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

Mother-infant bonding difficulties can impair the emotional connection between mother and child and affect child development. We examined the association between postpartum depressive symptoms (PPDS) and mother-infant bonding in the first year postpartum and explored sociocultural factors that may influence bonding. We employed a cross-sectional mixed-methods approach at three health facilities. Surveys included 399 mothers within 12 months postpartum. PPDS were assessed using the Patient Health Questionnaire-9 with a cut-off 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 significant reduction of 3% in bonding (adjusted mean ratio 0.97; 95% confidence interval 0.95-0.99; p = 0.01), among affected mothers compared to those not affected. However, the magnitude of this association was modest and should be interpreted with caution. Qualitative findings 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.