Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis

Purpose Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. Methods We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. Results We included 133 studies representing 118 samples; 99 samples (110,968 mothers) were eligible for meta-analysis. Results showed concurrent associations across a range of timepoints during the first year postpartum, between bonding problems and depression ( r = .27 [95% CI 0.20, 0.35] to r = .47 [95% CI 0.41, 0.53]), anxiety ( r = .27 [95% CI 0.24, 0.31] to r = .39 [95% CI 0.15, 0.59]), and stress ( r = .46 [95% CI 0.40, 0.52]). Associations between antenatal distress and subsequent postpartum bonding problems were mostly weaker and with wider confidence intervals: depression ( r = .20 [95% CI 0.14, 0.50] to r = .25 [95% CI 0.64, 0.85]), anxiety ( r = .16 [95% CI 0.10, 0.22]), and stress ( r = .15 [95% CI − 0.67, 0.80]). Pre-conception depression and anxiety were associated with postpartum bonding problems ( r = − 0.17 [95% CI − 0.22, − 0.11]). Conclusion Maternal psychological distress is associated with postpartum mother-infant bonding problems. Co-occurrence of psychological distress and bonding problems is common, but should not be assumed. There may be benefit in augmenting existing perinatal screening programs with well-validated mother-infant bonding measures.