This article was downloaded by: [University of Sherbrooke] On: 04 May 2015, At: 17:32 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Attachment & Human Development Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rahd20
The relationship between attachment style and postpartum depression a
b
c
Mari Ikeda , Momoko Hayashi & Kiyoko Kamibeppu a
Nursing Administration and Advanced Clinical Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan b
College of Contemporary Psychology, Rikkyo University, Kitano, Niiza-shi, Japan c
Click for updates
Family Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Japan Published online: 06 Aug 2014.
To cite this article: Mari Ikeda, Momoko Hayashi & Kiyoko Kamibeppu (2014) The relationship between attachment style and postpartum depression, Attachment & Human Development, 16:6, 557-572, DOI: 10.1080/14616734.2014.941884 To link to this article: http://dx.doi.org/10.1080/14616734.2014.941884
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Attachment & Human Development, 2014 Vol. 16, No. 6, 557–572, http://dx.doi.org/10.1080/14616734.2014.941884
The relationship between attachment style and postpartum depression Mari Ikedaa*, Momoko Hayashib and Kiyoko Kamibeppuc a
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
Nursing Administration and Advanced Clinical Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; bCollege of Contemporary Psychology, Rikkyo University, Kitano, Niiza-shi, Japan; cFamily Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Japan (Received 14 June 2013; accepted 2 July 2014) Although an increasing number of studies show an association between adult attachment style and mood disorders, the relationship between adult attachment style and depression associated with childbirth is largely unknown. This study investigated the association between women’s attachment style, postpartum depression (PPD), and other risk factors. During the 32nd week of pregnancy, 84 women were interviewed using the Attachment Style Interview. Participants also completed self-report questionnaires about reaction to pregnancy, family relationships, current life stresses, and symptoms of depression and anxiety. At one-month postpartum, they were evaluated for postpartum depressive symptoms using the Mini-International Neuropsychiatric Interview. Eighty-two women completed the second self-report questionnaires and were evaluated for PPD. The data of 76 women were eligible for analysis. PPD was present in 21%. An insecure attachment style was significantly related to depression. A multiple logistic regression analysis showed significant effects for insecure attachment, social economic status, and antenatal depression on PPD. Adding the insecure attachment style factor to the logistic model that predicted PPD increased the area under the curve to 0.87 (95% CI .77–.98; p < .05). The inclusion of attachment styles in assessments of perinatal depressive disorders could improve screening and the design of interventions. Keywords: Attachment Style Interview; insecure attachment style; Japanese; postpartum depression; pregnant women
Despite the stereotype that the perinatal phase is a period of contentment, women frequently experience adjustment difficulties and depressive symptoms during pregnancy and the postpartum period. Approximately 8.5–11% of women experience either minor or major depression (mMD) during pregnancy. Furthermore, 19% of women have mMD in the first three months following delivery (Gavin et al., 2005). A recent large-scale epidemiological study provided evidence of increased risk for depression in the postpartum period compared to women who were neither pregnant nor postpartum (Vesga-López et al., 2008). In Japan, depression in the first month following delivery is reported to occur in 20.4% of mothers (Yamashita, Yoshida, Nakano, & Tashiro, 2000). Typically, a woman experiencing postpartum depression (PPD) appears to be unhappy, anxious, or irritable, and feels unable to cope (Milgrom, Burrows, Snellen, Stamboulakis, *Corresponding author. Email: [email protected] © 2014 Taylor & Francis
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& Burrows, 1998). The quality of life for such women and their families is severely compromised and can result in marital breakdown (Beck & Gable, 2000). A meta-analysis of 19 studies revealed that PPD had a moderate to large adverse effect on maternal–infant interaction during the first 12 months after delivery (Beck, 1995). Postpartum depression was found to have a small, significant, and delayed negative effect on the cognitive and emotional development of children at one year or older in a metaanalysis of nine studies (Beck, 1996a, 1996b), even after controlling for mothers’ current depression level. In a longitudinal study of children whose mothers were depressed at three months after childbirth, intellectual problems in 11-year-old children were reported (Hay, Hurley, McGuire, & Hay, 2001). Children whose mothers had experienced this mood disorder during 3 months after delivery had significantly lower IQ, more attention problems, and difficulty in mathematic reasoning. Boys’ performance IQ was more severely affected than that of girls. With this same cohort of children (Hay, Pawlby, Angold, Harold, & Sharp, 2003), violence at age 11 was predicted by the mothers’ PPD at 3 months after delivery. Risk factors for PPD include previous depression, anxiety, and depressive symptoms during pregnancy, recent stressful life events, a lack of social support, and low self-esteem (Blackmore et al., 2006). Early and accurate identification and intervention is crucial to the prevention of long-term consequences for families. Since 1978, when the first checklist of risk factors for PPD evidenced during pregnancy was introduced (Braverman & Roux, 1978), several instruments have been developed. However, both specificity and sensitivity for predicting PPD are poor in the current screening protocols, possibly because personality structure is largely excluded (Austin & Lumley, 2003). Studies from social psychology use a personality construct known as “attachment style” to predict risk for depression (Bifulco, Moran, Ball, & Bernazzani, 2002; Gerlsma & Luteijn, 2000). Based on the work of Bowlby (1988) in developmental psychology, as well as that of cognitive and interpersonal theorists (Beck, Rush, Shaw, & Emeny, 1979; Brown & Harris, 1978), this approach suggests that people who