title: The association of prenatal attachment and perinatal factors with pre- and postpartum depression in first-time mothers.
abstract: OBJECTIVE
  This prospective study investigated associations between prenatal attachment of adult first-time mothers to the unborn child, perinatal factors and levels of depression before and up to 18 months after delivery.
  
  
  METHODS
  Primiparas (N = 161) without specific risk factors answered the following questionnaires during the last term of pregnancy (t1): Edinburgh Postnatal Depression Scale (EPDS), Maternal Antenatal Attachment Scale (MAAS), questionnaire on the schema of the unborn child, and a questionnaire about the pregnancy. Perinatal data were taken from the patients' files. The EPDS was answered 3 weeks (t2, N = 157), 6 months (t3, N = 159), and 18 months (t4, N = 132) postpartum.
  
  
  RESULTS
  During pregnancy, 16.9 % of the women indicated mild depressive symptoms, and 7.5 %, medium to severe symptoms of depression. Mild symptoms of depression were found in 25.5 % at t2, 10.1 % at t3, and 12.2 % at t4; medium to severe symptoms were reported by 7.6, 1.9 and 5.6 %, respectively. Women with low control during delivery (emergency Caesarean) showed a tendency for higher levels (p = 0.067) of depression at t3 than women with elective Caesarean did. The quality of prenatal attachment to the unborn child correlated negatively with depressive symptoms at t1-t4.
  
  
  CONCLUSIONS
  The closer the prenatal attachment of a mother to her unborn child, the less symptoms of depression she reports during the last term of pregnancy and postpartum. Therefore, promoting good mother-child attachment during pregnancy might influence the level of postpartum depression.
authors.affiliation: Department of Obstetrics and Gynecology, University of Erlangen, Universitätsstr. 21-23 Erlangen, Germany. tamme.goecke@uk-erlangen.de
authors.forename: T W
authors.initials: TW
authors.lastname: Goecke
authors.forename: F
authors.initials: F
authors.lastname: Voigt
authors.forename: F
authors.initials: F
authors.lastname: Faschingbauer
authors.forename: G
authors.initials: G
authors.lastname: Spangler
authors.forename: M W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: A
authors.initials: A
authors.lastname: Beetz
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D006801:Humans; D009034:Mother-Child Relations; D009769:Object Attachment; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D055815:Young Adult