Adult attachment style as a risk factor for maternal postnatal depression: a systematic review.
BACKGROUND
Postnatal depression (PND) is an important health problem of global relevance for maternal health and impacts on the health and wellbeing of the child over the life-course. Multinational data is hard to locate, the economic burden of PND on health care systems have been calculated in several countries, including Canada and in the UK. In Canada, health and social care costs for a mother with PND were found to be just over twice that of mothers with no mental illness. The extra community care cost for women with PND living in the UK was found to be £35.7 million per year.


METHODS
We carried out a systematic search to the literature to investigate the associations between attachment style and PND, using meta-narrative analysis methods, reporting statistical data and life narratives. The following databases were searched: PsycInfo, PsycExtra Web of Science, The Cochrane Library and Pubmed. We focused on research papers that examined adult attachment styles and PND, and published between 1991 and 2013. We included any papers showing relationship between maternal adult attachment and PND. Out of 353 papers, 20 met the study inclusion criteria, representing a total of 2306 participants. Data from these 20 studies was extracted by means of a data extraction table.


RESULTS
We found that attachment and PND share a common aetiology and that 'insecure adult attachment style' is an additional risk factor for PND. Of the insecure adult attachment styles, anxious styles were found to be associated with PND symptoms more frequently than avoidant or dismissing styles of attachment.


CONCLUSIONS
More comprehensive longitudinal research would be crucial to examine possible cause-effect associations between adult attachment style (as an intergenerational construct and risk factor) and PND (as an important maternal mental health), with new screening and interventions being essential for alleviating the suffering and consequences of PND. If more is understood about the risk profile of a new or prospective mother, more can be done to prevent the illness trajectory (PND); as well as making existing screening measures and treatment options more widely available.
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Old Anatomy Building, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK ; Faculty Member, HPRT, Department of Continuing Medical Education, Harvard Medical School, 22 Putnam Avenue, Cambridge, MA, Boston 02139 USA.
Nasir
N
Warfa
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Old Anatomy Building, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK.
Melissa
M
Harper
Sapienza University, Piazzale Aldo Moro, 5, 00185 Rome, Italy.
Giampaolo
G
Nicolais
Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Old Anatomy Building, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK.
Kamaldeep
K
Bhui
Adult attachment style; Attachment theory; Maternal depression; Maternal mental health; Postnatal depression; Review systematic