Arch Womens Ment Health DOI 10.1007/s00737-014-0419-6
SHORT COMMUNICATION
Correlates of impaired mother-infant bonding in a partial hospital program for perinatal women Laura E. Sockol & Cynthia L. Battle & Margaret Howard & Thamara Davis
Received: 5 September 2013 / Accepted: 2 March 2014 # Springer-Verlag Wien 2014
Abstract Maternal psychopathology is a risk factor for impaired mother-infant bonding, but not all women with this illness experience impaired bonding. This study investigated correlates of mother-infant bonding among 180 postpartum women treated in a psychiatric partial hospitalization program. Women completed self-report measures of depressive symptoms and mother-infant bonding, and a retrospective chart review assessed demographic characteristics, clinician-rated diagnoses, and obstetric factors. Symptoms of depression, self-reported suicidality, demographic characteristics, and mode of delivery were significantly associated with impaired bonding.
mother-infant bond. Bonding disorders, which may include lack of maternal affective involvement, increased irritability, aggressive impulses, or outright rejection of the infant, are relatively common in perinatal psychiatric populations (Brockington et al., 2006). While maternal psychiatric illness represents a risk factor, not all perinatal patients experience impaired bonding (Brockington et al., 2006). Thus, it is important to identify specific factors that predict mother-infant bonding impairments, particularly among high-risk women. Our goal was to assess predictors of impaired mother-infant bonding among perinatal psychiatric patients.
Keywords Mother-infant bonding . Mother-infant relationship . Bonding . Postpartum depression . Postpartum Bonding Questionnaire (PBQ)
Method
Psychiatric illnesses are common during pregnancy and postpartum, with 10–15 % of women experiencing a significant mood or anxiety disorder (Meltzer-Brody, 2013). In addition to treating psychiatric symptoms, it is important to assess maternal role functioning, including difficulties in the L. E. Sockol (*) Williams College, Williamstown, MA, USA e-mail: [email protected] L. E. Sockol University of Pennsylvania, Philadelphia, PA, USA L. E. Sockol : C. L. Battle : M. Howard Alpert Medical School of Brown University, Providence, RI, USA C. L. Battle Butler Hospital, Providence, RI, USA C. L. Battle : M. Howard : T. Davis Women & Infants Hospital of Rhode Island, Providence, RI, USA
Clinical records of postpartum patients in a partial hospitalization program for women with perinatal psychiatric conditions were retrospectively reviewed by trained research staff members. Of the 224 postpartum patients admitted to the program between January 2005 and April 2007, 180 (80 %) completed the PBQ as part of their initial evaluation and were included in the current study. A data abstraction form was created for the study that included variables to be obtained from clinical admission records, including demographic information (age, race/ethnicity, number of weeks postpartum, number of children at home), information about the pregnancy and delivery (e.g., mode of delivery, delivery complications), and clinicianrated diagnoses. Research staff were trained in chart abstraction procedures and 13 % (n=29) of charts were reviewed by multiple raters to examine inter-rater reliability. Inter-rater reliability for 11 dichotomous variables in the data set was good to very good (average kappa=0.93). Depressive symptoms and mother-infant bonding were assessed using self-report measures. Patients completed the Edinburgh Post-Natal Depression Scale, a widely used 10-
L.E. Sockol et al.
question measure that has been validated to assess depressive symptoms in perinatal populations (EPDS; Cox et al., 1987). For the current sample, the internal reliability of the EPDS was α=0.76. Patients also completed the Postpartum Bonding Questionnaire (PBQ), a 25-item self-report measure developed to assess impairment in the mother-infant relationship during the perinatal period (Brockington et al., 2001). The measure is comprised of four distinct factors. The first factor, Impaired Bonding, includes responses on 12 items and is a general factor that represents overall impairment in the mother-baby relationship (e.g., “I feel close to my baby”). The second factor, Rejection/Pathological Anger, includes responses on seven items and reflects high maternal anger toward the infant (e.g., “I regret having my baby”). The third factor, Maternal Anxiety, includes responses on four items and reflects high maternal anxiety and anxious attachment (e.g., “I feel confident when caring for my baby”). The fourth factor, Risk of Abuse, includes responses on two items and represents risk for physical abuse (“I have done harmful things to my baby” and “I feel like hurting my baby”). In the current study, the internal reliability coefficients were α=0.86 for Impaired Bonding, α=0.89 for Rejection/Pathological Anger, α=0.67 for Maternal Anxiety, and α=0.10 for Risk of Abuse. Given the low reliability of the Risk of Abuse subscale, and because positive responses on this subscale were rare, the variable was dichotomized so that participants with a positive response to either question on this subscale were coded as 1 and all other participants were coded as 0.
