Coping as a Mediator between Attachment and Depressive Symptomatology Either in Pregnancy or in the Early Postpartum Period: A Structural Equation Modelling Approach

Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of coping strategies in mediating the relationship between women’s attachment style and depressive symptomatology in pregnancy and one week after giving birth in a large sample of women (N = 1664). Our hypothesis was that the relationship between anxious and avoidant attachment and depressive symptomatology would be mediated by use of maladaptive coping strategies. The assessment instruments were Edinburgh Postnatal Depression Scale (EPDS), Brief Coping Orientation for Problem Experiences (COPE), and Experiences in Close Relationship Scale (ECR). The results indicated that the effect of insecure attachment styles (anxious and avoidant attachment) on antepartum depressive symptomatology was partially mediated by dysfunctional coping styles. Anxious attachment also has an indirect significant effect on postpartum depressive symptomatology through emotional coping; however, avoidant attachment does not seem to be significantly related to postpartum depressive symptoms. Our findings revealed that not only is it important to consider attachment in understanding peripartum depressive symptomatology, but also that coping plays an important role in these relationships. These findings would help a preventive coping-based intervention strategy to enhance the capacity of women with insecure attachment styles to use more adaptive coping during and after pregnancy.

[1]  J. Fisher,et al.  Prevalence of early postpartum depression and associated risk factors among selected women in southern Malawi: a nested observational study , 2023, BMC Pregnancy and Childbirth.

[2]  G. Kotzalidis,et al.  The Impact of the COVID-19 Pandemic on Postpartum Maternal Mental Health , 2022, Journal of personalized medicine.

[3]  V. Frokjaer,et al.  Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression: A Systematic Review and Meta-analysis. , 2022, JAMA psychiatry.

[4]  A. Bellomo,et al.  Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy , 2022, Frontiers in Psychiatry.

[5]  N. Yanaihara,et al.  Antenatal screening timeline and cutoff scores of the Edinburgh Postnatal Depression Scale for predicting postpartum depressive symptoms in healthy women: a prospective cohort study , 2022, BMC Pregnancy and Childbirth.

[6]  N. R. van den Broek,et al.  Physical morbidity and psychological and social comorbidities at five stages during pregnancy and after childbirth: a multicountry cross-sectional survey , 2022, BMJ Open.

[7]  Xiu-jing Guo,et al.  The mediating role of coping styles in the relationship between perceived social support and antenatal depression among pregnant women: a cross-sectional study , 2022, BMC Pregnancy and Childbirth.

[8]  A. M. Speranza,et al.  Effects of COVID-19 Epidemic Lockdown on Postpartum Depressive Symptoms in a Sample of Italian Mothers , 2020, Frontiers in Psychiatry.

[9]  A. Gigantesco,et al.  Prevalence of maternal antenatal and postnatal depression and their association with sociodemographic and socioeconomic factors: A multicentre study in Italy. , 2020, Journal of affective disorders.

[10]  C. Carver,et al.  Personality and coping. , 2020, Annual review of psychology.

[11]  S. Carletto,et al.  Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study , 2020, BMC Pregnancy and Childbirth.

[12]  C. Niolu,et al.  The anxious aspects of insecure attachment styles are associated with depression either in pregnancy or in the postpartum period , 2020, Annals of General Psychiatry.

[13]  R. Polman,et al.  Stress and Coping in Esports and the Influence of Mental Toughness , 2020, Frontiers in Psychology.

[14]  Tao Wang,et al.  Epigenetic signatures of attachment insecurity and childhood adversity provide evidence for role transition in the pathogenesis of perinatal depression , 2020, Translational Psychiatry.

[15]  M. C. Canavarro,et al.  The role of emotion regulation difficulties in the relationship between attachment representations and depressive and anxiety symptoms in the postpartum period. , 2018, Journal of affective disorders.

[16]  Or Dagan,et al.  Adult attachment representations and depressive symptoms: A meta-analysis. , 2018, Journal of affective disorders.

[17]  A. Fekadu,et al.  Coping strategies of women with postpartum depression symptoms in rural Ethiopia: a cross-sectional community study , 2018, BMC Psychiatry.

[18]  Nicholas J. Rockwood,et al.  Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. , 2017, Behaviour research and therapy.

[19]  M. Gratacós,et al.  Coping strategies for postpartum depression: a multi-centric study of 1626 women , 2016, Archives of Women's Mental Health.

[20]  R. Langan,et al.  Identification and Management of Peripartum Depression. , 2016, American family physician.

