Objective: To prospectively examine the impact of parental mental health (PTSD, depression and anxiety), the couple’s relationship quality and the infant temperament on the parent–baby bond in first-time mothers and fathers. Background: Evidence suggests that poor parental mental health, difficult infant temperament and/or lower quality of the couple’s relationship may impede the parent–baby bond. However, little research has included both parents or followed these measures across time. Methods: 75 women and 66 men completed questionnaire measures during pregnancy, 3 and 15 months postpartum, assessing mental health symptoms, the parent–baby bond, the couple’s relationship and infant characteristics. The response rates at different time-points were 90%, 77% and 70%. Results: The parent–baby bond was associated with parental mental health, the couple’s relationship and infant characteristics. The most important predictors of the parent–baby bond three months postpartum for both men and women were the couple’s relationship during pregnancy and their baby’s temperament at three months. At 15 months postpartum, after accounting for the parent–baby bond at 3 months, only concurrent infant temperament remained a significant predictor for women. However, men’s bond with their baby at 15 months was predicted by their relationship with their partner in pregnancy and concurrent affective symptoms. Few significant gender differences were found, apart from women reporting more mental health symptoms than men.
Conclusion: This study highlights the significance of the couple’s relationship in pregnancy and the infant’s temperament on the development of the parent–baby bond. Future research is needed to examine this in larger more representative samples.

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty-two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE-index) of parent–infant interactions. At 5 months postpartum, in-depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post-traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes.

The aims of the current study were to examine the effect of fathers' and mothers' pre and postnatal mental health on mother-infant and father-infant interactions. Mental health was broadly defined to include anxiety, depression and PTSD. A community sample of 44 mothers and 40 fathers from 45 families completed questionnaire measures of mental health in late pregnancy and three months postpartum. Mother-infant and father-infant interactions were observed and videoed three months postpartum and analysed using the CARE-index. Results showed that prenatal mental health, in particular anxiety, was associated with parent-infant interactions to a greater extent than postnatal mental health. Fathers' prenatal symptoms were associated with higher paternal unresponsiveness and infant passivity whilst fathers' postnatal symptoms were associated with higher levels of infant difficulty in the father-baby interaction. The results also indicated that mothers and fathers interaction with their babies were similar, both on average and within the couples, with 34% being inept or at risk. These findings highlight the need for early detection and prevention of both mental health and parent-infant relationship problems in fathers as well as mothers. However, further prospective and longitudinal studies are needed to understand the influences of parental mental health on the parent-infant interactions further. Also it should be noted that the mental health scores were low in this sample, which may reflect the sample characteristics. Future studies therefore would benefit from focusing on more vulnerable groups of parents.

BACKGROUND

There is converging evidence that between 1% and 3% of women develop posttraumatic stress disorder (PTSD) after childbirth. Various vulnerability and risk factors have been identified, including mode of birth and support during birth. However, little research has looked at the role of adult attachment style in how women respond to events during birth. This study prospectively examined the interaction between attachment style, mode of birth, and support in determining PTSD symptoms after birth.

METHOD

A longitudinal study of women (n=57) from the last trimester of pregnancy to three months postpartum. Women completed questionnaire measures of attachment style in pregnancy and measures of PTSD, support during birth, and mode of birth at three months postpartum.

RESULTS

Avoidant attachment style, operative birth (assisted vaginal or caesarean section) and poor support during birth were all significantly correlated with postnatal PTSD symptoms. Regression analyses showed that avoidant attachment style moderated the relationship between operative birth and PTSD symptoms, where women with avoidant attachment style who had operative deliveries were most at risk of PTSD symptoms.

LIMITATIONS

The study was limited to white European, cohabiting, primiparous women. Future research is needed to see if these findings are replicated in larger samples and different sociodemographic groups.

CONCLUSIONS

This study suggests avoidant attachment style may be a vulnerability factor for postpartum PTSD, particularly for women who have operative births. If replicated, clinical implications include the potential to screen for attachment style during pregnancy and tailor care during birth accordingly.

