Qualities of Attachment-Based Representations of Infants In Utero Differentially Moderate the Impact of Depression on Child Maltreatment Risk Among Expectant Mothers and Fathers

Purpose: While maternal depression is a significant risk factor for child maltreatment (CM), this link has not been examined among fathers, and the factors that moderate this association differently for mothers versus fathers. Attachment theory guides our current investigation of potential moderators. Parents’ attachment-based representations of infants, including the ways that parents interpret infants’ behaviors and the emotional states that color their perceptions of the infant, determine parent-child relationship quality and parenting behaviors. Grounded in this framework, the purpose of this study was to examine how maternal and paternal representations moderate the influence of depression on parents’ CM risk differently for expectant fathers versus mothers.

Methods: Data were collected from 51 low income urban-dwelling expectant heterosexual couples. Parents were interviewed during the third trimester of pregnancy using the Working Model of the Child Interview, the Brief Child Abuse Potential Scale, and the Edinburgh Perinatal Depression Scale. Using linear regression and Bootstrapping in PROCESS for SPSS, we examined the direct association between prenatal depression and CM risk, and the role of attachment-based representations in moderating this association.

Results: Depression was significantly positively associated with mothers’ (β=.48, p<.001) and fathers’ (β=.42, p=.02) CM risk. Distinct qualities of parents’ attachment-based representations of infants in utero were also directly associated with CM risk. Among mothers, greater sensitivity (β= -.339, p=.005), acceptance (β= -.25, p=.05), and reflective functioning (β = -.27, p=.04) were associated with lower CM risk, while greater anger (β=.40, p=.001), anxiety (β=.28, p=.02), resentment (β=.328, p<.05), helplessness (β=.33, p=.007), and perception of infant difficulty (β=.34, p=.008) were associated with greater CM risk. Among fathers, greater helplessness in parenting (β=.35, p=.009) and guilt (β =.39, p=.005) were associated with higher CM risk. Distinct qualities of representations moderated the impact of depression on child maltreatment risk for mothers versus fathers. Positive representations (sensitivity t= -2.41, p=.02; acceptance t= -3.01, p=.005; reflective functioning t= -2.44, p=.02) mitigated the impact of maternal depression on CM risk, while negative representations (helplessness t=5.07, p<.001; infant difficulty t=3.10, p=.004; resentment t=2.98, p=.005) increased the impact of maternal depression on CM risk for mothers. Among fathers, intensity of emotional involvement (t=2.401, p=.02), acceptance of the parenting role (t=2.233, p=.03), joy (t=2.599, p=.01), indifference (t= -2.673, p=.02), and fear (t=2.781, p<.008) all moderated the association between depression and CM risk.

Conclusion: This study adds to a growing understanding of the distinct importance of fathers’ mental health and internal experiences of infants and the parenting role to early parenting. Prenatal depression is associated with CM risk in both expectant mothers and fathers, and distinct qualities of attachment-based representations of the infant in utero moderate this association. Understanding and assessing pertinent qualities of attachment representations for mothers and fathers may further social workers’ capacity to assess CM risk during early parenting. Assessing depression and representations of the infant among fathers, as well as mothers, and intervening with both mother-infant and father-infant relationships may mitigate the impact of depression on the parent-infant relationship and infant development, contributing to an equitable future for all.