have an insecure attachment style, characterized by either worry about the emotional availability and support of others or by distrust or fear of closeness, attend selectively to aspects of interpersonal interactions which support their views. Insecure schemas also influence behavior as people act in response to these distorted perceptions, inadvertently alienating others and undermining relationships, which confirm the specific schema. These cognitive schemas of relationships – which function largely outside of awareness – can engender feelings of loss and isolation and, therefore, predispose people to depression. Newer research applying attachment theory to perinatal psychiatric symptoms has found that pregnant women with Insecure attachment styles are at greater risk for PPD (Feeney, 2003; McMahon, Barnett, Kowalenko, & Tennant, 2005; Simpson, Rholes, Campbell, Tran, & Wilson, 2003). In this research, the transition to parenthood is conceptualized as a general life stressor that activates the attachment system. This “world view” engendered by insecure attachment schemas and associated behaviors contributes to depression in insecure pregnant women, as well as anxiety, throughout the perinatal period (Bifulco et al., 2004; Feeney, 2003; Simpson et al., 2003). We hypothesized that there would be a significant relationship between maternal depression and attachment style. Our aims in this study are to describe the attachment style of pregnant Japanese women and to investigate the associations between women’s attachment style, the risk for PPD, and other risk factors, such as previous depression, lack of social support, and recent stressful life events.
Attachment & Human Development
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Methods Participants This study was conducted at a university hospital. The study protocol and the assessment procedures were reviewed and approved by the Ethics Committee of the University of Tokyo. All primipara women who were planning to give birth at the hospital were potentially eligible for the study. The data were collected from October 2009 to September 2010. To facilitate recruitment, the aims of the study and a request for volunteers were presented at antenatal class. To be included in the study, a woman had to be between 28 and 32 gestational weeks pregnant, married, carrying a single fetus, willing to sign an informed consent release, and available by telephone or email. Exclusion criteria for the study were age
Attachment & Human Development Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/rahd20
The relationship between attachment style and postpartum depression a
b
c
Mari Ikeda , Momoko Hayashi & Kiyoko Kamibeppu a
Nursing Administration and Advanced Clinical Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan b
College of Contemporary Psychology, Rikkyo University, Kitano, Niiza-shi, Japan c
Click for updates
Family Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Japan Published online: 06 Aug 2014.
To cite this article: Mari Ikeda, Momoko Hayashi & Kiyoko Kamibeppu (2014) The relationship between attachment style and postpartum depression, Attachment & Human Development, 16:6, 557-572, DOI: 10.1080/14616734.2014.941884 To link to this article: http://dx.doi.org/10.1080/14616734.2014.941884
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Attachment & Human Development, 2014 Vol. 16, No. 6, 557–572, http://dx.doi.org/10.1080/14616734.2014.941884
The relationship between attachment style and postpartum depression Mari Ikedaa*, Momoko Hayashib and Kiyoko Kamibeppuc a
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
Nursing Administration and Advanced Clinical Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan; bCollege of Contemporary Psychology, Rikkyo University, Kitano, Niiza-shi, Japan; cFamily Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Japan (Received 14 June 2013; accepted 2 July 2014) Although an increasing number of studies show an association between adult attachment style and mood disorders, the relationship between adult attachment style and depression associated with childbirth is largely unknown. This study investigated the association between women’s attachment style, postpartum depression (PPD), and other risk factors. During the 32nd week of pregnancy, 84 women were interviewed using the Attachment Style Interview. Participants also completed self-report questionnaires about reaction to pregnancy, family relationships, current life stresses, and symptoms of depression and anxiety. At one-month postpartum, they were evaluated for postpartum depressive symptoms using the Mini-International Neuropsychiatric Interview. Eighty-two women completed the second self-report questionnaires and were evaluated for PPD. The data of 76 women were eligible for analysis. PPD was present in 21%. An insecure attachment style was significantly related to depression. A multiple logistic regression analysis showed significant effects for insecure attachment, social economic status, and antenatal depression on PPD. Adding the insecure attachment style factor to the logistic model that predicted PPD increased the area under the curve to 0.87 (95% CI .77–.98; p < .05). The inclusion of attachment styles in assessments of perinatal depressive disorders could improve screening and the design of interventions. Keywords: Attachment Style Interview; insecure attachment style; Japanese; postpartum depression; pregnant women
Despite the stereotype that the perinatal phase is a period of contentment, women frequently experience adjustment difficulties and depressive symptoms during pregnancy and the postpartum period. Approximately 8.5–11% of women experience either minor or major depression (mMD) during pregnancy. Furthermore, 19% of women have mMD in the first three months following delivery (Gavin et al., 2005). A recent large-scale epidemiological study provided evidence of increased risk for depression in the postpartum period compared to women who were neither pregnant nor postpartum (Vesga-López et al., 2008). In Japan, depression in the first month following delivery is reported to occur in 20.4% of mothers (Yamashita, Yoshida, Nakano, & Tashiro, 2000). Typically, a woman experiencing postpartum depression (PPD) appears to be unhappy, anxious, or irritable, and feels unable to cope (Milgrom, Burrows, Snellen, Stamboulakis, *Corresponding author. Email: [email protected] © 2014 Taylor & Francis