[21]  M. Biondi,et al.  Perinatal Depression and Patterns of Attachment: A Critical Risk Factor? , 2015, Depression research and treatment.

[22]  M. Gratacós,et al.  Coping Strategies and Postpartum Depressive Symptoms: a Structural Equation Modelling Approach , 2015, European Psychiatry.

[23]  J. Cassidy,et al.  Infant capacities related to building internal working models of attachment figures: A theoretical and empirical review , 2015 .

[24]  Xiaolian Jiang,et al.  Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya’an, China , 2015, PloS one.

[25]  Z. Kozinszky,et al.  Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period. , 2015, Journal of affective disorders.

[26]  M. Biondi,et al.  [Perinatal depression and affective bonds: experience in close relationship during pregnancy]. , 2015, Rivista di psichiatria.

[27]  K. Bhui,et al.  Adult attachment style as a risk factor for maternal postnatal depression: a systematic review , 2014, BMC psychology.

[28]  K. Kamibeppu,et al.  The relationship between attachment style and postpartum depression , 2014, Attachment & human development.

[29]  C. Dunkel Schetter,et al.  Coping during pregnancy: a systematic review and recommendations , 2014, Health psychology review.

[30]  Casey K. Gardiner,et al.  INSECURE ATTACHMENT AS A PREDICTOR OF DEPRESSIVE AND ANXIOUS SYMPTOMOLOGY , 2012, Depression and anxiety.

[31]  B. Matteo,et al.  Determinants of ante-partum depression: a multicenter study , 2012, Social Psychiatry and Psychiatric Epidemiology.

[32]  J. Cruz,et al.  The relationship between multidimensional competitive anxiety, cognitive threat appraisal, and coping strategies: A multi-sport study , 2012 .

[33]  Y. Park,et al.  The Simplified Edinburgh Postnatal Depression Scale (EPDS) for Antenatal Depression: Is It a Valid Measure for Pre-Screening? , 2011, International journal of medical sciences.

[34]  P. Slade,et al.  Posttraumatic stress symptoms and postpartum depression in couples after childbirth: the role of partner support and attachment. , 2011, Journal of anxiety disorders.

[35]  L. Kooistra,et al.  Validation of the Edinburgh Depression Scale during pregnancy. , 2011, Journal of psychosomatic research.

[36]  K. Leight,et al.  The relationship between women’s attachment style and perinatal mood disturbance: implications for screening and treatment , 2008, Archives of Women's Mental Health.

[37]  Glenn I. Roisman,et al.  Insecurity, stress, and symptoms of psychopathology: contrasting results from self-reports versus interviews of adult attachment , 2008, Attachment & human development.

[38]  N. Williams,et al.  PTSD-RELATED COGNITIONS AND ROMANTIC ATTACHMENT STYLE AS MODERATORS OF PSYCHOLOGICAL SYMPTOMS IN VICTIMS OF INTERPERSONAL TRAUMA , 2007 .

[39]  C. Pariante,et al.  Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women. , 2007, General hospital psychiatry.

[40]  K. Pakenham,et al.  Application of a stress and coping model to antenatal depressive symptomatology , 2007, Psychology, health & medicine.

[41]  James B. Schreiber,et al.  Reporting Structural Equation Modeling and Confirmatory Factor Analysis Results: A Review , 2006 .

[42]  J. Crowell,et al.  Attachment and externalizing disorders: a developmental psychopathology perspective. , 2006, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  R. Maunder,et al.  The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. , 2006, Journal of psychosomatic research.

[44]  Dianne M. Finkelstein,et al.  A Beginner's Guide to Structural Equation Modeling , 2005, Technometrics.

[45]  Gerald Gartlehner,et al.  Perinatal Depression: A Systematic Review of Prevalence and Incidence , 2005, Obstetrics and gynecology.

[46]  H. Le,et al.  Review of screening instruments for postpartum depression , 2005, Archives of Women’s Mental Health.

[47]  D. Vogel,et al.  Adult Attachment and Help-Seeking Intent: The Mediating Roles of Psychological Distress and Perceived Social Support. , 2005 .

[48]  L. Dickinson,et al.  Stress, Coping, and Health: A Comparison of Mexican Immigrants, Mexican-Americans, and Non-Hispanic Whites , 2005, Journal of Immigrant Health.

[49]  E. Spitz,et al.  Pre- and postnatal depression and coping: a comparative approach. , 2005, Journal of affective disorders.

