Eitenmüller Pia, Köhler Siegmund, Hirsch Oliver, Christiansen Hanna
Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany.
Department of Obstetrics and Gynecology, University of Giessen-Marburg, Marburg, Germany.
Front Psychiatry. 2022 May 30;13:815822. doi: 10.3389/fpsyt.2022.815822. eCollection 2022.
Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.
Three hundred and fifty-four women (18-43 years; = 30.13, = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.
Primipara reported significantly more birth complications ( = 0.048), with path analysis confirming this result ( < 0.001). Birth complications were associated with a more negative rating of the overall birth experience ( < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores ( < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment ( > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding ( < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.
The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.
产后母婴联结受损对母亲及其新生儿心理健康以及后续儿童发育产生的负面影响已有充分记录。先前的研究表明，负面的分娩经历与影响产后母婴联结的产后心理健康之间存在关联。本研究调查产前抑郁和分娩经历在多大程度上影响母亲的产后心理健康及其与新生儿的联结，以及这些影响是否因胎次和自我报告的既往心理健康问题而有所不同。
354名年龄在18至43岁之间（平均年龄 = 30.13岁，标准差 = 5.10岁）的女性在产前和产后填写了爱丁堡产后抑郁量表（EPDS）、母婴依恋量表（MFAS）、评估分娩经历的萨尔蒙项目清单（SIL）以及产后联结问卷（PBQ）；她们还被问及分娩并发症和胎次情况。
初产妇报告的分娩并发症显著更多（p = 0.048），路径分析证实了这一结果（p < 0.001）。分娩并发症与对整体分娩经历的更负面评价相关（p < 0.001）。自我报告有既往心理健康问题的母亲产前抑郁得分更高（p < 0.001），但在其他变量上与没有自我报告既往心理健康问题的母亲没有差异。在产后评估时，自我报告有既往心理健康问题的母亲和没有此类问题的母亲之间的抑郁得分差异消失（p > 0.05）。路径分析突出了产后抑郁的关键作用，它是母婴联结产后受损的唯一显著预测因素（p < 0.001）。分娩经历和产前抑郁得分通过产后抑郁对产后母婴联结产生间接影响。
本研究证明了准妈妈产前心理健康的重要性，尤其是那些自我报告有既往心理健康问题的准妈妈。结果支持减少孕妇的心理健康问题可能有助于获得更积极的分娩经历，并有可能减轻产后抑郁症状。由于产后抑郁与亲子联结受损有关，此类有针对性的干预措施可能会促进儿童发育。初产妇和经产妇之间的群体差异表明，分娩经历可能是产后心理健康的一个影响因素。
