Maternal attachment style and depression associated with childbirth : preliminary results from a european and US cross-cultural study

Abstract

Background: Insecure attachment style relates to major depression in women, but its relationship to depression associated with childbirth is largely unknown. A new UK-designed measure, the Attachment Style Interview (ASI), has potential for cross-cultural use as a risk marker for maternal disorder. Aims: To establishthe reliability of the ASI across centres, its stability over a 9-month period, and its associations with context and major or minor depression. Method: The ASI was used by nine centres antenatally on 204 women, with 174 followed up 6 months postnataly. Interrater reliability was tested and ASI was repeated on a subset of 96 women. Affective disorder was assessed by means of the Structured Clinical Interview for DSM IV. Results: Satisfactory interrater reliability was achieved with relatively high stability rates at follow-up.Insecure attachment related to lower social class position and more negative social context. Specific associations of avoidant attachment style (angry - dismissive or withdrawn) with antenatal disorder, and anxious style (enmeshed or fearful) with postnatal disorder were found. Conclusions: The ASI can be used reliably in European and US centres as a measure for risk associated with childbirth. Its use will contribute to theoretically underpinned preventive action for for disorders associated with childbirth.