The relationship between women's attachment style and perinatal mood disturbance: implications for screening and treatment

To investigate women's attachment style in relation to risk for pregnancy-specific distress and perinatal depression. During the 2nd trimester, 186 women were evaluated for Axis I psychiatric disorders. In the 3rd trimester they self-reported: attachment style, pregnancy experience, current life stress, and symptoms of depression and anxiety. At 4 months post partum, a sub-sample of them (n=56) repeated the self-report questionnaires. Wariness of attachments (high on fear dimension) was associated with greater 'hassles' compared to 'uplifts' in the assessment of pregnancy (r=0.31, p <= 0.001) while attachment security was negatively related to this ratio (r=-0.31, p <= 0.001). Healthy women, versus women with a psychiatric diagnosis, scored higher on security (t=(150) -3.47, p <= 0.001) and lower on attachment fear (t=(150) -2.32, p <= 0.05). Using multiple regression models, there was a significant main effect of fearful attachment style on prenatal depressive symptoms (beta=1.7, p <= 0.05), and of fearful and secure attachment styles for postpartum depression (beta=-2.88, p <= 0.05, beta=-3.78, p <= 0.05, respectively), even in the context of other known risk factors (in the two models, F(8, 106)=29.33, p <= 0.0001, F(3, 33)=10.85, p <= 0.0001, respectively). A hierarchical regression showed that attachment security uniquely contributed to the risk for postpartum depression, beyond depression during pregnancy (R-2 change from 0.25 to 0.35). An approach to perinatal psychiatric disorders that includes psychological factors such as attachment could improve screening, and provide pregnant women with specifically-tailored psychosocial interventions focused on modifying attachment schemas.