first trimester of pregnancy [1]
Infant age at admission was significantly higher for women with Postpartum depression (PD) compared to women with postpartum psychosis (PP)
Differences in Bonding Problems between PP and PD. In this prospective cohort study, we found that impaired mother-to-infant bonding is a major problem in inpatient women with severe postpartum depression (57.1%), while less than 1 out 5 women with postpartum psychosis reported impaired bonding (17.6%)

Summary

Introduction

Affective and protective feelings towards the child usually begin during the first trimester of pregnancy [1]. These feelings gradually increase during pregnancy, in response to fetal movements [2]. Studies have shown associations between impaired mother-to-infant bonding and child behavior problems in early childhood [5], and an increased child’s risk of developing psychopathology in adulthood [6]. Mothers who reported impaired mother-to-infant bonding experienced high levels of parenting stress during toddlerhood [7], and these children are at risk for maltreatment later in life [8]. While in most situations adequate bonding develops gradually after birth, bonding can be impaired when the mother suffers from a psychiatric disorder [8]

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