Fetal Attachment and Depression: Measurement Matters
The purpose of this study was to examine the relationship between Fetal Attachment (FA) and depression. Condon and Corkindale (1997) have found a relationship between the quality of FA and depression, in women, using the Antenatal Attachment Inventory (AAI; Condon, 1993) to measure FA and four different instruments to measure depression. Previous studies have failed to find a consistent relationship between FA and depression when employing the Fetal Attachment Scale (FAS; Cranley, 1981) to measure FA. In a critical review of the FA research, Muller (1992) proposed that inconsistencies were possibly artifacts of the FAS. This study is both a replication and an elaboration of Condon and Corkindale's study. Several modifications were made to the procedures employed by Condon. This study used both the FAS and the AAI to measure FA, to illuminate whether they would perform equally in explicating the relationship between FA and depression. In addition, the Center for Epidemiologic Studies in Depression Scale (CES-D; Rodloff, 1977) was used to measure depression to determine if Condon and Corkindale's results would be upheld with a fifth measure of depression. Other modifications included: testing males to determine any sex differences and comparing persons with and without a history of major depression. There were 68 expecting adults in the study (35 females and 33 male partners).
Results from this study, demonstrated that it does matter how FA is measured. As expected, the FAS did not correlate with the CES-D and, as Condon and Corkindale found, the AAI-Quality subscale did. For women, there was a significant inverse relationship between FA-Quality and depression (r = -.62, p < .01) and there was no association between FA-Intensity (i.e., the amount of time women spent engaging in FA behavior) and depression. Further analysis of the relationship between FA and depression was obtained by investigating results from the AAI data. Sex differences were detected; there were no significant associations between FA-Quality and depression for males. It was expected and confirmed that parents with a history of depression report greater depressive symptoms than parents without a history of major depression. Further exploration of the types of symptoms reported by individuals, with a history of major depression, revealed that women reported more somatic symptoms than men, but not more non-somatic symptoms. However, women, with a history of depression, reported more non-somatic symptoms of depression than women, without a history of major depression. Possible mechanisms that could account for the link between FA and depression are considered and the clinical importance of early detection and treatment of depression during pregnancy are discussed.
Allister, L., Barry, L. M., Carr, S., & Liu, J. (2001). The effects of maternal depression on fetal heart rate response to vibroacoustic stimulation. Developmental Neuropsychology, 20(3), 639-651.
Beck, A. T. (1967). Depression. New York: Harper & Row.
Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50, 275-285.
Beck, C. T. (1996). A meta-analysis of predictors of postpartum depression. Nursing Research, 45, 297-303.
Bloom, K. C. (1995). The development of attachment behaviors in pregnant adolescents. Nursing Research, 44(5), 284-289.
Caccia, N., Johnson, J. M., Rominson, G. E., & Barna, T. (1991). Impact of prenatal testing on maternal-fetal bonding: Chorionic villus sampling versus amniocentesis. American Journal of Obstetrics and Gynecology, 165, 112-1125.
Cohn, J. F., & Tronick, E. Z. (1983). Three month old infants' reaction to simulated maternal depression. Child Development, 54, 185-193.
Cohn, J. F., & Tronick, E. Z. (1989). Specificity of infants' response to mothers' affective behavior. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 242-248.
Cohn, J. F., Campbell, S. B., Matias, R., & Hopkins, J. (1990). Face-to-face interactions of postpartum depressed and nondepressed mother-infant pairs at 2 months. Developmental Psychology, 26, 15-23.
Cohn, J. F., Matias, R., Tronick, E. Q., Connell, D., & Lyons-Ruth, D. (1986). Face to face interactions of depressed mothers and their infants. In E.Z. Tronick & Field (Eds.), Maternal depression and infant disturbances (new directions for child development, No. 34). San Francisco: Jossey-Bass.
Condon, J. T. (1993). The assessment of antenatal emotional attachment: Development of a questionnaire instrument. British Journal of Medical Psychology, 66, 167-183.
Condon, J. T., & Corkindale C. (1997). The correlates of antenatal attachment in pregnant women. British Journal of Medical Psychology, 70(4), 359-372.
Cox, A. D., Puckering, C., Pound, A., & Mills, M. (1987). The impact of maternal depression in young children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 28, 917-928.
Cranley, M. S. (1981a). Development of a tool for the measurement of maternal attachment during pregnancy. Nursing Research, 30(5), 281-284.
Davidson, P. R., Parker, K. C. H., & Robinson, M. J. (2002) Depression and Childbirth: Which comes first? Poster presented at the 64th Annual Canadian Psychological Association Convention, Vancouver, BC.
Field, T., Diego, M. A., Dieter, J., Hernandez-Rief, M., Schanberg, S., Kuhn, C., Yando, R., & Bendell, D. (2001). Depressed withdrawn and intrusive mothers' effects on their fetuses and neonates. Infant behavior and Development, 24, 27-39.
