The Relationship between anxious attachment style and postpartum depression in regard to mediating role of difficulties in emotion regulation among postpartum women

Document Type : Original Article

Authors

1 Master of Clinical Psychology, Science and Culture University, Tehran, Iran

2 Assistant Professor, Department of Psychology, University of Science and Culture, Tehran, Iran

Abstract

Introduction: The present study was conducted with the aim of investigating the mediating role of difficulty in emotion regulation in the relationship between anxious attachment style and postpartum depression.
materials and methods: The method of the current research was descriptive-correlation and structural equation model type. The participants included 206 women who had given birth two weeks to three months ago and were selected by available sampling method. To collect data from the Edinburgh Postpartum Depression Scales (EPDS), Collins and Reed Adult Attachment Style (RAAS) and Gertz and Romer's Difficulty in Regulating Emotions (DERS) and to analyze the data using SPSS 26 software and AMOS 24 was used.
Results: : The results showed well goodness of fit to the proposed model, In this model relationship between postpartum depression with anxious attachment style (p<0.01) and difficulty in emotional regulation (p<0.01) was positive and significant. Also, there was a positive and significant relationship between difficulty in emotion regulation and anxious attachment style (p < 0.01). The results of the structural equation model showed that difficulty in emotional regulation plays a mediating role in the relationship between anxious attachment style and postpartum depression.
Conclusion: Two important factors related to postpartum depression in women are anxious attachment style and difficulty in emotional regulation. Focusing on preventive programs based on emotion regulation skills and paying attention to the attachment style and emotional regulation problems of mothers can help in the prevention and treatment of postpartum depression.