Results Sample Average maternal age was 29 years (range 15–43); mean infant age was 9 weeks (range 1–44). Approximately half of the sample was primiparous (47 %). Just over half of the sample identified as Caucasian (58 %), 16 % identified as Latina, 17 % as African-American, 2 % as American Indian/ Hawaiian Native, and 6 % as another race/ethnicity or as multiracial. Approximately half of patients were married or cohabitating with a partner (51 %), slightly less than half were single (42 %), and the remainder was divorced or separated (6 %). In terms of clinical characteristics, many patients (37 %) received more than one psychiatric diagnosis. The most common diagnosis was a Major Depressive Disorder (MDD) (77 %). Over one-fourth (29 %) of patients received a diagnosis of an anxiety disorder. Four patients had a substance use diagnosis, and three had a psychotic disorder diagnosis. Other diagnoses included adjustment disorder, bipolar disorder, and mood disorder NOS. EPDS scores ranged from 6 to 30, with a mean of 19.9; 97 % of respondents had scores 12 or greater, indicating clinically significant symptoms (Cox et al.,
1996). Approximately half of the sample (49 %) endorsed some level of suicidality on the EPDS. Univariate analyses Higher EPDS scores were significantly associated with the PBQ subscales of impaired bonding, rejection/ pathological anger, and risk of abuse (r=0.20 to 0.29, all ps
SHORT COMMUNICATION
Correlates of impaired mother-infant bonding in a partial hospital program for perinatal women Laura E. Sockol & Cynthia L. Battle & Margaret Howard & Thamara Davis
Received: 5 September 2013 / Accepted: 2 March 2014 # Springer-Verlag Wien 2014
Abstract Maternal psychopathology is a risk factor for impaired mother-infant bonding, but not all women with this illness experience impaired bonding. This study investigated correlates of mother-infant bonding among 180 postpartum women treated in a psychiatric partial hospitalization program. Women completed self-report measures of depressive symptoms and mother-infant bonding, and a retrospective chart review assessed demographic characteristics, clinician-rated diagnoses, and obstetric factors. Symptoms of depression, self-reported suicidality, demographic characteristics, and mode of delivery were significantly associated with impaired bonding.
mother-infant bond. Bonding disorders, which may include lack of maternal affective involvement, increased irritability, aggressive impulses, or outright rejection of the infant, are relatively common in perinatal psychiatric populations (Brockington et al., 2006). While maternal psychiatric illness represents a risk factor, not all perinatal patients experience impaired bonding (Brockington et al., 2006). Thus, it is important to identify specific factors that predict mother-infant bonding impairments, particularly among high-risk women. Our goal was to assess predictors of impaired mother-infant bonding among perinatal psychiatric patients.
