Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal?
Abstract
Purpose Although the negative consequences of maternal depression on infants has been documented in several Western societies, similar studies have not been conducted in Middle-Eastern countries where cultural norms and traditions may differ. The main objective of this study was to determine the risk factors for postpartum depression (PPD) and its relationship to mother -infant bonding in a Lebanese population. Methods One hundred and fifty participants were administered the Edinburgh Postpartum Depression Scale (EPDS), and the social support scale at 2-3 days postpartum. At 10-12 weeks mother-infant bonding using the Postpartum Bonding Questionnaire (PBQ) and depression using the Beck Inventory (BDI-II) were assessed during a telephone interview. Results The prevalence of depression was 19% with an average score of 10.9 ± 6.02 on the EPDS. At 10-12 weeks 2.7% of the whole sample was depressed with an average score of 18.60 ± 16.87 on the BDI-II. Risk factors of PPD on the EPDS were; history of alcohol use, complications during pregnancy, not a good marital relationship, baby admitted to an intensive care unit, history of depression and low social support. Risk factors for impaired bonding were age, history of depression, BDI-II scores above 20 and low social support. The multiple regression analysis found that impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance, F = 7.12, p = 0.02. Conclusion The prevalence of PPD was higher than previously reported at day 2-3 post-delivery, but lower at 10-12 weeks postpartum. Impaired mother- infant bonding was associated older mothers, history of depression, low social support and BDI-II scores above 20 which should alert practitioner to assessing these factors in post-partum mothers.
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Numerous studies emphasize the importance of early diagnosis and treatment of PPD.
“This notion is supported by numerous studies emphasizing the importance of early diagnosis and treatment of PPD [30, 31].”
From Challenges in diagnosing and treating postpartum depression in the primary care Setting- a qualitative study (2025) · cites this paper as [30]
Cites
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Dubber, S., Reck, C., Müller, M., & Gawlik, S. (2015) · Archives of Women's Mental Health · doi:10.1007/s00737-014-0445-4 · Cited by 400 · cited 1× · see citing works
“…were assessed in this study and included: age, parity, education, type of delivery, complications during pregnancy, happy with pregnancy, infant’s gender, social support,history of alcohol use and depression and having a sick newborn (Dennis & Ross, 2006; Dubber et al., 2015; Ko et al., 2017).”
MethodTrends in postpartum depressive symptoms- 27 States, 2004, 2008, and 2012
Ko, J. Y., Rockhill, K. M., Tong, V. T., Morrow, B., & Farr, S. L. (2017) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6606a1 · Cited by 334 · see citing works
Association between parental depressive symptoms and impaired bonding with the infant
Kerstis, B., Aarts, C., Tillman, C., Persson, H., Engström, G., Edlund, B., Öhrvik, J., Sylvén, S., & Skalkidou, A. (2016) · Archives of Women's Mental Health · doi:10.1007/s00737-015-0522-3 · Cited by 165 · see citing works
Mother-to-Infant Emotional Involvement at Birth
Figueiredo, B., Costa, R., Pacheco, A., & Pais, Á. (2009) · Maternal and Child Health Journal · doi:10.1007/s10995-008-0312-x · Cited by 145 · see citing works
Screening and diagnosing postpartum depression: When and how?
Moraes, G. P. D. A., Lorenzo, L., Pontes, G. A. R., Montenegro, M. C., & Cantilino, A. (2017) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2016-0034 · Cited by 138 · see citing works
Tharner, A., Luijk, M. P. C. M., van IJzendoorn, M. H., Bakermans-Kranenburg, M. J., Jaddoe, V. W. V., Hofman, A., Verhulst, F. C., & Tiemeier, H. (2012) · Attachment & Human Development · doi:10.1080/14616734.2012.636659 · Cited by 69 · see citing works
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Krepak, D. K., Kopit, A. B., Biderman, A., Yehoshua, I., & Adler, L. (2025) · BMC Primary Care · doi:10.1186/s12875-025-03004-8 · Cited by 1 · see citing works
- Authors
- Badr, L. K., Ayvazian, N., Lameh, S., & Charafeddine, L.
- Affiliations
- Azusa Pacific University (US)
- American University of Beirut Medical Center (LB)
- Corresponding author
- Badr, Lina Kurdahi
- Venue
- Infant Behavior and Development
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 51
- Pages
- 15-23
- ISSN
- 0163-6383 (ISSN-L)
- OpenAlex
- W2790360731
- Cited by
- 71
- References
- 8
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 10 · 2023: 11 · 2022: 11 · 2021: 10 · 2020: 5 · 2019: 8
- FWCI
- 5.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Infant Behavior and Development (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- postpartum depression, mother-infant bonding, social support, risk factors, Lebanese women, Middle Eastern culture, maternal depression, history of depression, maternal age, pregnancy complications, intensive care unit admission
- MeSH terms
- Adult, Female, Hospitalization, Humans, Infant, Lebanon, Longitudinal Studies, Male, Mothers, Object Attachment, Pregnancy, Prospective Studies, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Social Support, Depression, Postpartum
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