Maternal childhood trauma and postpartum well-being in a Turkish sample: The path from attachment to alexithymia

Year 2023, Volume: 7 Issue: 1, 1 - 10, 02.05.2023

Yasemin Kahya Sait Uluç

https://doi.org/10.57127/kpd.26024438m000076X

Abstract

Childhood traumas predispose adult individuals to develop insecure attachment styles in close relationships and alexithymia features causing limitations in emotional capacity. For new mothers, postpartum is a period in itself that may increase mood problems such as depression and anxiety and mothers may question their efficacy in their maternal role. Thus, the purpose of the current research was to examine the relationship between maternal childhood trauma, mood problems, and self-efficacy via serial mediation of insecure attachment styles and alexithymia. A sample of postpartum Turkish mothers with healthy singleton infants (N = 63, Mage = 29.19) participated in the research. Mothers filled out the Childhood Trauma Questionnaire-Short Form, the Perceived Maternal Parenting Self-Efficacy Tool, CES-Depression Scale, the State-Trait Anxiety Inventory, the Experiences in Close Relationships Inventory-II, and the Toronto Alexithymia Scale during a home visit when the infants were one month old. In statistical analyses, the PROCESS macro for serial multiple mediation was applied. The results indicated that the relationship between maternal childhood trauma and postpartum depression and anxiety was serially mediated by anxious attachment and, in turn, alexithymia. On the other hand, the serial mediator roles of insecure attachment styles and alexithymia on the relationship between maternal childhood trauma and postpartum self-efficacy were not significant; rather, the direct effect of maternal childhood trauma on postpartum self-efficacy was significant. Findings suggest anxious, rather than avoidant, attachment, and alexithymia as intervention targets to buffer the effects of maternal childhood trauma on postpartum mood problems and self-efficacy, which may consequently prevent the intergenerational transmission of risk.

Keywords

childhood trauma, alexithymia, depression, anxiety, self-efficacy, insecure attachment

Türk bir anne örnekleminde çocukluk çağı travmaları ve postpartum iyilik hali: Bağlan-madan aleksitimiye giden yol

Abstract

Çocukluk çağı travmaları, yetişkin bireylerin yakın ilişkilere yönelik güvensiz bağlanma stilleri geliştirmelerine neden olabilmekte ve bu bireyleri duygusal bir sınırlılığa neden olan aleksitimiya özelliklerine yatkın kılabilmektedir. Yeni anne olanlar için ise postpartum (doğum sonrası) dönemin kendisi depresyon, kaygı gibi duygudurum belirtilerinin yüksek olabildiği ve annelerin kendilerini annelik rolünde yeterlik açısından sorgulayabildikleri bir dönemdir. Buradan hareketle mevcut araştırmanın amacı, çocukluk çağı travmaları ve postpartum depresyon, kaygı ile öz-yeterlik arasındaki ilişkide güvensiz bağlanma stillerinin ve aleksitiminin seri aracı rolünü incelemektir. Araştırmaya ilk ve sağlıklı bebeğine sahip olmuş postpartum dönemdeki Türk anneler katılım sağlamıştır (N = 63, Ort.yaş = 29.19). Bebekleri bir aylıkken yapılan ev ziyaretinde annelere Çocukluk Çağı Travmaları Ölçeği-Kısa Formu, Annelerin Ebeveynliğe İlişkin Algıladıkları Öz-Yeterlik Ölçeği, CES-Depresyon Ölçeği, Durumluk-Sürekli Kaygı Envanteri ve Yakın İlişkilerde Yaşantılar Envanteri-II verilmiştir. İstatistiksel analizlerde, seri aracı analizi için PROCESS makro kullanılmıştır. Bulgular, çocukluk çağı travmaları ve annenin postpartum dönemdeki depresyonu ile kaygısı arasındaki ilişkide, kaygılı bağlanmanın ve takibinde aleksitiminin seri aracı rolü olduğunu göstermiştir. Diğer yandan, çocukluk çağı travmaları ve annenin postpartum dönemdeki öz-yeterliği arasındaki ilişki üzerinde güvensiz bağlanma stillerinin ve aleksitiminin seri aracı rolleri anlamlı olmamıştır. Bunun yerine, annenin postpartum dönemdeki öz-yeterliği üzerinde çocukluk çağı travmalarının doğrudan etkisi anlamlı olmuştur. Bu bulgular, çocukluk çağı travmalarının annenin postpartum dönemdeki duygudurum belirtileri ve öz-yeterliği üzerindeki etkilerini ortadan kaldırmak için kaçınıcı yerine kaygılı bağlanmanın ve aleksitiminin müdahale hedefleri olmasını önermektedir. Böylelikle, riskin nesiller-arası aktarımı önlenebilir.

