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      Attachment Style Modifies the Effect of Spousal Support on Postpartum Depression in Women

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          Abstract

          Objective:

          This study aims to examine the impact of spousal support on postpartum depression in women with different attachment styles and assessing if attachment style influences this effect.

          Methods:

          From March to May 2022, 96 couples with late-stage pregnant women were randomly selected from tertiary maternity hospitals in Shandong and Guangdong provinces for a prepartum survey. Psychological assessments were conducted using the Adult Attachment Scale, Dyadic Coping Inventory, and the Patient Health Questionnaire-9 (PHQ-9) Depression Scale. To examine the relationship between each variable and postpartum depression, univariate and multiple logistic regression analyses were employed. Additionally, interaction analysis was used to analyze the interplay between different attachment styles and how spousal support influences women’s postpartum depression.

          Results:

          The findings revealed that even after accounting for confounding variables, prepartum spousal support was an independent predictor of postpartum depression (adjusted odds ratio (OR) = 0.82, 95% CI: 0.69-0.96, P = .015). Women with a secure attachment style showed a significantly lower incidence of postpartum depression compared to those with insecure attachment styles (24.2% vs. 46%, P = .037). In the secure attachment group, spousal support had a protective effect against postpartum depression (adjusted OR = 0.57, 95% CI: 0.36-0.91, P = .018), and attachment style emerged as a potential interactive factor influencing the impact of spousal support on postpartum depression ( P for interaction = .029).

          Conclusion:

          The provision of spousal support, especially to individuals with secure attachment styles, plays a preventive role in postpartum depression. This underscores the importance of considering attachment styles in interventions targeting postpartum depression prevention.

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          Most cited references26

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          Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

          Background Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. Methods We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6–18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I 2 = 98%), ranging from 3% (2–5%) in Singapore to 38% (35–41%) in Chile. Nations with significantly higher rates of income inequality (R 2 = 41%), maternal mortality (R 2 = 19%), infant mortality (R 2 = 16%), or women of childbearing age working ≥40 h a week (R 2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. Interpretation The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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            Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women

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              Screening for Postpartum Depression and Associated Factors Among Women in China: A Cross-Sectional Study

              Objectives: This study examined what percentage of Chinese mothers during a three-year postpartum period were screened for postpartum depression and explored the correlation between postpartum depression and various socio-demographic, psychological, and cultural factors. Study design: Cross-sectional survey. Methods: A total of 506 mothers 23 years of age and older who were within three years postpartum completed the online survey. The survey collected information such as family economic status, a history of depression, preparation for pregnancy, relationships with husbands, and family members, adult attachment types (Adult Attachment Scale, AAS), and depression (The Center for Epidemiologic Studies Depression Scale, CESD). Results: Approximately 30% of mothers 1–3 years postpartum reported symptoms above the CESD cut-off score (≥16 scores) associated with the risk for depression (28.0% in the first year, 30.8% in the second year, and 31.8% in the third year). Factors significantly associated with depression in participants in the correlation analysis were education level; family income; preparation for pregnancy; a history of depression; amount of time spent with their husbands; relationships with husbands, parents, and parents-in-law; and a close, dependent, and/or anxious attachment style. Multiple regression analyses revealed that a history of depression; less preparation for pregnancy; poorer relationships with husbands, parents, and parents-in-law; and a more anxious attachment style were strongly related to a higher risk of postpartum depression. Conclusion: The overall percentage of mothers after delivery who were vulnerable to depression in China remains high. Various factors were significant predictors of postpartum depression. The research findings have several valuable implications for intervention practices. For example, attachment styles and depression history in the assessments of perinatal depression could improve screenings and the design of interventions. Additionally, improving the family relationships and family environments of women post-delivery may be promising approach for postpartum depression prevention or intervention.
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                Author and article information

                Journal
                Alpha Psychiatry
                Alpha Psychiatry
                Alpha Psychiatry
                AVES
                2757-8038
                June 2024
                01 June 2024
                : 25
                : 3
                : 388-394
                Affiliations
                [1 ]CAS Key Laboratory of Mental Health , Institute of Psychology, Chinese Academy of Sciences, Beijing, China
                [2 ]Department of Psychology , University of Chinese Academy of Sciences, Beijing, China
                [3 ]Health Care Department for Women , Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
                Author notes
                Corresponding author: Zhiyan Chen ✉ chenzhiyan00@ 123456sina.com

                Cite this article as: Liu R, Wu Y, Li H, Chen Z. Attachment style modifies the effect of spousal support on postpartum depression in women. Alpha Psychiatry. 2024; 25(3): 388-394.

                Author information
                http://orcid.org/0009-0006-4251-6066
                http://orcid.org/0009-0002-1574-7740
                http://orcid.org/0009-0003-7926-2942
                http://orcid.org/0000-0002-5924-2376
                Article
                ap-25-3-388
                10.5152/alphapsychiatry.2024.231495
                11322732
                39148601
                b8fb2563-9f7d-4449-bc04-be2332518020
                2024 authors

                Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 22 December 2023
                : 11 April 2024
                Funding
                This work was supported by the National Mental Health Database, Institute of Psychology, Chinese Academy of Sciences (grant number: CAS-WX2021PY-0204)
                Categories
                Original Article

                postpartum depression,social support,attachment styles,mental health,women’s health

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