Postpartum bonding at the beginning of the second year of child’s life: the role of postpartum depression and early bonding impairment

Background: We evaluated the association between mother–child bonding and maternal depression at 6–8 months after birth with bonding impairment at 12–15 months in a sample of mothers at high risk of postnatal depression. Methods: A prospective cohort study with 346 low-income postpartum women with antenatal depression. The Postpartum Bonding Questionnaire (PBQ) and the Patient Health Questionnaire-9 (PHQ-9) were used, at 6–8 and 12–15 months after delivery, to assess the mother–infant bonding and postnatal depression (PPD), respectively. Results: The percentage of the main outcome, bonding impairment (BI) at 12–15 months, was 9.9% (95% CI 6.6–13.7). Using logistic regression models, BI was associated with: having an occupation (OR = 2.82; 95% CI 1.00–7.94, p =.049), unplanned pregnancy (OR = 3.46; 95% CI 1.01–11.8, p =.047), and presence of BI at 6–8 months (OR= 13.0; 95% CI 3.76–45.4, p ≤.001). Maternal depression was marginally associated with BI at 12–15 months. Conclusions: BI affects 1 in 10 mothers, and although BI and PPD are strongly associated at 6–8 and 12–15 months after delivery, BI at 6–8 months is the main predictor of later BI. Based on the study findings, PPD screening in combination with BI assessment is highly recommended during the first year of child’s life.