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
558
M. Ikeda et al.
& Burrows, 1998). The quality of life for such women and their families is severely compromised and can result in marital breakdown (Beck & Gable, 2000). A meta-analysis of 19 studies revealed that PPD had a moderate to large adverse effect on maternal–infant interaction during the first 12 months after delivery (Beck, 1995). Postpartum depression was found to have a small, significant, and delayed negative effect on the cognitive and emotional development of children at one year or older in a metaanalysis of nine studies (Beck, 1996a, 1996b), even after controlling for mothers’ current depression level. In a longitudinal study of children whose mothers were depressed at three months after childbirth, intellectual problems in 11-year-old children were reported (Hay, Hurley, McGuire, & Hay, 2001). Children whose mothers had experienced this mood disorder during 3 months after delivery had significantly lower IQ, more attention problems, and difficulty in mathematic reasoning. Boys’ performance IQ was more severely affected than that of girls. With this same cohort of children (Hay, Pawlby, Angold, Harold, & Sharp, 2003), violence at age 11 was predicted by the mothers’ PPD at 3 months after delivery. Risk factors for PPD include previous depression, anxiety, and depressive symptoms during pregnancy, recent stressful life events, a lack of social support, and low self-esteem (Blackmore et al., 2006). Early and accurate identification and intervention is crucial to the prevention of long-term consequences for families. Since 1978, when the first checklist of risk factors for PPD evidenced during pregnancy was introduced (Braverman & Roux, 1978), several instruments have been developed. However, both specificity and sensitivity for predicting PPD are poor in the current screening protocols, possibly because personality structure is largely excluded (Austin & Lumley, 2003). Studies from social psychology use a personality construct known as “attachment style” to predict risk for depression (Bifulco, Moran, Ball, & Bernazzani, 2002; Gerlsma & Luteijn, 2000). Based on the work of Bowlby (1988) in developmental psychology, as well as that of cognitive and interpersonal theorists (Beck, Rush, Shaw, & Emeny, 1979; Brown & Harris, 1978), this approach suggests that people who have an insecure attachment style, characterized by either worry about the emotional availability and support of others or by distrust or fear of closeness, attend selectively to aspects of interpersonal interactions which support their views. Insecure schemas also influence behavior as people act in response to these distorted perceptions, inadvertently alienating others and undermining relationships, which confirm the specific schema. These cognitive schemas of relationships – which function largely outside of awareness – can engender feelings of loss and isolation and, therefore, predispose people to depression. Newer research applying attachment theory to perinatal psychiatric symptoms has found that pregnant women with Insecure attachment styles are at greater risk for PPD (Feeney, 2003; McMahon, Barnett, Kowalenko, & Tennant, 2005; Simpson, Rholes, Campbell, Tran, & Wilson, 2003). In this research, the transition to parenthood is conceptualized as a general life stressor that activates the attachment system. This “world view” engendered by insecure attachment schemas and associated behaviors contributes to depression in insecure pregnant women, as well as anxiety, throughout the perinatal period (Bifulco et al., 2004; Feeney, 2003; Simpson et al., 2003). We hypothesized that there would be a significant relationship between maternal depression and attachment style. Our aims in this study are to describe the attachment style of pregnant Japanese women and to investigate the associations between women’s attachment style, the risk for PPD, and other risk factors, such as previous depression, lack of social support, and recent stressful life events.
Attachment & Human Development
559
Downloaded by [University of Sherbrooke] at 17:32 04 May 2015
Methods Participants This study was conducted at a university hospital. The study protocol and the assessment procedures were reviewed and approved by the Ethics Committee of the University of Tokyo. All primipara women who were planning to give birth at the hospital were potentially eligible for the study. The data were collected from October 2009 to September 2010. To facilitate recruitment, the aims of the study and a request for volunteers were presented at antenatal class. To be included in the study, a woman had to be between 28 and 32 gestational weeks pregnant, married, carrying a single fetus, willing to sign an informed consent release, and available by telephone or email. Exclusion criteria for the study were age
