Punamäki Raija-Leena, Qouta Samir R, Diab Safwat Y
Tampere University, Faculty of Social Sciences, Department of Psychology, Finland.
Doha Institute For Graduate Studies, Qatar.
Heliyon. 2019 Dec 12;5(12):e02867. doi: 10.1016/j.heliyon.2019.e02867. eCollection 2019 Dec.
Infant care is a demanding task in dangerous war conditions, but research on the wellbeing of mother-infant dyads is mainly available in peaceful conditions. Knowledge on protective versus risking processes is especially vital for tailoring effective help, and the present study proposes the maternal attachment style to play an important role in dangerous war conditions.
The study analyses, first, how various traumatic war events, such as losses, horrors and life-threat, are associated with maternal mental health and dyadic mother-infant interaction quality, indicated by maternal emotional availability (EA). Second, it tests a hypothesis that maternal insecure attachment risks and secure attachment protects good mental health and optimal EA from negative impacts of traumatic war events.
The prospective three-wave study involved 502 Palestinian mothers, who were pregnant during the 2014 War on Gaza, and participated at delivery (T1), and when the infant was seven (T2; = 392) and eighteen (T3; = 386) months. Mothers reported about war events at T1 and T2 (death and losses, witnessing horrors and life-threat), and posttraumatic stress disorder (PTSD) and depression symptoms at T2 and T3. Dyadic interaction quality was assessed by mother-perceived emotional availability (EA) scale at T2 and T3, and attachment styles by mothers' self-reports at T3.
Death and losses, witnessing horrors, and life-threat were all associated with a high level of maternal PTSD, but only at T2, whereas death and losses were associated with her depressive symptoms both at T2 and T3. Witnessing horrors was associated with a low close and positive and a high distant and negative emotional availability at T2 and T3. As hypothesized, maternal avoidant attachment was associated with a low level of close and positive EA in general, and especially when the dyads were exposed to a high level of traumatic war events, thus indicating a risking function. Against the hypothesis, secure attachment did not show any protective function on emotional availability, while, unexpectedly, maternal preoccupied attachment was associated with close and positive emotional availability, when dyads were exposed to a high level of traumatic war events.
Mothering in conditions of war and military violence is an overwhelmingly demanding task, and mother-infant dyads need legal, social, and psychological assistance. Knowledge and reflection of unique responses and meanings of different attachment styles would be fruitful in tailoring effective help.
在危险的战争环境中，照顾婴儿是一项艰巨的任务，但关于母婴二元组福祉的研究主要是在和平环境中进行的。了解保护与风险过程对于提供有效的帮助尤为重要，本研究提出母亲的依恋风格在危险的战争环境中起着重要作用。
本研究首先分析各种创伤性战争事件，如损失、恐怖经历和生命威胁，如何与母亲的心理健康以及母婴二元组互动质量相关联，母婴二元组互动质量由母亲的情感可及性（EA）来表示。其次，检验一个假设，即母亲的不安全依恋会带来风险，而安全依恋能保护良好的心理健康和最佳的情感可及性免受创伤性战争事件的负面影响。
这项前瞻性的三阶段研究涉及502名巴勒斯坦母亲，她们在2014年加沙战争期间怀孕，并在分娩时（T1）、婴儿7个月时（T2；n = 392）和18个月时（T3；n = 386）参与研究。母亲们在T1和T2时报告战争事件（死亡和损失、目睹恐怖事件和生命威胁），在T2和T3时报告创伤后应激障碍（PTSD）和抑郁症状。在T2和T3时通过母亲感知的情感可及性（EA）量表评估二元组互动质量，在T3时通过母亲的自我报告评估依恋风格。
死亡和损失、目睹恐怖事件以及生命威胁都与母亲高水平的PTSD相关，但仅在T2时如此，而死亡和损失在T2和T3时都与她的抑郁症状相关。目睹恐怖事件在T2和T3时与低水平的亲密和积极情感可及性以及高水平的疏远和消极情感可及性相关。正如所假设的，母亲的回避型依恋总体上与低水平的亲密和积极情感可及性相关，尤其是当二元组暴露于高水平的创伤性战争事件时，这表明其具有风险作用。与假设相反，安全依恋在情感可及性方面未显示出任何保护作用，而意外的是，当二元组暴露于高水平的创伤性战争事件时，母亲的痴迷型依恋与亲密和积极的情感可及性相关。
在战争和军事暴力环境中育儿是一项极其艰巨的任务，母婴二元组需要法律、社会和心理援助。了解不同依恋风格的独特反应和意义并进行反思，对于提供有效的帮助将富有成效。
