Postpartum Depressive Symptoms and Mother–Infant Bonding: A Mixed-Methods Study Among Postpartum Women in Ghana

Abstract

Mother–infant bonding difculties can impair the emotional connection between mother and child and afect child development. We examined the association between postpartum depressive symptoms (PPDS) and mother–infant bonding in the frst year postpartum and explored sociocultural factors that may infuence bonding. We employed a cross-sectional mixed-methods ap proach at three healthfacilities. Surveys included 399 mothers within12 monthspostpartum.PPDSwereassessedusingthePatient Health Questionnaire-9 with a cut-of score >9, and bonding was measured with the Pre- and Postnatal Bonding Scale. We used a log-normal multivariable regression model to estimate the association between PPDS and mother–infant bonding, adjusting for potential confounders. Qualitative interviews were conducted with 31 mothers (19 with depressive symptoms and 12 without) and were analysed thematically. Overall, 29% of mothers screened positive for depressive symptoms. Screening positive was associated with a small, statistically signifcant reduction of 3% in bonding (adjusted mean ratio 0.97; 95% confdence interval 0.95–0.99; p =0.01), among afected mothers compared to those not afected. However, the magnitude of this association was modest and should be interpreted with caution. Qualitative fndings suggested that bonding appeared to be sustained through maternal instinct; caregiving; social support and religious, cultural and societal expectations in both groups, which may help explain the modest association observed. Culturally sensitive support and strengthened social networks may help mothers maintain strong bonds during the postpartum period.