Keywords

çocukluk çağı travmaları, aleksitimi, postpartum, depresyon, kaygı, öz-yeterlik, güvensiz bağlanma, childhood trauma, alexithymia, depression, anxiety, self-efficacy, insecure attachment

References

• Aceti, F., Aveni, F., Baglioni, V., Carluccio, G. M., Colosimo, D., Giacchetti, N., Mairini, I., Meuti, V., Motta, P., Zaccagni, M., & Biondi, M. (2012). Perinatal and postpartum depression: From attachment to personality. A pilot study. Journal of Psychopathology, 18, 328-334.
• Agishtein, P., & Brumbaugh, C. (2013). Cultural variation in adult attachment: The impact of ethnicity, collectivism, and country of origin. Journal of Social, Evolutionary, and Cultural Psychology, 7(4), 384-405. http://dx.doi.org/10.1037/h0099181
• Aust, S., Alkan Härtwig, E., Heuser, I., & Bajbouj, M. (2013). The role of early emotional neglect in alexithymia. Psychological Trauma: Theory, Research, Practice, and Policy, 5(3), 225-232. https://doi.org/10.1037/a0027314
• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994a). The twenty-item Toronto Alexithymia Scale: I. Item selection and cross validation of the factor structure. Journal of Psychosomatic Research, 38, 23-32. https://doi.org/10.1016/0022-3999(94)90005-1
• Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (2020). Twenty-five years with the 20-item Toronto alexithymia scale. Journal of Psychosomatic Research, 131, 109940. https://doi.org/10.1016/j.jpsychores.2020.109940
• Bagby, R. M., Taylor, G. J., & Parker, J. D. A. (1994b). The twenty-item Toronto Alexithymia Scale: II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38, 33-40. https://doi.org/10.1016/0022-3999(94)90006-X
• Bailey, H. N., Moran, G., & Pederson, D. R. (2007). Childhood maltreatment, complex trauma symptoms, and unresolved attachment in an at-risk sample of adolescent mothers. Attachment & Human Development, 9(2), 139-161. https://doi.org/10.1080/14616730701349721
• Barnes, C. R., & Adamson‐Macedo, E. N. (2007). Perceived Maternal Parenting Self‐Efficacy (PMP S‐E) Tool: Development and validation with mothers of hospitalized preterm neonates. Journal of Advanced Nursing, 60(5), 550-560. https://doi.org/10.1111/j.1365-2648.2007.04445.x
• Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., Stokes, J., Handelsman, L., Medrano, M., Desmond, D., & Zule, W. (2003). Development and validation of a brief screening version of the childhood-trauma questionnaire. Child Abuse & Neglect, 27, 169-190. https://doi.org/10.1016/S0145-2134(02)00541-0
• Besharat, M. A., & Khajavi, Z. (2013). The relationship between attachment styles and alexithymia: Mediating role of defense mechanisms. Asian Journal of Psychiatry, 6(6), 571-576. https://doi.org/10.1016/j.ajp.2013.09.003
• Bianciardi, E., Vito, C., Betrò, S., De Stefano, A., Siracusano, A., & Niolu, C. (2020). The anxious aspects of insecure attachment styles are associated with depression either in pregnancy or in the postpartum period. Annals of General Psychiatry, 19(1), 1-9. https://doi.org/10.1186/s12991-020-00301-7
• Bifulco, A., Figueiredo, B., Guedeney, N., Gorman, L. L., Hayes, S., Muzik, M., Glatigny-Dallay, E., Valoriani, V., Kammerer, M. H., & Henshaw, C. A. (2004). Maternal attachment style and depression associated with childbirth: preliminary results from a European and US cross-cultural study. The British Journal of Psychiatry, 184(46), 31-37. https://doi.org/ 10.1192/bjp.184.46.s31
• Bowlby, J. (1969/1982). Attachment and loss: Vol. 1. Attachment. Basic Books.