Keywords

Main Subjects

References

  1. منابع

    1. Dinni SM. Predictors of postpartum depression: the role of emotion regulation, maternal self-confidence, and marital satisfaction on postpartum depression. Jurnal Psikologi. 2020;47(3):220-38.
    2. Gastaldon C, Solmi M, Correll CU, Barbui C, Schoretsanitis G. Risk factors of postpartum depression and depressive symptoms: umbrella review of current evidence from systematic reviews and meta-analyses of observational studies. The British Journal of Psychiatry. 2022,221(4).
    3. Alrida NA, Al-Zu’bi B. The Prevalence and Risk Factors of Postpartum Depression among Women: A Review Paper. 2023,4(4)540-539.
    4. Heidari F, Helali H, Baradaran Binazir M. Prevalence and Screening of Determinants of Depression Disorder during Pregnancy and after Childbirth; Case-Control Study. Depiction of Health. 2021;12(2):170-7. [In Persian]
    5. Shah A, Banner N, Heginbotham C, Fulford B. 7. American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing, Arlington, VA. 8. Bechara, A., Dolan, S. and Hindes, A. (2002) Decision-making and addiction (Part II): myopia for the future or hypersensitivity to reward? Neuropsychologia, 40, 1690–1705. 9. Office of Public Sector Information (2005) The Mental Capacity Act 2005. http://www. Substance Use and Older People. 2014;21(5):9.
    6. Norhayati M, Hazlina NN, Asrenee A, Emilin WW. Magnitude and risk factors for postpartum symptoms: a literature review. Journal of affective Disorders. 2015;175:34-52.
    7. Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Frontiers in psychiatry. 2018;8:248.
    8. Saei Ghare N, Mohaddesi H, Edalatnemun R. The Predisposing Factors Of Postpartum Depression In Women Referring To Selected Health Centers In Urmia In 2015. Journal Of Urmia Nursing And Midwifery Faculty. 2017;14:11-88.
    9. Batt MM, Duffy KA, Novick AM, Metcalf CA, Epperson CN. Is postpartum depression different from depression occurring outside of the perinatal period? A review of the evidence. Focus. 2020;18(2):106-19.
    10. e Couto TC, Brancaglion MYM, Alvim-Soares A, Moreira L, Garcia FD, Nicolato R, et al. Postpartum depression: A systematic review of the genetics involved. World journal of psychiatry. 2015;5(1):103.
    11. Šebela A, Hanka J, Mohr P. Etiology, risk factors, and methods of postpartum depression prevention. Ceska gynekologie. 2018;83(6):468-73.
    12. Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Annual review of clinical psychology. 2015;11:99-137.
    13. Bianciardi E, Vito C, Betrò S, De Stefano A, Siracusano A, Niolu C. The anxious aspects of insecure attachment styles are associated with depression either in pregnancy or in the postpartum period. Annals of general psychiatry. 2020;19:1-9.
    14. Zdolska-Wawrzkiewicz A, Bidzan M, Chrzan-Dętkoś M, Pizuńska D. The dynamics of becoming a mother during pregnancy and after childbirth. International Journal of Environmental Research and Public Health. 2020;17(1):57.
    15. Robakis TK, Zhang S, Rasgon NL, Li T, Wang T, Roth MC, et al. Epigenetic signatures of attachment insecurity and childhood adversity provide evidence for role transition in the pathogenesis of perinatal depression. Translational Psychiatry. 2020;10(1):48.
    16. Perrotta G. Dysfunctional attachment and psychopathological outcomes in childhood and adulthood. Open Journal of Trauma, Open J Trauma. 2020;4(1):012-21.
    17. Baryshnikov I, Joffe G, Koivisto M, Melartin T, Aaltonen K, Suominen K, et al. Relationships between self-reported childhood traumatic experiences, attachment style, neuroticism and features of borderline personality disorders in patients with mood disorders. Journal of affective disorders. 2017;210:82-9.
    18. Huh HJ, Kim KH, Lee H-K, Chae J-H. Attachment style, complicated grief and post-traumatic growth in traumatic loss: The role of intrusive and deliberate rumination. Psychiatry investigation. 2020;17(7):636.
    19. Bartholomew K, Horowitz LM. Attachment styles among young adults: a test of a four-category model. Journal of personality and social psychology. 1991;61(2):226.
    20. Amani R, Majzoobi MR, Azadi Fard S. Mother-infant attachment style as a predictor of depression among female students. Journal of Midwifery and Reproductive Health. 2017;5(1):834-41.
    21. Molmen Lichter M, Peled Y, Levy S, Wiznitzer A, Krissi H, Handelzalts JE. The associations between insecure attachment, rooming‐in, and postpartum depression: A 2 months’ longitudinal study. Infant Mental Health Journal. 2021;42(1):74-86.
    22. Axfors C, Sylvén S, Ramklint M, Skalkidou A. Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits. Journal of affective disorders. 2017;222:177-84.
    23. Nieto L, Lara MA, Navarrete L. Prenatal predictors of maternal attachment and their association with postpartum depressive symptoms in Mexican women at risk of depression. Maternal and child health journal. 2017;21:1250-9.
    24. Nanni RC, Troisi A. Maternal attachment style and psychiatric history as independent predictors of mood symptoms in the immediate postpartum period. Journal of affective disorders. 2017;212:73-7.
    25. Amianto F. Neuroimaging and Attachment in Eating Disorders: Parental Love Nurtues the Brain. ACTA PSYCHOPATHOLOGICA. 2016;1(3):1-5.
    26. Brophy K, Brähler E, Hinz A, Schmidt S, Körner A. The role of self-compassion in the relationship between attachment, depression, and quality of life. Journal of affective disorders. 2020;260:45-52.
    27. Marques R, Monteiro F, Canavarro MC, Fonseca A. The role of emotion regulation difficulties in the relationship between attachment representations and depressive and anxiety symptoms in the postpartum period. Journal of affective disorders. 2018;238:39-46.
    28. Malik S, Wells A, Wittkowski A. Emotion regulation as a mediator in the relationship between attachment and depressive symptomatology: A systematic review. Journal of affective disorders. 2015;172:428-44.
    29. Edwards ES, Holzman JB, Burt NM, Rutherford HJ, Mayes LC, Bridgett DJ. Maternal emotion regulation strategies, internalizing problems and infant negative affect. Journal of Applied Developmental Psychology. 2017;48:59-68.
    30. Haga SM, Ulleberg P, Slinning K, Kraft P, Steen TB, Staff A. A longitudinal study of postpartum depressive symptoms: multilevel growth curve analyses of emotion regulation strategies, breastfeeding self-efficacy, and social support. Archives of women's mental health. 2012;15:175-84.
