Relationship between birth satisfaction and mother-baby bonding: The role of posttraumatic stress disorder and depressive symptoms following childbirth

Važnu ulogu u povezivanju majke s dojenetom ima mentalno zdravlje, posebno razliite emocionalne teškoće koje se mogu javiti nakon porođaja. Posttraumatski stresni poremećaj (PTSP) nakon porođaja javlja se kod 3 do 4% svih majki, u visokom je komorbiditetu s poslijeporođajnom depresijom te je povezan s iskustvom porođaja. Recentno istraživanje je pokazalo kako simptomi PTSP-a i depresije nakon porođaja djeluju kao serijalni medijatori između zadovoljstva porođajem i povezivanja majke i dojeneta (Blažević i sur., 2018). Dosadašnja istraživanja PTSP-a nakon porođaja koristila su općenite mjere simptoma PTSP-a koje nisu pratile nove kriterije prema DSM-5. Cilj ovog istraživanja bio je provjeriti prethodno spomenuti model serijalne medijacije koristeći pritom novu skalu simptoma PTSP-a prema kriterijima DSM-5, specifino razvijenu za žene nakon porođaja. U jednokratnom korelacijskom istraživanju sudjelovale su majke dojenadi dobi od 1 do 12 mjeseci (N=590) koje su online ispunile Revidiranu skalu zadovoljstva porođajem (Hollins Martin i Martin, 2014), Skalu porođajne traume City (Ayers i sur., 2018), Edinburšku ljestvicu poslijeporođajne depresivnosti (Cox i sur., 1987) i Upitnik poslijeporođajnog povezivanja (Brockington i sur., 2001). Uinjena je i validacija hrvatske verzije Skale porođajne traume City, kojom je utvrđeno kako Skala pokazuje zadovoljavajuće psihometrijske karakteristike u identifikaciji PTSP-a nakon porođaja. Utvrđena je dvofaktorska struktura te se pokazala visoko pouzdanom. Serijalnom je analizom provjeren model uinka zadovoljstva porođajem na povezivanje majke s dojenetom, pri emu su simptomi PTSP-a nakon porođaja bili prvi medijator, a poslijeporođajna depresivnost drugi medijator. Model se pokazao statistiki znaajnim, pri emu je zadovoljstvo porođajem imalo neizravan uinak na majino povezivanje s dojenetom putem serijalne medijacije simptoma PTSP-a i depresije nakon porođaja. Izravni uinak zadovoljstva porođajem na povezivanje majke s dojenetom nije se pokazao znaajnim. Dobiveni rezultati upućuju na važnost zadovoljstva porođajem za povezivanje majke s dojenetom te na pripadajuću važnost identifikacije simptoma PTSP-a i depresije nakon porođaja.Mental health has a vital role in mother-infant bonding, especially regarding different emotional difficulties which can appear after childbirth. Posttraumatic stress disorder (PTSD) following childbirth affects 3-4% of mothers, it is highly co-morbid with postnatal depression (PND), and also correlates with the birth experience. A recent study showed that PTSD and PPD symptoms acted as serial mediators in a relationship between childbirth experience and mother-infant bonding (Blažević et al., 2018). However, previous studies used non-specific PTSD measures that did not follow the new DSM-5 criteria. The aim of this study was to test the previously mentioned model of serial mediation while using a new questionnaire developed specifically to measure birth-related PTSD, according to DSM-5 criteria. In a crosssectional online study 590 mothers of infants aged 1 to 12 months completed the following questionnaires: Birth Satisfaction Scale–Revised (Hollins Martin & Martin, 2014), City Birth Trauma Scale (Ayers et al., 2018), Edinburgh Postnatal Depression Scale (Cox et al., 1987) and Postpartum Bonding Questionnaire (Brockington et al., 2001). Validation of the Croatian version of City Birth Trauma Scale showed good psychometric properties in identifying PTSP following childbirth. Principal component analysis resulted in two correlated components. Scale has also shown high reliability. Serial mediation analysis tested the model of birth satisfaction effect on mother-infant bonding, where PTSD symptoms were entered as the first mediator and PND symptoms as the second mediator. The model was significant, whereas birth satisfaction had an indirect effect on mother-infant bonding through a serial mediation by PTSD and PPD symptoms. On the other hand, a direct effect of birth satisfaction on motherinfant bonding was not significant. These findings highlight the importance of birth satisfaction for early bonding between mother and baby. Also, screening for PTSD and PND symptoms should be an integral part of standard perinatal health care