• Bowbly, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.
• Brazeau, N., Reisz, S., Jacobvitz, D., & George, C. (2018). Understanding the connection between attachment trauma and maternal self‐efficacy in depressed mothers. Infant Mental Health Journal, 39, 30-43. https://doi.org/10.1002/imhj.21692
• Caldwell, J. G., Shaver, P. R., Li, C. S., & Minzenberg, M. J. (2011). Childhood maltreatment, adult attachment, and depression as predictors of parental self-efficacy in at-risk mothers. Journal of Aggression, Maltreatment, & Trauma, 20, 595-616. https://doi.org/10.1080/10926771.2011.595763
• Carpenter, L., & Chung, M. C. (2011). Childhood trauma in obsessive compulsive disorder: The roles of alexithymia and attachment. Psychology and Psychotherapy: Theory, Research and Practice, 84(4), 367-388. https://doi.org/10.1111/j.2044-8341.2010.02003.x
• England-Mason, G., Kimber, M., Khoury, J., Atkinson, L., MacMillan, H., & Gonzalez, A. (2017). Difficulties with emotion regulation moderate the association between childhood history of maltreatment and cortisol reactivity to psychosocial challenge in postpartum- women. Hormones and Behaviour, 95, 44-56. https://doi.org/10.1016/j.yhbeh.2017.07.007
• Field, T. (2018). Postnatal anxiety prevalence, predictors and effects on development: A narrative review. Infant Behavior and Development, 51, 24-32. https://doi.org/10.1016/j.infbeh.2018.02.005
• Fraley, R. C., Waller, N. G., & Brennan, K. A. (2000). An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology, 78, 350-365. https://doi.org/10.1037/0022-3514.78.2.350
• George, C., Kaplan, N., & Main, M. (1985). The Berkeley adult attachment interview. Unpublished protocol. Berkeley: Department of Psychology, University of California.
• George, C., & Solomon, J. (2008). The caregiving system: A behavioral systems approach to parenting. In J. Cassidy, & P. R. Shaver (Eds.), Handbook of attachment: Theory, research, and clinical application (pp. 833-856). The Guilford Press.
• Gilbert, R., Widom, C.S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373, 6881. https://doi.org/10.1016/S0140-6736(08)61706-7
• Güleç, H., Köse, S., Güleç, M. Y., Çitak, S., Evren, C., Borckardt, J., & Sayar, K. (2009). Reliability and factorial validity of the Turkish version of the 20-item Toronto alexithymia scale (TAS-20). Bulletin of Clinical Psychopharmacology, 19(3), 214-220.
• Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
• Huth-Bocks, A. C., Muzik, M., Beeghly, M., Earls, L., & Stacks, A. M. (2014). Secure base scripts are associated with maternal parenting behavior across contexts and reflective functioning among trauma-exposed mothers. Attachment & Human Development, 16(6), 535-556. https://doi.org/10.1080/14616734.2014.967787
• Ikeda, M., Hayashi, M., & Kamibeppu, K. (2014). The relationship between attachment style and postpartum-depression. Attachment & Human Development, 16, 557-572. https://doi.org/10.1080/14616734.2014.941884
• Kahya, Y., & Uluç, S. (2021). The Perceived Maternal Self-Efficacy Tool (PMS-ET): The adaptation study in the context of attachment styles and mood in the first-time mothers. The Journal of Psychiatry and Neurological Sciences, 1(34), 50-63. https://doi.org/10.14744/DAJPNS.2021.00120
• Kajanoja, J., Karukivi, M., Scheinin, N. M., Ahrnberg, H., Karlsson, L., & Karlsson, H. (2020). Early-life adversities and adult attachment in depression and alexithymia. Development and Psychopathology, 33(4), 1-9. https://doi.org/10.1017/S0954579420000607
