Digital archive of theses discussed at the University of Pisa


Thesis etd-06282017-191326

Thesis type
Tesi di specializzazione (5 anni)
Thesis title
Lifetime and antenatal predictors of post-partum psychopathology: a focus on maternal bonding and previous depressive episode
Course of study
relatore Prof. Perugi, Giulio
  • risk factors
  • post-partum depression
  • maternal attachment
Graduation session start date
Introduction: Depressive mood disorders affect approximately between 8.5% and 10% of the women during pregnancy and between 6.5 and 12.9% of the women in the first post-partum year. Poor maternal attachment has been associated with the occurrence of depression during gestation and post-partum. Both perinatal depression and maternal attachment seems to be important for infant’s social, emotional and cognitive development. Several risk factors, including antenatal psychopathology and the personal history of depression, have been identified as predictors of maternal depression. Some studies reported that also the quality of the maternal-foetal attachment may play a role in determining post-partum depression. The aim of this study was to evaluate the association of maternal antenatal attachment with post-partum psychopathology and maternal-infant bonding, while checking for antenatal psychopathology and for lifetime psychiatric diagnosis. Further aim of the study was to evaluate the correlation between previous depression and the occurrence of maternal antenatal and postnatal psychopathology.
Methods: One hundred-six women recruited at the first month of pregnancy (T0) were evaluated with the structured interview for DSM-IV TR (SCID-I) to assess the presence of lifetime psychiatric diagnosis and completed the Perinatal Depression Predictor Inventory-Revised (PDPI-R), the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). At the sixth month of pregnancy (T1) and at the first month post-partum (T2), all patients completed self-evaluation with the PDPI-R, the EPDS, the STAI, and the Maternal Antenatal Attachment Scale (MAAS), only at T1, and the Maternal Postnatal Attachment Scale (MPAS), only at T2.
Results: Univariate regression analyses showed that the maternal-foetal attachment was the variable most significantly associated with postnatal symptoms of depression and anxiety and the quality of maternal-infant attachment. The logistic regression analysis showed that antenatal attachment predicted postnatal depressive (OR: 0.83 – IC [0.74-0.95], p=0.005) and anxious symptoms (OR:0.88 – IC [0.79-0.98], p=0.02), and maternal postnatal attachment (OR:1.17 – IC [1.08-1.27], p<0.001), also after controlling for the known risk factors and lifetime psychiatric diagnosis. The history of lifetime mood disorders was associated with the occurrence of depressive symptoms at the first month of pregnancy (OR: 1.23 – IC [1.06-1.43], p=0.006) and at the first month post-partum (OR: 1.16 – IC [1.02-1.32], p=0.024).
Conclusion: The quality of maternal-foetal bonding may independently predict the quality of maternal-infant attachment and post-partum depressive and anxiety symptoms. The history of depression is associated with the onset of depressive symptoms at the beginning of pregnancy and in the early post-partum. A comprehensive assessment of maternal risk factors for perinatal psychopathology during pregnancy should include the evaluation of maternal-foetal attachment. In fact, maternal antenatal attachment differently from other variables, such as the history of depression, could be modifiable by specific interventions promoting the quality of bonding.