[50]  J. Abela,et al.  Adult Attachment Dimensions and Specificity of Emotional Distress Symptoms: Prospective Investigations of Cognitive Risk and Interpersonal Stress Generation as Mediating Mechanisms , 2005, Personality & social psychology bulletin.

[51]  C. Dennis,et al.  Identifying women at‐risk for postpartum depression in the immediate postpartum period , 2004, Acta psychiatrica Scandinavica.

[52]  P. Menezes,et al.  Postpartum depression: in relation to life events and patterns of coping , 2004, Archives of Women’s Mental Health.

[53]  F. Medway,et al.  Adolescents' attachment and coping with stress , 2004 .

[54]  C. Dennis,et al.  Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh Postnatal Depression Scale? , 2004, Journal of affective disorders.

[55]  P. P. Heppner,et al.  Perceived coping as a mediator between attachment and psychological distress: A structural equation modeling approach , 2003 .

[56]  P. Bennett,et al.  Predicting postnatal depression. , 2003, Journal of affective disorders.

[57]  E. Skinner,et al.  Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. , 2003, Psychological bulletin.

[58]  B. Priel,et al.  Trait vulnerability and coping strategies in the transition to motherhood , 2003 .

[59]  Frederick G. Lopez,et al.  Adult attachment orientations and college student distress: Test of a mediational model , 2002 .

[60]  A. Picardi,et al.  Il questionario «Experiences in Close Relationships» (ECR) per la valutazione dell'attaccamento negli adulti: Ampliamento delle evidenze di validità per la versione Italiana , 2002 .

[61]  S. Schmidt,et al.  Attachment and coping with chronic disease. , 2002, Journal of psychosomatic research.

[62]  James T. Johnson,et al.  Client attachment and coping resources , 2002 .

[63]  A. Bifulco,et al.  Adult attachment style. I: Its relationship to clinical depression , 2002, Social Psychiatry and Psychiatric Epidemiology.

[64]  Frederick G. Lopez,et al.  Adult Attachment Orientations and College Student Distress: The Mediating Role of Problem Coping Styles , 2001 .

[65]  D. da Costa,et al.  Psychosocial correlates of prepartum and postpartum depressed mood. , 2000, Journal of affective disorders.

[66]  J. Cox,et al.  The Edinburgh Postnatal Depression Scale: validation for an Italian sample. , 1999, Journal of affective disorders.

[67]  C. Pariante,et al.  Validation of the Edinburgh Postnatal Depression Scale in Italy. , 1997, Journal of psychosomatic obstetrics and gynaecology.

[68]  M. Mikulincer,et al.  When Marriage Breaks Up-Does Attachment Style Contribute to Coping and Mental Health? , 1997 .

[69]  N. Collins,et al.  Working models of attachment: implications for explanation, emotion and behavior. , 1996, Journal of personality and social psychology.

[70]  M. Mikulincer,et al.  Appraisal of and Coping with a Real-Life Stressful Situation: The Contribution of Attachment Styles , 1995 .

[71]  M. Mikulincer,et al.  Attachment styles, coping strategies, and posttraumatic psychological distress: the impact of the Gulf War in Israel. , 1993, Journal of personality and social psychology.

[72]  K. Bartholomew,et al.  Attachment styles among young adults: a test of a four-category model. , 1991, Journal of personality and social psychology.

[73]  A. Carothers,et al.  The Validation of the Edinburgh Post-natal Depression Scale on a Community Sample , 1990, British Journal of Psychiatry.

[74]  C. Carver,et al.  Assessing coping strategies: a theoretically based approach. , 1989, Journal of personality and social psychology.

[75]  J. Cox,et al.  Detection of Postnatal Depression , 1987, British Journal of Psychiatry.

[76]  C. Hazan,et al.  Romantic love conceptualized as an attachment process. , 1987, Journal of personality and social psychology.

[77]  S Roth,et al.  Approach, avoidance, and coping with stress. , 1986, The American psychologist.

[78]  M. Bartlett.  THE EFFECT OF STANDARDIZATION ON A χ2 APPROXIMATION IN FACTOR ANALYSIS , 1951 .

[79]  K. Preis,et al.  Personality type, social support and other correlates of risk for affective disorders in early puerperium. , 2016, Ginekologia polska.

[80]  R. Perrine.  Stress and College Persistence as a Function of Attachment Style. , 1999 .

[81]  C. Carver.  You want to measure coping but your protocol’ too long: Consider the brief cope , 1997, International journal of behavioral medicine.

[82]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.