Relationship Of Maternal Emotional State,Social Support And Mother-Infant Bonding In The Early Postpartum Period

ObjectivesTo estimate the bonding status between women and infants in the early postpartum period and it’s relationship with social support,postpartum depression,and postpartum anxiety,and further explore the mediating effect of social support on postpartum depression,postpartum anxiety and mother-infant bonding in order to provide references for reasonable and effective health education and intervention measures to promote the health of mothers and their infants.MethodsA total of 413 postpartum women in a tertiary hospital in Wuhan from August to November 2018 were recruited conveniently.A self-designed maternal general information questionnaire,Chinese-version of Postpartum Bonding Questionnaire(C-PBQ),Edinburgh Postnatal Depression Scale(EPDS),Self-rating Anxiety Scale(SAS)and Social Support Revalued Scale(SSRS)were used for data collection.SPSS 22.0 was used for data analysis.The mean and standard deviation and percentage were used to make a descriptive analysis of the basic obstetrical data and the scores of the scales.Mann Whitney U test and Kruskal Wallis H test were used to analyze the differences between the independent variables and mother-infant bonding.Spearman rank correlation analysis and multivariate stepwise regression analysis were used to estimate the relationship between the independent variables and mother-infant bonding.The mediating effect of social support on postpartum depression,postpartum anxiety,and mother-infant bonding was analyzed by stepwise test regression coefficient and Bootstrap method.Results(1)The total score of C-PBQ was 13.75±9.62.The scores of its four scales were as following: 7.44±4.75 in impaired bonding,3.52±3.38 in rejection & pathological anger,2.70±2.57 in anxiety about care,and 0.09±0.44 in risk of abuse,respectively.The rate of normal mother-infant bonding was 80.8%,mild abnormal bonding 17.4%,potential rejection 1.5%,and explicit rejection 0.2%.(2)The total score of maternal social support was 41.73±5.99.Its sub-scores were 9.78±2.41 in objective support,23.89±3.97 in subjective support,and 8.07±1.77 in social support utilization,respectively.(3)The incidence of postpartum depression was 31% with 17.4% for mild to moderate depression and 13.6% for severe depression.The incidence of postpartum anxiety was 3.1%.(4)Univariate analysis showed that:(1)Significant differences in the total score of mother-infant bonding were found among different groups of education,pregnancy history,and marital relationship satisfaction.The higher the mother’s education level,the higher the total score of mother-infant bonding(P=0.001).The total score of mother-infant bonding of the primipara is higher than that of the multipara(P<0.001).Mothers who were satisfied with relationship had lower mother-infant bonding scores than those who feel dissatisfied(P=0.004),(2)significant differences in the total score of mother-infant bonding were found among different groups of maternal sleep time,sleep quality,feeding pattern,and infant care pattern.The shorter the mother’s sleep,the higher the total score of mother-infant bonding(P<0.001).The better the maternal sleep quality,the higher the total score of mother-infant bonding(P<0.001).Mothers with mixed feeding scored higher in mother-infant bonding than those with breastfeeding and artificial feeding(P=0.013).Mothers who took care of infants with others had higher mother-infant bonding scores than those who took care of babies by themselves(P=0.031),(3)a significant difference in the total score of mother-infant bonding was found between different groups of depression and anxiety during pregnancy.Mothers with depression during pregnancy scored high in the total score of mother-infant than those without(P<0.001).Mothers with anxiety during pregnancy scored high in the total score of mother-infant than those without(P<0.001).(5)Mother-infant bonding was negatively correlated with maternal social support(r=-0.271,P<0.001),objective support(r=-0.105,P=0.033),subjective support utilization(r=-0.297,P<0.001),support availability(r=-0.129,P=0.009).While mother-infant bonding was positively correlated with maternal postpartum depression(r=0.419,P<0.001),and postpartum anxiety(r=0.403,P<0.001).Maternal perceived social support was negatively correlated with postpartum depression(r=-0.379,P<0.001)and postpartum anxiety(r=-0.215,P<0.001).(6)Regression analysis showed that postpartum depression(β=0.532,P<0.001),postpartum anxiety(β=0.313,P<0.001),primipara(β=3.296,P<0.001),and sleep time(β=1.949,P=0.020)were positive predictors of mother-infant bonding,while complete baby-care by mothers(β=-2.899,P=0.002)was the negative.These factors explaining 24.8% of total variance.(7)Social support mediated the relationship between postpartum depression,anxiety,and maternal-infant bonding.The mediating effect was 11.86%(95%CI: 0.026-0.188,P=0.009)and 11.32%(95%CI: 0.028-0.113,P<0.001),respectively.Conclusion(1)There is impaired mother-infant bonding among women in early postpartum period.(2)Education,pregnancy history,marital satisfaction,infant feeding pattern,infant care pattern,mother’s sleep time,mother’s sleep quality,pregnancy depression,pregnancy anxiety,postpartum social support,postpartum depression,and postpartum anxiety affect mother-infant bonding in the early postpartum period.Among them,postpartum depression,postpartum anxiety,pregnancy history,infant care pattern,and sleep time have significant predictive effects on mother-infant bonding.(3)Social support has a partial mediating effect between postpartum depression,postpartum anxiety and mother-infant bonding.