The relationship between women's attachment style and perinatal mood disturbance: implications for screening and treatment.

To investigate women's attachment style in relation to risk for pregnancy-specific distress and perinatal depression. During the 2nd trimester, 186 women were evaluated for Axis I psychiatric disorders. In the 3rd trimester they self-reported: attachment style, pregnancy experience, current life stress, and symptoms of depression and anxiety. At 4 months post partum, a sub-sample of them (n = 56) repeated the self-report questionnaires. Wariness of attachments (high on fear dimension) was associated with greater 'hassles' compared to 'uplifts' in the assessment of pregnancy (r = 0.31, p <or= 0.001) while attachment security was negatively related to this ratio (r = -0.31, p <or= 0.001). Healthy women, versus women with a psychiatric diagnosis, scored higher on security (t = (150) -3.47, p <or= 0.001) and lower on attachment fear (t = (150) -2.32, p <or= 0.05). Using multiple regression models, there was a significant main effect of fearful attachment style on prenatal depressive symptoms (beta = 1.7, p <or= 0.05), and of fearful and secure attachment styles for postpartum depression (beta = -2.88, p <or= 0.05, beta = -3.78, p <or= 0.05, respectively), even in the context of other known risk factors (in the two models, F(8, 106) = 29.33, p <or= 0.0001, F(3, 33) = 10.85, p <or= 0.0001, respectively). A hierarchical regression showed that attachment security uniquely contributed to the risk for postpartum depression, beyond depression during pregnancy (R2 change from 0.25 to 0.35). An approach to perinatal psychiatric disorders that includes psychological factors such as attachment could improve screening, and provide pregnant women with specifically-tailored psychosocial interventions focused on modifying attachment schemas.