The transition to parenthood involves psychological and social adjustments for men and women, with evidence of possible declines in mental health and close relationships. This thesis examined the relationship between parents’ mental health (depression, anxiety, PTSD), the parent-infant relationship, couple’s relationship and infant development. The five articles in this thesis were part of a prospective multi-method investigation of first-time parents. Parents completed questionnaires in late pregnancy, 3 months and 15 months postpartum (Article 3 & 4), detailed observations of parent-infant interactions 3 months postpartum (CARE-index; Article 4), in-depth interviews (Birmingham Interview of Maternal Mental Health) 5 months postpartum (Article 1 and 2), and infant development (Bayley Scales III) was examined at 17 months postpartum (Article 5).
Results showed that a proportion of men and women suffered from poor mental health. Mental health problems were more common in pregnancy than postpartum. Women experienced worse mental health than men, but few other gender or within couple differences were found (Articles 2 & 3). A relatively high rate of poor parent-infant interactions was found (Article 4) and many parents reported feelings of anger towards their infant (Articles 1 & 2). Parents’ perceptions of their infant’s characteristics were important for the parent-infant relationship (Article 3) and infant’s cognitive, language and motor development (Article 5). Additionally, women’s postpartum PTSD and prenatal depression were associated with poor infant development (Article 5). Men’s mental health was associated with poor interaction with their infants (Article 4), negative perceptions of the father-infant and couple’s relationship (Article 3). These findings suggest that both men and women should be included in early mental health and family relationship interventions. However, the small low-risk sample limits generalizability of results. Future research would benefit from exploring the links between parental, infant and family relationship variables further, over time in larger more representative samples.

Parents' postnatal mental health and subjective perceptions of their baby are likely to influence the quality of their relationship with their baby. To date, this has largely been examined in mothers; therefore, this study aimed to also explore this in both parents. Semistructured clinical interviews [The Birmingham Interview for Maternal Mental Health (BIMMH); Brockingon, Chandra et al., 2006] were carried out with 85 first-time parents. The BMMHI identifies disorders of anxiety, depression, PTSD, and parental anger. Sections of the BMMHI also elicit qualitative accounts of parenthood. These were transcribed and analyzed using thematic analysis. Differences in the frequency of themes were examined for parents with or without mental health disorders or parental anger. Themes are reported for (a) baby characteristics, needs, and development; (b) parents' emotions, responses, coping strategies, and general parenthood; and (c) parent and baby relationship. Results indicated that both the presence of parental mental health problems and, more notably, parental anger were associated with more negative accounts of the self, the baby, and parenthood. This study provides insight into first-time parents' perceptions of early parenthood. Results especially highlight the need to consider parental experiences of anger in more detail for assessment and interventions in the early postpartum period

Background: There is converging evidence that approximately 2% of women fulfill PTSD criteria following childbirth. This study examined the presentation and symptom structure of PTSD after birth and key risk factors in women from internet and community samples. Methods: PTSD was measured in 1423 women after birth recruited via the community (n = 502) or internet (n = 921). Demographic, obstetric, and trauma history variables were also measured. Results: Full PTSD diagnostic criteria were endorsed by 2.5% of women from the community and 21% of women on the internet. Many more endorsed individual PTSD symptom criteria, suggesting this might be inflated by postnatal factors. Samples differed on demographic and obstetric characteristics. Factor analysis found two PTSD symptom clusters of re-experiencing and avoidance (RA) and numbing and arousal (NA). PTSD cases were predicted by parity, delivery type, NA and RA symptoms, and the interaction between sexual trauma and delivery type. This correctly identified 60% of PTSD cases. Limitations: Questionnaire measurement of PTSD means prevalence rates may be over-estimated. Differences between samples suggest that internet samples over represent symptomatic women. Conclusions: Results emphasise the importance of measuring full diagnostic criteria in postnatal samples, as reports of symptoms may be inflated. In addition a few risk factors are identified that could be used to screen for women at risk.

Objectives: Research has shown that between 1 and 3% of women may suffer from post-traumatic stress disorder (PTSD) following childbirth. However, the potential effect of childbirth on fathers, and the implications of post-natal symptoms of PTSD for family relationships, have received little attention. The current study therefore examined the potential effects of PTSD symptoms on the couple's relationship and parent-baby bond. Design: Internet-based questionnaire study. Methods: One hundred and fifty-two parents (126 women and 26 men) completed questionnaire measures of PTSD, depression, quality of the couple's relationship, and the parent-baby bond. Results: Symptoms of PTSD and depression were significantly correlated with the couples' relationship and parent-baby bond. Structural equation modelling found the model that best fitted the data was one where PTSD symptoms had a direct effect on the parent-baby bond, but the effect of PTSD on the couples' relationship was mediated by depression. Conclusions: The results indicate the importance of examining the psychological reactions of men and women after birth; and suggest that symptoms of PTSD have an effect on the parent-baby bond. However, methodological considerations mean further research is needed to replicate and extend this study before firm conclusions can be drawn.