Perinatal posttraumatic stress disorder as a predictor of mother-child bonding quality 8 months after childbirth: a longitudinal study.

Background: Negative childbirth experiences can be related to the onset of perinatal post-traumatic stress symptomatology (P-PTSS), which significantly impacts the mother and the infant. As a response in the face of the discomfort caused by P-PTSS, maladaptive emotion regulation strategies such as brooding can emerge, contributing to the consolidation of post-partum depressive symptoms. Ultimately, both types of symptomatology, P-PTSS and post-partum depression, can act as risk factors for developing mother-child bonding difficulties. Still, this full set of temporal paths has to date remained untested. The present longitudinal study aimed to analyze the risk factors associated with the appearance of P-PTSS after post-partum and to test a path model considering the role of P-PTSS as an indirect predictor of bonding difficulties at eight months of postpartum.

Methods: An initial sample of pregnant women in the third trimester of gestation (N = 594) participated in a longitudinal study comprising two follow-ups at two and eight months of postpartum. The mothers completed online evaluations that included socio-demographic data and measures of psychological variables. A two-step linear regression model was performed to assess the predictive role of the variables proposed as risk factors for P-PTSS, and a path model was formulated to test the pathways of influence of P-PTSS on bonding difficulties.

Results: A history of psychopathology of the mother, the presence of depression during pregnancy, the presence of medical complications in the mother, and the occurrence of traumatic birth experiences all acted as significant predictors of P-PTSS, explaining 29.5% of its variance. Furthermore, the path model tested further confirmed an indirect effect of P-PTSS, triggered by a negative childbirth experience, on subsequent bonding difficulties eight months after labor through its association with higher levels of brooding and, ultimately, postpartum depression levels. A further path showed that bonding difficulties at two months postpartum can persist at eight months postpartum due to the onset of brooding and postpartum depression symptoms.

Conclusion: We identified a set of robust predictors of P-PTSS: the mother's previous history of depression, perinatal depression during pregnancy, the presence of medical complications in the mother and the occurrence of traumatic birth experiences, which has important implications for prevention. This is particularly relevant, as P-PTSS, when triggered by a negative childbirth experience, further indirectly predicted the development of mother-child bonding difficulties through the mediation of higher use of brooding and symptoms of postpartum depression. These findings can serve as a basis for developing new longitudinal studies to further advance the understanding of perinatal mechanisms of mental health.