Hamideh Bayrampour Basmenj

Background: Anxiety, feelings of persistent and excessive worry about numerous events or activities, is common during the first year postpartum. Postpartum-specific anxiety is considered a distinct concept from general anxiety, wherein the mother’s anxiety is maternal- and infant-focused. The mother-infant bond is defined as the physical and emotional connection developed from mother to infant in the first years of life. Poor bonding is associated with adverse health and psychological outcomes for mother and child. Most research on this topic has focused on associations between mother-infant bonding, general anxiety, and postpartum depression. Evidence on the role of postpartum-specific anxiety is scarce.Objectives: The aim of this research was to assess associations between general and postpartum-specific anxiety and mother-infant bonding, and to determine if there is variance in mother-infant bonding quality that can be uniquely explained by postpartum-specific anxiety. Methods: A cross-sectional study using data from the Pregnancy Specific Anxiety Scale study was conducted. Mothers of singleton infants were followed from pregnancy through 4 months postpartum. Mother-infant bonding quality was measured using the Mother-to-Infant Bonding Scale (MIBS) (primary outcome). A modified version of the Postpartum Bonding Questionnaire (PBQ) was used to measure bonding disorders (secondary outcome) at 4 months postpartum. General anxiety and postpartum-specific anxiety were measured using the Generalized Anxiety Disorder Scale (GAD-7), and Postpartum Worry Scale-Revised (PWS-R), respectively. To examine associations between general and postpartum-specific anxiety and mother-infant bonding, multiple linear regression models were constructed while accounting for confounders.Results: The study sample included 297 postpartum participants. General anxiety was not a significant predictor of mother-infant bonding quality or disorder, after controlling for postpartum depression and other confounders. No significant associations were found between postpartum-specific anxiety and bonding quality (as measured by the MIBS). Postpartum-specific anxiety was significantly associated with bonding disorders as measured by the PBQ (p=0.006). Postpartum depression remained a significant predictor of mother-infant bonding quality and disorders in all multivariate models.Conclusion: Findings showed a small, but unique contribution of postpartum-specific anxiety to disordered mother-infant bonding. Results also confirmed the significant influence of postpartum depression on the mother-infant bond, which has been well established in previous literature.

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This thesis presents an interpretive description of twelve primary antenatal care providers’ (PACP) attitudes and perspectives towards anxiety and depression (AD) during pregnancy.In British Columbia (BC), pregnant people (PP) can choose to be cared for throughout the perinatal period by a Family Physician (FP), Registered Midwife (RM), and/or Obstetrician-Gynecologist (ObGyn). Each profession operates under different mandates and care modalities. Thus, a purposive sample of twelve English-speaking PACPs (n=12) participated in one-on-one semi-structured interviews, including five FPs, four RMs, and three ObGyns. Interviews were transcribed verbatim and analyzed inductively using thematic analysis. Current practices in identifying and managing AD with PP, existing resources to support mental health during pregnancy, PACP’s perceived capacity to address AD during pregnancy, what could help address AD, and considerations for implementation in perinatal care settings are described. The knowledge constructed throughout interviews, analysis, and reporting portrays complex phenomena with significant implications for research, practice and policy.Anxiety and depression in the antenatal period are associated with short and long-term morbidity for PP and families. As the main and most constant point of contact with the healthcare system, PACPs are instrumental in shaping healthy pregnancy outcomes. With increasing calls to integrate mental health in perinatal care, this thesis explores and describes the perspectives of those on the frontline of care and offers insights to how we can improve responsiveness to needs. The latter focuses on organizational and system-level supports needed to facilitate the integration of mental health in perinatal care in the interest of healthy pregnancy outcomes.

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