• Karukivi, M., Tolvanen, M., Karlsson, H., & Karlsson, L. (2015). Alexithymia and postpartum-anxiety and depression symptoms: A follow-up study in a pregnancy cohort. Journal of Psychosomatic Obstetrics & Gynecology, 36, 142-147. https://doi.org/10.3109/0167482X.2015.1089228
• Koelen, J. A., Eurelings-Bontekoe, E. H., Stuke, F., & Luyten, P. (2015). Insecure attachment strategies are associated with cognitive alexithymia in patients with severe somatoform disorder. The International Journal of Psychiatry in Medicine, 49(4), 264-278. https://doi.org/10.1177/0091217415589303
• Kohlhoff, J., & Barnett, B. (2013). Parenting self-efficacy: Links with maternal depression, infant behaviour and adult attachment. Early Human Development, 89(4), 249-256. https://doi.org/10.1016/j.earlhumdev.2013.01.008
• Li, Y., Long, Z., Cao, D., & Cao, F. (2017). Maternal history of child maltreatment and maternal depression risk in the perinatal period: A longitudinal study. Child Abuse & Neglect, 63, 192-201. https://doi.org/10.1016/j.chiabu.2016.12.001
• Luke, N., & Banerjee, R. (2013). Differentiated associations between childhood maltreatment experiences and social understanding: A meta-analysis and systematic review. Developmental Review, 33, 1-28. https://doi.org/10.1016/j.dr.2012.10.001
• Lyons-Ruth, K., Yellin, C., Melnick, S., & Atwood, G. (2003). Childhood experiences of trauma and loss have different relations to maternal unresolved and hostile-helpless states of mind on the AAI. Attachment & Human Development, 5(4), 330-352. https://doi.org/10.1080/14616730310001633410
• Madigan, S., Wade, M., Plamondon, A., & Jenkins, J. (2015). Maternal abuse history, postpartum-depression, and parenting: Links with preschoolers’ internalizing problems. Infant Mental Health Journal, 36, 146-155. https://doi.org/10.1002/imhj.21496
• Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. Guilford Press.
• Mikulincer, M., & Shaver, P. R. (2016). Attachment in adulthood: Structure, dynamics, and change (2nd ed). Guilford Press.
• Moe, V., Von Soest, T., Fredriksen, E., Olafsen, K. S., & Smith, L. (2018). The multiple determinants of maternal parenting stress 12 months after birth: The contribution of antenatal attachment style, adverse childhood experiences, and infant temperament. Frontiers in Psychology, 9, 1987. https://doi.org/10.3389/fpsyg.2018.01987
• Montebarocci, O., Codispoti, M., Baldaro, B., & Rossi, N. (2004). Adult attachment style and alexithymia. Personality & Individual Differences, 36, 499-507. https://doi.org/10.1016/S0191-8869(03)00110-7
• Morelen, D., Menke, R., Rosenblum, K. L., Beeghly, M., & Muzik, M. (2016). Understanding bidirectional mother-infant affective displays across contexts: Effects of maternal maltreatment history and postpartum-depression and PTSD symptoms. Psychopathology, 49, 305-314. https://doi.org/10.1159/000448376
• Morelen, D., Rosenblum, K. L., & Muzik, M. (2018). Childhood maltreatment and motherhood: Implications for maternal well-being and mothering. In Motherhood in the face of trauma (pp. 23-37). Springer.
• Muller, R. T., Thornback, K., & Bedi, R. (2012). Attachment as a mediator between childhood maltreatment and adult symptomatology. Journal of Family Violence, 27(3), 243-255. https://doi.org/10.1007/s10896-012-9417-5
• Öner, N., & Le Compte, A. (1985). Handbook of state-trait anxiety inventory. Bogazici University.
