رابطه بین دلبستگی بزرگسالان و افسردگی در مادران کره ای در اولین 2 سال پس از زایمان: مدل میانجی گری نظارت شده عزت نفس و خودکارآمدی مادران

This study examined a possible pathway to better understand the relationships between attachment schema and maternal depression through self-esteem and maternal self-efficacy. Questionnaires regarding attachment style, self-esteem, maternal self-efficacy, and depression were completed by 176 mothers who visited paediatrics centres. The results showed that self-esteem fully mediated the relationship between preoccupied attachment and maternal depression and partially mediated the association between fearful attachment and maternal depression. The mediating effects of self-esteem in the relationship between insecure attachments (preoccupied and fearful types) were moderated by the mother’s parenting efficacy. More specifically, mothers with high maternal efficacy (scores ⩾ 32, upper 10th percentile) were protected from the detrimental impact of attachment insecurity and low self-esteem on maternal depression, compared with mothers with low parenting-efficacy. Maternal depression benefits from intervention targeting the mother’s parenting efficacy.

Women of child-rearing age are at high risk for depression, with a prevalence of 7–14.5% in the first 3 months after childbirth and 8–15% during the first year (Gavin et al., 2005, Murray and Cooper, 1997 and O’Hara and Swain, 1996). Of mothers who have experienced postpartum depression, 50–60% are twice as likely to experience subsequent depression over the first postpartum year, compared with those without postpartum depression (Cooper & Murray, 1995; see Goodman, 2004 for a review). This implies that attention to postpartum depression should extend through the first 2 years after giving birth. Insecure attachment in close adult relationships is considered a risk factor for depressive symptoms (Gotlib and Hammen, 1992, Hammen et al., 1995 and Mickelson et al., 1997). However, only a few studies have examined this relationship in the context of postpartum depression. In a longitudinal study, Bifulco et al. (2004) found that preoccupied and fearful adult attachment types significantly predicted the onset of postpartum depression. Meredith and Noller (2003) reported that, when measuring adult attachment style, mothers with a preoccupied attachment type were more prone to experiencing elevated depressive symptoms than those with secure attachment styles during their postnatal periods. Recently, Wilkinson and Mulcahy (2010) found that mothers with preoccupied and fearful attachment styles in their close adult relationships reported higher levels of depressive symptoms than did those with secure and dismissive attachment styles. Insecure attachment might affect psychopathology indirectly via a mediating effect through self-esteem. For example, Roberts, Gotlib, and Kassel (1996) found that insecure adult attachment, mediated by low self-esteem, led to depression in university students. Similarly, Lee and Hankin (2009) showed that self-esteem mediated the relationship between anxious adult attachment type (not avoidant) and depression among adolescents. Although self-esteem could be an important psychological characteristic of the mother, only a few studies have explored the role of global self-esteem on mother’s psychological well-being. As postpartum mothers, compared with non-postpartum individuals, are more likely to suffer from fewer social contacts and child-rearing stress, mothers with insecure adult attachment might be more susceptible to low self-esteem, which in turn, affects a mothers’ depressive symptoms. Few studies so far have explored the possible role of mother’s self-esteem on her depressive symptoms. For example, one study found that daily stressors during the postpartum period affected postpartum depressive symptoms through the mother’s self-esteem (Hall, Kotch, Browne, & Rayens, 1996). Another study reported that, during postpartum period, mother’s self-esteem significantly predicted maternal self-efficacy, which in turn had significant impact on mother’s behaviours under infant-rearing distress (Leerkes & Crockenberg, 2002). Mother’s self-esteem might therefore play a pivotal role in not only mother’s depressive symptoms but also her own maternal behaviours. In the present study, we aim to explore the mediating mechanism of self-esteem in the relationship between insecure adult attachment and mother’s depressive symptoms. Along with mother’s self-esteem, maternal self-efficacy, as defined as a person’s belief in her abilities to carry out various parenting roles (Coleman & Karraker, 1998), has been considered to play a pivotal role in parenting styles, as well as in the mother’s well-being. There is evidence that higher parental self-efficacy is associated with positively attuned interactive and sensitive parenting (Ardelt and Eccles, 2001, Bohlin and Hagekull, 1987, Donovan et al., 1990 and Teti and Gelfand, 1991), whereas lower parental self-efficacy is related to a hostile and aggressive attitude in the face of difficult child behaviours (Bondy and Mash, 1999 and Gross et al., 1999). Research has found that parental self-efficacy is associated with maternal depression (Cutrona, 1984, Leahy-Warren et al., 2012 and Surkan et al., 2008). For example, Porter and Hsu (2003) found that the prenatal anticipated maternal self-efficacy and 1-month maternal efficacy were associated inversely with concurrent depression. Studies have shown that parental efficacy mediated the effect of infant difficulty or social support on postpartum depression (Cutrona and Troutman, 1986 and Haslam et al., 2006). However, research considering parental efficacy as a moderator is sparse. Bolten, Fink, and Stadler (2012) found that high maternal efficacy, measured during the mother’s third trimester, buffered the postpartum effect of prenatal stress on the infant’s crying, suggesting the importance of intervention on maternal self-efficacy in parenting programs. In sum, previous studies have shown that insecure attachment, especially fearful and preoccupied type, was significantly associated with an increased risk of postpartum depression. The mediating effect of self-esteem in the relationship between attachment insecurity and depressive symptoms has been reported in university students and adolescents, but not in mothers under a stress condition of postpartum period. The present study aims to investigate the possible mediating effect of mother’s self-esteem in the link between mother’s insecure attachment and depressive symptoms. On the other hand, there has been evidence that mother’s self-esteem significantly predicts maternal efficacy which has also been associated with postpartum depression. Following a recent study that considered maternal efficacy as a moderator (Bolten et al., 2012), the present study, for the first time, proposes the moderated mediation model of self-esteem and maternal efficacy in the relationship between mother’s insecure attachment and depressive symptoms. More specifically, we investigated whether the mediating effect of self-esteem in the relationship between insecure attachment and maternal depression would be moderated by maternal efficacy. The specific hypotheses examined were as follows: Hypothesis 1: Self-esteem mediates the relationship between insecure adult attachment (preoccupied or fearful attachment) and maternal depression. Hypothesis 2a: The inverse relationship between self-esteem and maternal depression is weaker in mothers with high maternal efficacy than in those with low maternal efficacy. Hypothesis 2b: Maternal efficacy moderates the positive and indirect effect of insecure adult attachment (preoccupied and fearful) on maternal depression via self-esteem. Specifically, self-esteem mediates the relationship between insecure adult attachment and maternal depression when maternal efficacy is low, but not when it is high. Figure 1 outlines the moderated mediation model proposed here. Full-size image (10 K) Fig. 1. Model of moderated mediation.

Table 1 presents the Pearson correlations, mean scores, and standard deviations for each of the variables, i.e., preoccupied attachment, fearful attachment, dismissive attachment, secure attachment, self-esteem, maternal efficacy, and depression. Preoccupied attachment was correlated inversely with self-esteem (r = −0.37, p < 0.001) and positively to depression (r = 0.32, p < 0.001). Fearful attachment was correlated inversely with self-esteem (r = −0.41, p < 0.001) and positively with depression (r = 0.35, p < 0.001). The dismissive and secure attachments were not correlated with depression (dismissive, r = −0.03, ns; secure, r = −0.15, ns) and were excluded from the subsequent analysis. Self-esteem was correlated positively with maternal efficacy (r = 0.42, p < 0.001) and inversely with depression (r = −0.54, p < 0.001). Maternal efficacy was also related inversely to depression (r = −0.37, p < 0.001).