The role of emotion regulation difficulties in the relationship between attachment representations and depressive and anxiety symptoms in the postpartum period

Abstract

Background: Insecure attachment representations have been established as a vulnerability factor for postpartum depressive symptoms. However, there is a lack of studies on the effects of attachment (in)security on postpartum anxiety symptoms, and on the mechanisms through which attachment representations may affect women's postpartum adjustment, namely, emotion regulation difficulties.

Methods: The sample included 450 women in the postpartum period (up to 12 months postpartum), who were recruited both online (advertisements on social media) and in person (study was presented by the researchers during the women's postpartum hospitalization).

Results: Approximately one third of the women with clinically significant symptoms (33.3%) presented comorbid symptoms of anxiety and depression, and these women presented more insecure attachment representations and more emotion regulation difficulties (p < .001) than did women without comorbid symptoms (p < .001). The relationship between more insecure attachment representations and depressive and anxiety symptoms occurred both directly and indirectly through emotional regulation difficulties.

Limitations: The cross-sectional nature of the study, the use of self-report questionnaires that do not allow the establishment of clinical diagnosis and the self-selected bias in recruitment were study limitations.

Conclusions: The results underline the need for attention to anxiety symptomatology, which is a condition that co-occurs frequently in this period. Interventions that focus on promoting adaptive strategies of emotional regulation are relevant rather than more intensive interventions to change attachment representations.

Keywords: Anxiety symptoms; Attachment representations; Depressive symptoms; Emotion regulation difficulties; Postpartum period.