A web-based survey of mother-infant bond, attachment experiences and metacognition in posttraumatic stress following childbirth

Objective: Post-natal depression is linked to adverse outcomes for parent and child, with metacognition and parenting experiences key variables in the development and maintenance of depression. The attachment between mother and infant is especially vulnerable to the effects of untreated post-natal depression. Despite high levels of reported post-natal stress symptoms, less attention has been given the relationship between attachment, metacognition and post-natal traumatic symptoms in the context of birth trauma.
This study tested several hypotheses regarding the relationships between recalled parenting experiences, metacognition, postnatal symptoms of PTSD and depression and perceptions of the mother-infant bond, confirming and extending upon metacognitive and mentalization theories.
Method: A web-based cross-sectional self-report questionnaire design was employed in an analogue sample of new mothers. Participants were 502 women recruited via open access websites associated with birth organisations. Structural equation modelling was employed for the principal analysis.
Results: Metacognition fully mediated the relationship between recalled parenting experiences and postnatal psychological outcomes. Posttraumatic stress was indirectly associated with maternal perceptions of the bond, with this relation mediated by depression.
Conclusion: Metacognition may have a key role in postnatal psychological distress. Where postnatal depression or traumatic birth experiences are identified, screening for posttraumatic stress is strongly indicated.