• Pearson, R. M., Melotti, R., Heron, J., Joinson, C., Stein, A., Ramchandani, P. G., & Evans, J. (2012). Disruption to the development of maternal responsiveness? The impact of prenatal depression on mother–infant interactions. Infant Behavior and Development, 35, 613-626. https://doi.org/10.1016/j.infbeh.2012.07.020
• Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. https://doi.org/10.1177/014662167700100306
• Rallis, S., Skouteris, H., McCabe, M., & Milgrom, J. (2014). The transition to motherhood: towards a broader understanding of perinatal distress. Women and Birth, 27, 68-71. https://doi.org/10.1016/j.wombi.2013.12.004
• Riggs, S. A. (2010). Childhood emotional abuse and the attachment system across the life cycle: What theory and research tell us. Journal of Aggression, Maltreatment & Trauma, 19(1), 5-51. https://doi.org/10.1080/10926770903475968
• Riggs, S. A., Cusimano, A. M., & Benson, K. M. (2011). Childhood emotional abuse and attachment processes in the dyadic adjustment of dating couples. Journal of Counseling Psychology, 58(1), 126-128. https://doi.org/10.1037/a0021319
• Schimmenti, A., & Caretti, V. (2018). Attachment, trauma, and alexithymia. In O. Luminet, R. M. Bagby, & G. J. Taylor (Eds.), Alexithymia: Advances in research, theory, and clinical practice (pp. 127-141). Cambridge University Press.
• Schury, K., Zimmermann, J., Umlauft, M., Hulbert, A. L., Guendel, H., Ziegenhain, U., & Kolassa, I. T. (2017). Childhood maltreatment, postnatal distress and the protective role of social support. Child Abuse & Neglect, 67, 228-239. https://doi.org/10.1016/j.chiabu.2017.02.021
• Selçuk, E., Günaydın, G., Sümer, N., & Uysal, A. (2005). A new scale developed to measure adult attachment dimensions: Experiences in Close Relationships-Revised (ECR-R)- Psychometric Evaluation in a Turkish Sample. Turkish Psychological Articles, 8, 1-11.
• Selçuk, E., Günaydin, G., Sümer, N., Harma, M., Salman, S., Hazan, C., Dogruyol, B., & Ozturk, A. (2010). Self-reported romantic attachment style predicts everyday maternal caregiving behaviour at home. Journal of Research in Personality, 44, 544–54. https://doi.org/10.1016/j.jrp.2010.05.007
• Sexton, M. B., Hamilton, L., McGinnis, E.W., Rosenblum, K. L., & Muzik, M. (2015). The roles of resilience and childhood-trauma history: Main and moderating effects on postpartum- maternal mental health and functioning. Journal of Affective Disorders, 174, 562-568. https://doi.org/10.1016/j.jad.2014.12.036
• Shahab, M. K., de Ridder, J. A., Spinhoven, P., Penninx, B. W., Mook-Kanamori, D. O., & Elzinga, B. M. (2021). A tangled start: The link between childhood maltreatment, psychopathology, and relationships in adulthood. Child Abuse & Neglect, 121, 105228.
• Sifneos, P. E. (1984). Alexithymia: Past and present. American Journal of Psychiatry, 153, 137-142. https://doi.org/10.1176/ajp.153.7.137
• Spangler, G., & Zimmermann, P. (1999). Attachment representation and emotion regulation in adolescents: A psychobiological perspective on internal working models. Attachment & Human Development, 1, 270-290. https://doi.org/10.1080/14616739900134151
• Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). Manual for State-Trait Anxiety Inventory. Consulting Psychologist Press.
• Stein, A., Lehtonen, A., Harvey, A. G., Nicol-Harper, R., & Craske, M. (2009). The influence of postnatal psychiatric disorder on child development. Psychopathology, 42, 11-21. https://doi.org/10.1159/000173699
• Sümer, N. (2012). Attachment patterns from childhood to late adolescence in Turkey. In M. Eskin, Ç. Dereboy, H. Harlak, & F. Dereboy (Eds.), Youth in Turkey: What we know, what we don’t know (pp. 23-32). Turkish Association for Child and Adolescent Psychiatry Publications.
