The Experience of Postpartum Depression among Mothers with Withdrawn Attachment Style during Pregnancy and the First Postnatal Month

Mari Ikeda^1*, Momoko Hayashi², Kiyoko Kamibeppu³

¹Nursing Administration and Advanced Clinical Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
²College of Contemporary Psychology, Rikkyo University, Saitama, Japan.
³Family Nursing, Division of Health Science & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

DOI: 10.4236/ojd.2015.44008                

Abstract

Approximately 19% of women experience minor or major depression in the first three months following childbirth. Most research suggests that women with withdrawn attachment styles are less likely to be depressed. However, unlike mothers in Western culture, mothers in Japan with withdrawn attachment styles are reported to have greater potential to become depressed. Thus, the aim of this study was to describe the behaviors and situational awareness of Japanese mothers’ with withdrawn attachment styles during pregnancy in order to reveal the specific dynamics underlying the withdrawn style. Interview data were analyzed using qualitative thematic content analysis. Of the 84 women assessed, 12 were determined to have a withdrawn style, and based on the Mini-International Neuropsychiatric Interview, five demonstrated the onset of postpartum depression (PPD). Two themes regarding relationships with partners emerged including: 1) confiding behavior: the importance of what is shared; and 2) need to be heard: wanting sympathy rather than criticism. Additionally, three themes describing mothers’ experiences during the first postnatal month emerged: 1) overwhelming experiences: the childbirth experience; 2) seeking help: behavior changes altered relationships; and 3) experience with the baby. Withdrawn style mothers keep distance from crisis, avoid closeness with others, and opt to manage problems by themselves. However, childbirth and infant care are not easily managed in this style. Mothers who used childbirth to confide in their partners may have reduced the severity of insecurity or developed a more secure style. Healthcare professionals are in the best position to develop good relationships with new mothers and provide support that focuses more on emotional factors and self-esteem levels.

Keywords

Attachment Style Interview, Japan, Postpartum Depression, Relationship with Partner, Withdrawn Style