Keywords Mother-infant bonding . Mother-infant relationship . Bonding . Postpartum depression . Postpartum Bonding Questionnaire (PBQ)
Method
Psychiatric illnesses are common during pregnancy and postpartum, with 10–15 % of women experiencing a significant mood or anxiety disorder (Meltzer-Brody, 2013). In addition to treating psychiatric symptoms, it is important to assess maternal role functioning, including difficulties in the L. E. Sockol (*) Williams College, Williamstown, MA, USA e-mail: [email protected] L. E. Sockol University of Pennsylvania, Philadelphia, PA, USA L. E. Sockol : C. L. Battle : M. Howard Alpert Medical School of Brown University, Providence, RI, USA C. L. Battle Butler Hospital, Providence, RI, USA C. L. Battle : M. Howard : T. Davis Women & Infants Hospital of Rhode Island, Providence, RI, USA
Clinical records of postpartum patients in a partial hospitalization program for women with perinatal psychiatric conditions were retrospectively reviewed by trained research staff members. Of the 224 postpartum patients admitted to the program between January 2005 and April 2007, 180 (80 %) completed the PBQ as part of their initial evaluation and were included in the current study. A data abstraction form was created for the study that included variables to be obtained from clinical admission records, including demographic information (age, race/ethnicity, number of weeks postpartum, number of children at home), information about the pregnancy and delivery (e.g., mode of delivery, delivery complications), and clinicianrated diagnoses. Research staff were trained in chart abstraction procedures and 13 % (n=29) of charts were reviewed by multiple raters to examine inter-rater reliability. Inter-rater reliability for 11 dichotomous variables in the data set was good to very good (average kappa=0.93). Depressive symptoms and mother-infant bonding were assessed using self-report measures. Patients completed the Edinburgh Post-Natal Depression Scale, a widely used 10-
L.E. Sockol et al.
question measure that has been validated to assess depressive symptoms in perinatal populations (EPDS; Cox et al., 1987). For the current sample, the internal reliability of the EPDS was α=0.76. Patients also completed the Postpartum Bonding Questionnaire (PBQ), a 25-item self-report measure developed to assess impairment in the mother-infant relationship during the perinatal period (Brockington et al., 2001). The measure is comprised of four distinct factors. The first factor, Impaired Bonding, includes responses on 12 items and is a general factor that represents overall impairment in the mother-baby relationship (e.g., “I feel close to my baby”). The second factor, Rejection/Pathological Anger, includes responses on seven items and reflects high maternal anger toward the infant (e.g., “I regret having my baby”). The third factor, Maternal Anxiety, includes responses on four items and reflects high maternal anxiety and anxious attachment (e.g., “I feel confident when caring for my baby”). The fourth factor, Risk of Abuse, includes responses on two items and represents risk for physical abuse (“I have done harmful things to my baby” and “I feel like hurting my baby”). In the current study, the internal reliability coefficients were α=0.86 for Impaired Bonding, α=0.89 for Rejection/Pathological Anger, α=0.67 for Maternal Anxiety, and α=0.10 for Risk of Abuse. Given the low reliability of the Risk of Abuse subscale, and because positive responses on this subscale were rare, the variable was dichotomized so that participants with a positive response to either question on this subscale were coded as 1 and all other participants were coded as 0.
Results Sample Average maternal age was 29 years (range 15–43); mean infant age was 9 weeks (range 1–44). Approximately half of the sample was primiparous (47 %). Just over half of the sample identified as Caucasian (58 %), 16 % identified as Latina, 17 % as African-American, 2 % as American Indian/ Hawaiian Native, and 6 % as another race/ethnicity or as multiracial. Approximately half of patients were married or cohabitating with a partner (51 %), slightly less than half were single (42 %), and the remainder was divorced or separated (6 %). In terms of clinical characteristics, many patients (37 %) received more than one psychiatric diagnosis. The most common diagnosis was a Major Depressive Disorder (MDD) (77 %). Over one-fourth (29 %) of patients received a diagnosis of an anxiety disorder. Four patients had a substance use diagnosis, and three had a psychotic disorder diagnosis. Other diagnoses included adjustment disorder, bipolar disorder, and mood disorder NOS. EPDS scores ranged from 6 to 30, with a mean of 19.9; 97 % of respondents had scores 12 or greater, indicating clinically significant symptoms (Cox et al.,
1996). Approximately half of the sample (49 %) endorsed some level of suicidality on the EPDS. Univariate analyses Higher EPDS scores were significantly associated with the PBQ subscales of impaired bonding, rejection/ pathological anger, and risk of abuse (r=0.20 to 0.29, all ps
