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Maternal perceived bonding towards the infant and parenting stress in women at risk of postpartum psychosis with and without a postpartum relapse

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)210-219
Number of pages10
JournalJournal of Affective Disorders
Early online date5 Jun 2021
Accepted/In press30 May 2021
E-pub ahead of print5 Jun 2021
Published1 Nov 2021

Bibliographical note

Funding Information: PD has received speaker's fees from Lundbeck and Janssen. CMP has received research funding from Johnson & Johnson for research on depression and inflammation and is funded by the Wellcome Trust strategy award to the Neuroimmunology of Mood Disorders and Alzheimer's Disease (NIMA) Consortium (104025), which is also funded by Janssen, GlaxoSmithKline, Lundbeck and Pfizer. LMH has received funding from the NIHR and the Nuffield Foundation for Research Programmes on maternal mental disorders. MAM has received research funding from Takeda Pharmaceuticals, Lundbeck, Johnson & Johnson and support in kind from AstraZeneca and has acted as a consultant for Lundbeck and Takeda. However, this paper is independent from this funding; there are no further declarations of interest. Funding Information: We thank the Perinatal Research Team and, most of all, the women who shared their early lives as mothers with us. Funding Information: This work was supported by the Medical Research Foundation [grant number C0439] and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. CMP is a NIHR Senior Investigator. The funding sources played no role in the study design, collection, analysis or interpretation of findings, in writing the report or in the decision to submit the article for publication. Publisher Copyright: © 2021 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Background: Postpartum psychosis (PP) is the most severe psychiatric disorder associated with childbirth. However, there is little research on maternal bonding towards the infant and parenting stress in this clinical population. Methods: We investigated maternal bonding during pregnancy and post-partum in 75 women: 46 at risk of PP (AR), because of a DSM-IV diagnosis of bipolar disorder, schizoaffective disorder or previous PP, and 29 healthy controls. Of the AR women, 19 developed a psychiatric relapse within 4 weeks’ post-partum (AR-unwell), while 27 remained symptom-free (AR-well). We investigated childhood maltreatment, parenting stress and psychiatric symptoms as potential predictors of maternal bonding. Results: In pregnancy, AR-unwell women reported a more negative affective experience towards their infants than AR-well women (d = 0.87, p = .001), while postnatally there was no significant difference in bonding. In contrast, AR women as a group reported a more negative affective experience than HC postnatally (d = 0.69, p = .002; d = 0.70, p = .010), but not antenatally. Parenting stress and psychiatric symptoms significantly predicted less optimal postnatal bonding (b = -0.10, t = -4.29, p < .001; b = -0.37, t = -4.85, p < .001) but only psychiatric symptoms explained the difference in bonding between AR and HC (b = -1.18, 95% BCa CI [-2.70,-0.04]). Limitations: A relatively small sample size precluded a more in-depth investigation of underlying pathways. Conclusion: This study provides new information on maternal bonding in women at risk of PP, and particularly in those that do and do not develop a postpartum relapse. The results suggest that improving maternal symptoms and parenting stress in the perinatal period in women at risk of PP could also have positive effects on bonding.

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