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bennett, I. M., Palmer, S., Marcus, S., Nicholson, J. M., Hantsoo, L., Bellamy, S. et al. (2009). One End Has Nothing to Do with the Other: Patient Attitudes Regarding Help Seeking Intention for Depression in Gynecologic and Obstetric Settings. Archives of Women’s Mental Health, 12, 301-308. http://dx.doi.org/10.1007/s00737-009-0103-4
[2]	Bifulco, A., Figueiredo, B., Guedeney, N., Gorman, L. L., Hayes, S., Muzik, M. et al. (2004). Maternal Attachment Style and Depression Associated with Childbirth: Preliminary Results from a European and US Cross-Cultural Study. British Journal of Psychiatry (Suppl), 46, s31-s37. http://dx.doi.org/10.1192/bjp.184.46.s31
[3]	Bifulco, A., Lillie, A., Ball, B., & Moran, P. (1998). Attachment Style Interview (ASI): Training Manual. London: Royal Holloway.
[4]	Bifulco, A., Moran, P. M., Ball, C., & Bernazzani, O. (2002). Adult Attachment Style. I: Its Relationship to Clinical Depression. Social Psychiatry and Psychiatric Epidemiology, 37, 50-59. http://dx.doi.org/10.1007/s127-002-8215-0
[5]	Bifulco, A., & Thomas, G. (2013). Understanding Adult Attachment in Family Relationships. Abingdon: Routledge.
[6]	Bowlby, J. (1982). Attachment (2nd ed.). New York: Basic Books.
[7]	Bowlby, J. (1988). Developmental Psychiatry Comes of Age. American Journal of Psychiatry, 145, 1-10. http://dx.doi.org/10.1176/ajp.145.1.1
[8]	Boyce, P., & Hickey, A. (2005). Psychosocial Risk Factors to Major Depression after Childbirth. Social Psychiatry and Psychiatric Epidemiology, 40, 605-612. http://dx.doi.org/10.1007/s00127-005-0931-0
[9]	Brown, G. W., & Harris, T. O. (1978). Social Origins of Depression: A Study of Psychiatric Disorders in Women. London: Tavistock.
[10]	Braun, V., & Clarke, V. (2006). Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3, 77-101. http://dx.doi.org/10.1191/1478088706qp063oa
[11]	DiPietro, J. A., Ghera, M. M., Costigan, K., & Hawkins, M. (2004). Measuring the Ups and Downs of Pregnancy Stress. Journal of Psychosomatic Obstetrics and Gynecology, 25, 189-201. http://dx.doi.org/10.1080/01674820400017830
[12]	Feeney, J. A. (2000). Implications of Attachment Style for Patterns of Health and Illness. Child: Care, Health, and Development, 26, 277-288. http://dx.doi.org/10.1046/j.1365-2214.2000.00146.x
[13]	Friedman, M., Rholes, W. S., Simpson, J., Bond, M., Diaz-Loving, R., & Chan, C. (2010). Attachment Avoidance and the Cultural Fit Hypothesis: A Cross-Cultural Investigation. Personal Relationships, 17, 107-126. http://dx.doi.org/10.1111/j.1475-6811.2010.01256.x
[14]	Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal Depression: A Systematic Review of Prevalence and Incidence. Obstetrics &Gynecology, 106, 1071-1083. http://dx.doi.org/10.1097/01.AOG.0000183597.31630.db
[15]	Gerlsma, C., & Luteijn, F. (2000). Attachment Style in the Context of Clinical and Health Psychology: A Proposal for the Assessment of Valence, Incongruence, and Accessibility of Attachment Representations in Various Working Models. British Journal of Medical Psychology, 73, 15-34. http://dx.doi.org/10.1348/000711200160273
[16]	Hammond, J. R., & Fletcher, G. J. O. (1991). Attachment Styles and Relationship Satisfaction in the Development of Close Relationships. New Zealand Journal of Psychology, 20, 56-62.
[17]	Hayashi, M. (2010). Attachment and Adolescence. Tokyo: Misuzu Shobo.
[18]	Ikeda, M., Hayashi, M., & Kamibeppu, K. (2014). The Relationship between Attachment Style and Postpartum Depression. Attachment and Human Development, 16, 557-572. http://dx.doi.org/10.1080/14616734.2014.941884
[19]	Mickelson, K. D., Kessler, R. C., & Shaver, P. R. (1997). Adult Attachment in a Nationally Representative Sample. Journal of Personality and Social Psycholology, 73, 1092-1106. http://dx.doi.org/10.1037/0022-3514.73.5.1092
[20]	Milgrom, J., Gemmill, A. W., Bilszta, J. L., Hayes, B., Barnett, B., Brooks, J. et al. (2008). Antenatal Risk Factors for Postnatal Depression: A Large Prospective Study. Journal of Affective Disorders, 108, 147-157. http://dx.doi.org/10.1016/j.jad.2007.10.014
[21]	Negron, N., Martin, A., Almog, M., Balbierz, A. L., & Howell, E. A. (2013). Social Support during the Postpartum Period: Mothers’ Views on Needs, Expectations, and Mobilization of Support. Maternal and Child Health Journal, 17, 616-623. http://dx.doi.org/10.1007/s10995-012-1037-4
[22]	Razurel, C., Bruchon-Schweitzer, M., Dupanloup, A., Irion, O., & Epiney, M. (2011). Stressful Events, Social Support and Coping Strategies of Primiparous Women during the Postpartum Period: A Qualitative Study. Midwifery, 27, 237-242. http://dx.doi.org/10.1016/j.midw.2009.06.005
[23]	Rholes, W., Simpson, J., Campbell, L., & Grich, J. (2001). Adult Attachment and the Transition to Parenthood. Journal of Personality and Social Psychology, 81, 421-435. http://dx.doi.org/10.1037/0022-3514.81.3.421
[24]	Rholes, W. S., Simpson, J. A., & Friedman, M. (2006). Avoidant Attachment and the Experience of Parenting. Personality and Social Psychology Bulletin, 32, 275-285. http://dx.doi.org/10.1177/0146167205280910
[25]	Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E. et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33; Quiz 34-57.
[26]	Simpson, J. A., Rholes, W. S., Campbell, L., Tran, S., & Wilson, C. L. (2003). Adult Attachment, the Transition to Parenthood, and Depressive Symptoms. Journal of Personality and Social Psychology, 84, 1172-1187. http://dx.doi.org/10.1037/0022-3514.84.6.1172
[27]	Thorp, S., Krause, E., Cukrowicz, K., & Lynch, T. (2004). Postpartum Partner Support, Demand-Withdraw Communication, and Maternal Stress. Psychology of Women Quarterly, 28, 362-369. http://dx.doi.org/10.1111/j.1471-6402.2004.00153.x
[28]	Will, A., & Shinar, O. (2000). Measuring Perceived and Received Social Support. In S. Cohen, L. G. Underwood, & B. Gottlieb (Eds.), Social Support Measurement and Intervention: A Guide for Health and Social Scientists (pp. 86-135). Toronto: Oxford University Press.