    31. Cardoso CFS. How do Depressive and Anxiety Symptoms Evolve in a Group of Mothers at-Risk for Postpartum Depression? The Mediator Role of Emotion Regulation Difficulties 2020.
    32. Deninotti J, Denis A, Berdoulat É. Emergency C-section, maternal satisfaction and emotion regulation strategies: effects on PTSD and postpartum depression symptoms. Journal of Reproductive and Infant Psychology. 2020;38(4):421-35.
    33. PallaviSolanki M, Sharma RK. A Critical Evaluation of Emotional Regulation and Suicidal Ideation on Postpartum Depression. The International Journal of Indian Psychȯlogy. 2019; 7(2).
    34. Gingnell M, Toffoletto S, Wikström J, Engman J, Bannbers E, Comasco E, et al. Emotional anticipation after delivery–a longitudinal neuroimaging study of the postpartum period. Scientific reports. 2017;7(1):114.
    35. Taube-Schiff M, Van Exan J, Tanaka R, Wnuk S, Hawa R, Sockalingam S. Attachment style and emotional eating in bariatric surgery candidates: The mediating role of difficulties in emotion regulation. Eating behaviors. 2015;18:36-40.
    36. Liu C, Ma J-L. Adult attachment style, emotion regulation, and social networking sites addiction. Frontiers in psychology. 2019;10:2352.
    37. Tholia G, Suri S. Attachment Styles and Emotion Regulation: Mediating Effect of Personality. Journal of the Indian Academy of Applied Psychology. 2020;46(1):54-62.
    38. Ferraro IK, Taylor AM. Adult attachment styles and emotional regulation: The role of interoceptive awareness and alexithymia. Personality and Individual Differences. 2021;173:110641.
    39. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. The British journal of psychiatry. 1987;150(6):782-6.
    40. Ahmadi kani Golzar A, GoliZadeh Z. Validation of Edinburgh Postpartum Depression Scale (EPDS) for screening postpartum depression in Iran. Iranian Journal of Psychiatric Nursing. 2015;3(3):1-10. [In Persian]
    41. Shafie M, Jolgeh HD, Dabirifard M, Dabirifard S, Shafiee M. The Relationship Between Social Support and Postpartum Depression in Mothers with Premature Babies. The Journal of Tolooebehdasht. 2018;17(4):81-93. [In Persian]
    42. Aydin N, Inandi T, Yigit A, Nalan Sahin Hodoglugil N. Validation of the Turkish version of the Edinburgh Postnatal Depression Scale among women within their first postpartum year. Social psychiatry and psychiatric epidemiology. 2004;39:483-6.
    43. Collins NL, Read SJ. Adult attachment, working models, and relationship quality in dating couples. Journal of personality and social psychology. 1990;58(4):644.
    44. Asl MS, Khanzadeh M, Hasani J, Edrisi F. Factor structure and psychometric properties of the persian version of state adult attachment scale (SAAS). J Res Psychol Health. 2012;6(1):66-78.
    45. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment. 2004;26:41-54.
    46. Gratz KL, Rosenthal MZ, Tull MT, Lejuez C, Gunderson JG. An experimental investigation of emotion dysregulation in borderline personality disorder. Journal of abnormal psychology. 2006;115(4):850.
    47. Ma B. Psychometri properties of the Cognitive Emotion Regulation Questionnaire in a sample of Iranian population. 2015;24 (84):61-70. [In Persian]
    48. Farsijani N, Besharat MA, Moghadamzadeh A. Predicting social adjustment based on attachment styles and cognitive emotion regulation strategies in adolescents. Journal of psychologicalscience. 2022;21(109):71-88. [In Persian]
    49. Robakis TK, Williams KE, Crowe S, Lin KW, Gannon J, Rasgon NL. Maternal attachment insecurity is a potent predictor of depressive symptoms in the early postnatal period. Journal of Affective Disorders. 2016;190:623-31.
    50. Varela LF, Wong KH, Shergill SS, Fett AK. Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first‐degree relatives and controls. British Journal of Clinical Psychology. 2021;60(3):339-56.
    51. Set Z. Potential regulatory elements between attachment styles and psychopathology: Rejection sensitivity and self-esteem. Archives of Neuropsychiatry. 2019;56(3):205.
    52. Trillingsgaard T, Elklit A, Shevlin M, Maimburg RD. Adult attachment at the transition to motherhood: Predicting worry, health care utility and relationship functioning. Journal of Reproductive and Infant Psychology. 2011;29(4):354-63.
    53. Cacador MI, Moreira H. Fatigue and mindful parenting in the postpartum period: The role of difficulties in emotion regulation and anxious and depressive symptomatology. Mindfulness. 2021;12(9):2253-65.
    54. Beck CT. Predictors of postpartum depression: an update. Nursing research. 2001;50(5):275-85.
    55. Ozeren GS. The correlation between emotion regulation and attachment styles in undergraduates. Perspectives in Psychiatric Care. 2022;58(2):482-90.
    56. Lewczuk K, Kobylińska D, Marchlewska M, Krysztofiak M, Glica A, Moiseeva V. Adult attachment and health symptoms: The mediating role of emotion regulation difficulties. Current Psychology. 2021;40:1720-33.
    57. Kahwagi RM, Zeidan RK, Haddad C, Hallit R, Sacre H, Kheir N, et al. Emotion regulation among Lebanese adults: Validation of the Emotion Regulation Questionnaire and association with attachment styles. Perspectives in Psychiatric Care. 2021;57(2).
    58. Owens GP, Held P, Hamrick L, Keller E. The indirect effects of emotion regulation on the association between attachment style, depression, and meaning made among undergraduates who experienced stressful events. Motivation and Emotion. 2018;42:429-37.
    59. Mikulincer M, Shaver PR. Attachment orientations and emotion regulation. Current opinion in psychology. 2019;25:6-10.
    60. Marganska A, Gallagher M, Miranda R. Adult attachment, emotion dysregulation, and symptoms of depression and generalized anxiety disorder. American journal of orthopsychiatry. 2013;83(1):131.
    61. Cacciola E, Psouni E. Insecure attachment and other help-seeking barriers among women depressed postpartum. International journal of environmental research and public health. 2020;17(11):3887.
    62. Iwanski A, Lichtenstein L, Mühling LE, Zimmermann P. Effects of father and mother attachment on depressive symptoms in middle childhood and adolescence: The mediating role of emotion regulation. Brain Sciences. 2021;11(9):1153.
    63. Simpson JA, Rholes WS, Campbell L, Tran S, Wilson CL. Adult attachment, the transition to parenthood, and depressive symptoms. Journal of personality and social psychology. 2003;84(6):1172.

Files

History

  • Receive Date: 04 December 2023
  • Revise Date: 21 January 2024
  • Accept Date: 28 February 2024

Share

How to cite

Statistics