• Sümer, N., & Kağıtçıbaşı, Ç. (2010). Culturally relevant parenting predictors of attachment security: Perspectives from Turkey. In P. Erdman, & K.-M. Ng (Eds.), Attachment: Expanding the cultural connections (pp. 157-180). Routledge/Taylor & Francis Group.
• Sümer, N., Sakman, E., Harma, M., & Savaş, Ö. (2016). Turkish mothers’ attachment orientations and mental representations of their children. Journal of Reproductive and Infant Psychology, 34(1), 49-63. https://doi.org/10.1080/02646838.2015.1092020
• Swanson, B., & Mallinckrodt, B. (2001). Family environment, love withdrawal, childhood sexual abuse, and adult attachment. Psychotherapy Research, 11(4), 455-472. https://doi.org/10.1080/713664062
• Şar, V., Öztürk, E., & İkikardeş, E. (2012). Validity and reliability of the Turkish version of Childhood-trauma Questionnaire. Turkiye Klinikleri Journal of Medical Sciences, 32, 1054-1063. https://doi.org/10.5336/medsci.2011-26947
• Şenkal, İ., & Işıklı, S. (2015). Childhood traumas and attachment style-associated depression symptoms: The mediator role of alexithymia. Turkish Journal of Psychiatry, 26(4), 261-67.
• Tatar, A., & Saltukoglu, G. (2010). The adaptation of the CES-Depression Scale into Turkish through the use of confirmatory factor analysis and item response theory and the examination of psychometric characteristics. Bulletin of Clinical Psychopharmacology, 20, 213-227. https://doi.org/10.1080/10177833.2010.11790662
• Taylor, G. J. (1984). Alexithymia: Concept, measurement, and implications for treatment. The American Journal of Psychiatry, 141, 725–732. https://doi.org/10.1176/ajp.141.6.725
• Taylor, G. J. (2010). Affects, trauma, and mechanisms of symptom formation: A tribute to John C. Nemiah, MD (1918–2009). Psychotherapy and Psychosomatics, 79, 339–349. https://doi.org/10.1159/000320119
• Terock, J., van der Auwera, S., Janowitz, D., Spitzer, C., Barnow, S., Miertsch, M., Freyberger, H. J., & Grabe, H. J. (2016). From childhood trauma to adult dissociation: the role of PTSD and alexithymia. Psychopathology, 49(5), 374-382. https://doi.org/10.1159/000449004
• van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (1996). Attachment representations in mothers, fathers, adolescents, and clinical groups: A meta-analytic search for normative data. Journal of Consulting and Clinical Psychology, 64(1), 8-21. https://doi.org/10.1037/0022-006X.64.1.8
• Warfa, N., Harper, M., Nicolais, G., & Bhui, K. (2014). Adult attachment style as a risk factor for maternal postnatal depression: A systematic review. BMC Psychology, 2, 1-11. https://10.1186/s40359-014-0056-x
• Wearden, A., Cook, L., & Vaughan-Jones, J. (2003). Adult attachment, alexithymia, symptom reporting, and health-related coping. Journal of Psychosomatic Research, 55, 341–347. https://doi.org/10.1016/S0022-3999(02)00635-9
• Zheng, L., Luo, Y., & Chen, X. (2020). Different effects of attachment anxiety and attachment avoidance on depressive symptoms: A meta-analysis. Journal of Social and Personal Relationships, 37(12), 3028-3050. https://doi.org/10.1177/0265407520946482
• Zou, Z., Huang, Y., Wang, J., He, Y., Min, W., Chen, X., Wang, J., & Zhou, B. (2016). Association of childhood trauma and panic symptom severity in panic disorder: Exploring the mediating role of alexithymia. Journal of Affective Disorders, 206, 133-139. https://doi.org/10.1016/j.jad.2016.07.027