Goldenberg, R. L. G. S. L. (1991). Social and psychological factors and pregnancy outcome. In S. H. Cherry & I. R. Merkatz (Eds.), Complications of pregnancy: Medical, surgical, gynecologic, psychosocial and perinatal (p. 80-96). Baltimore: Williams & Wilkins.
Grace, J. T. (1989). Development of maternal-fetal attachment during pregnancy. Nursing Research, 38(4), 228-232.
Kelly, R. H., Russo, J., & Katon, W. (2001). Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplification revisited? General Hospital Psychiatry, 23, 107-113.
Kwalombota, M. (2002). The effect of pregnancy in HW-infected women. AfDS Care, 14, 431-433.
Kunkel, G. F. (2002). Fetal Attachment: Measurement Matters-Relationships among depression, marital satisfaction and emotional intelligence. Unpublished Masters Thesis, York University, Toronto, Ontario.
Liefer, M. (1977). Psychological changes accompanying pregnancy and motherhood. Genetic Psychology Monographs, 95, 55-96.
Lindgren, K. (2001). Relationships among maternal-fetal attachment, prenatal depression and health practices in pregnancy. Research in Nursing & Health, 24, 203-217.
Mercer, R. T., Ferketich, S., May, K., DeJoseph, J., & Sollid (??) (1988). Further exploration of maternal and paternal fetal attachment. Research in Nursing and Health, 11(2), 83-95.
Miller, W. H. (1992). Chronic mental illness. In J. P. O'Grady & M. Rosenthal (Eds.), Obstetrics: Psychological and psychiatric symptoms (p. 139-149). New York: Elsevier.
Muller, M. E. (1992). A critical review of prenatal attachment research. Scholarly Inquiry for Nursing Practice, 6(1), 5-22.
Muller, M. E. (1993) The development of the prenatal attachment inventory. Western Journal of Nursing Research, 15(2), 199-215.
Murray, C. J. L., & Lopez, A. D. (1996) (Eds.) The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Harvard University Press, Boston.
Nolen-Hoeksema, S. (1987). Sex differences in unipolar depression: Evidence and theory, Psychological Bulletin, 101, 259-282.
O'Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression-a metaanalysis. International Review of Psychiatry, 8, 37-54.
O'Hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). A prospective study of postpartum depression: Prevalence, course and predictive factors. Journal of Abnormal Psychology, 93, 158-171.
O'Hara, M. W., Zekoski, E. M., Philippe, L. H., & Wright, E. J. (1990). A controlled prospective study of postpartum mood disorders: Comparison of child bearing and non-childbearing women. Journal of Abnormal Psychology, 99, 3-15.
Pelton, S. L. (1995). The effect of prenatal depression on maternal fetal attachment and maternal adjustment to pregnancy. Dissertation Abstracts International: Section B, 56(3-B): 1707.
Priel, B., & Besser, A. (1999). Vulnerability to postpartum depressive symptomatology: Dependency, self-criticism and the moderating role of antenatal attachment. Journal of Social and Clinical Psychology, 18, 240-253.
Radloff, L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Journal of Applied Psychological Measurement, 1, 385-401.
Radloff, L., & Rae, D. S. (1981). Components of the sex differences in depression. Research in Community and Mental Health, 2, 111-137.
Reebye, P. N., Morison, S. J., Panikkar, H., Misri, S., & Grunau, R. E. (2002). Affect expression in prenatally psychotropic exposed and nonexposed mother-infant dyads. Infant Mental Health Journal, 23(4), 403-416.
Rothman, B. K., (1993). The tentative pregnancy: How amniocentesis changes the experience of motherhood. New York: W.W. Norton.
Steiner, M., Dunn, E., & Born, L. (2003). Hormones and mood: From menarche to menopause and beyond. Journal of Affective Disorders, 74, 67-83.
Tronick, E. Z., & Field, T. (Eds.) (1986). Maternal depression and infant disturbance. San Francisco: Jossey-Bass.
Tronick, E. Z., & Weinberg, M. K. (1997). Depressed mothers and their infants. Failure to form dyadic states of consciousness. In L. Murray & P. J. Cooper (Eds.), Postpartum depression and child development (p. 54-81). New York: Guildford Press.
Weinberg, M. K., & Tronick, E. Z. (1994). Beyond the face: An empirical study of infant affective configurations of facial, vocal, gestural, and regulatory behaviors. Child Development, 65, 1495-1507.
Whiffen, V. E., & Gotlib, I. H. (1989). Infants of postpartum depressed mothers: Temperament and cognitive status. Journal of Abnormal Psychology, 98, 274-279.
Gail F. Kunkel, M.A. and Helen McK. Doan, Ph.D.
Gail Kunkel, M.A. is a doctoral student in Clinical Developmental Psychology at York University, Toronto, Ontario. This paper was based on her Master's thesis. Helen McKinnon Doan, Ph.D. is a Senior Scholar and Professor Emeritus in the Department of Psychology, York University and a Psychologist in Private Practice. The postal address for both authors is the Department of Psychology, York University, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3. Their email addresses are firstname.lastname@example.org and email@example.com.