Mother-child bonding assessment tools

Perrelli, Jaqueline Galdino Albuquerque; Zambaldi, Carla Fonseca; Cantilino, Amaury; Sougey, Everton Botelho

doi:10.1590/0103-0582201432318

Acessibilidade / Reportar erro

Brasil

Revista Paulista de Pediatria

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW ARTICLES • Rev. paul. pediatr. 32 (3) • Sept 2014 • https://doi.org/10.1590/0103-0582201432318 copy

Mother-child bonding assessment tools^☆ ☆ Study conducted at Universidade Federal de Pernambuco, Recife, PE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools.

Data source:

Research studies available on PUBMED, LILACS, ScienceDirect, PsycINFO and CINAHL databases with the following descriptors: mother-child relations and mother infant relationship, as well as the expressions validity, reliability and scale.

Data synthesis:

23 research studies were selected and fully analyzed. Thirteen evaluation research tools were identified concerning mother and child attachment: seven scales, three questionnaires, two inventories and one observation method. From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child.

Conclusions:

The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area.

Mother-child relations; Maternal behavior; Reproducibility of results

Instrumentos	Tipo	Estudos	Propriedades Psicométricas: Validade
MFAS/PFAS	Scale	Sjögren et al¹²12 Sjögren B, Edman G, Widström AM, Mathiesen AS, Uvnäs-Moberg K. Maternal foetal attachment and personality during first pregnancy. J Reprod Infant Psychol 2004;22:57-69.	Construct validity: Factorial analysis (FA): five factor model (concern for the health and behavior of the fetus, mental preparation for caring for the child, the experience of pregnancy, experience with fetal movements, and baby's name).
MFAS/PFAS	Scale	Shin, Kim¹³13 Shin H, Kim YH. Maternal attachment inventory: psychometric evaluation of the Korean version. J Adv Nurs 2007;59:299-307.	Criterion validity – Concurrent validity: correlation with MFAS-MAI: r=0.46 (p<0.01).
MAAS	Scale	Gomez, Leal¹⁴14 Gomez R, Leal I. Vinculação parental durante a gravidez: versão portuguesa da forma materna e paterna da antenatal emotional attachment scale. Psic Saude & Doenças 2007;8:153-65.	Construct validity: two-factor model. Adjusted version showed better reliability: maternal with 17 items and paternal with 14 items.
PAI	Inventory	Gau, Lee¹⁵15 Gau ML, Lee TY. Construct validity of the prenatal attachment inventory: a confirmatory factor analysis approach. J Nurs Res 2003;11:177-87.	Construct validity: FA: 1-factor model.
PAI	Inventory	Damato¹⁶16 Damato EG. Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 2004;4:274-91.	Criterion validity - Concurrent validity: PAI-MAI Correlation (r=0.38)

Tools	Type	Studies	Psychometric properties: reliability
MFAS/PFAS	Scale	Shin, Kim¹³13 Shin H, Kim YH. Maternal attachment inventory: psychometric evaluation of the Korean version. J Adv Nurs 2007;59:299-307.	Internal consistency: MFAS: α=0.92
		Seimyr et al¹⁷17 Seimyr L, Sjögren B, Welles-Nyström B, Nissen E. Antenatal maternal depressive mood and paternal-fetal attachment at the end of pregnancy. Arch Womens Ment Health 2009;12:269-79.	Internal consistency: MFAS: total α=0.82; MFAS subscales: variation of α=0.50 to α=0.70; PFAS: total α=0.85; and PFAS subscales: variation of α=0.40 to α=0.80.
		Ustunsoz et al¹⁸18 Ustunsoz A, Guvenc G, Akyuz A, Oflaz F. Comparison of maternal-and paternal-fetal attachment in Turkish couples. Midwifery 2010;26:1-9.	Internal consistency of the translated version and adapted to Turkish culture: MFAS (α=0.82) and PFAS (α=0.86).
MAAS	Scale	Gomez, Leal¹⁴14 Gomez R, Leal I. Vinculação parental durante a gravidez: versão portuguesa da forma materna e paterna da antenatal emotional attachment scale. Psic Saude & Doenças 2007;8:153-65.	Internal consistency: maternal: α=0.78 and paternal: α=0.73.
MAAS	Scale		Stability (test-retest): test: r=0.69 (maternal) and r=0.80 (paternal).
MAMA	Questionnaire with subscales	Figueiredo et al¹⁹19 Figueiredo B, Mendonça M, Sousa R. Versão portuguesa do maternal adjustment and maternal attitudes (MAMA). Psic Saude & Doenças 2004;5:31-51.	Internal consistency and coefficient of bipartition (split-half): MAMA total: α=0,85 and split-half r=0.86; Subscale: body image: α=0.74 and split-half r=0.76;
			Subscale: somatic symptoms: α=0.62 and split-half r=0.65;
			Subscale: marital relationship: α=0.75 and split-half r=0.75;
			Subscale: attitudes toward sex: α=0.82 and split-half r=0.80;
			Subscale: attitudes toward the pregnancy and the baby: α=0.48 and split-half r=0.54.
PAI	Inventory	Gau, Lee¹⁵15 Gau ML, Lee TY. Construct validity of the prenatal attachment inventory: a confirmatory factor analysis approach. J Nurs Res 2003;11:177-87.	Internal consistency: α=0.89.
		Damato¹⁶16 Damato EG. Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 2004;4:274-91.	Internal consistency total PAI: α=0.89.

Instrumentos	Estudos	Propriedades Psicométricas: Medidas de validade
PBQ	Reck et al²⁹29 Reck C, Klier CM, Pabst K, Stehle E, Steffenelli U, Struben K et al. The german version of the postpartum bonding instrument: psychometric properties and association with postpartum depression. Arch Womens Ment Health 2006;9:265-71.	CV: PBQ and EPDS: r=0.43 (25 items) and r=0.41 (16 items), with p<0.001. FA: one-factor model. Nine items showed non-significant factorial load and were therefore removed from the German version.
	Bronckington et al³⁰30 Bronckington IF, Fraser C, Wilson D. The postpartum bonding questionnaire: a validation. Arch Womens Ment Health 2006;9:233-42.	PV: WB: (E=0.68, S=0.82); RR: (E=0.95, S=0.88); A: (E=0.64, S=0.61). IA showed low sensitivity.
	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	CV: PBQ - total PAQ: 8^th-12^th week after birth: (ρ=-0.67); 20^th-25^th week (ρ=-0.63).
		Total PBQ - MIBS: 8^th-12^th week (ρ=0.60) and 20^th-25^th week (ρ=0.56)
	Wittkowski et al³²32 Wittkowski A, Williams J, Wieck A. An examination of the psychometric properties and factor structure of the postpartum bonding questionnaire in a clinical inpatient sample. Br J Clin Psychol 2010;49:163-72.	Construct validity: FA: three-factor model.
	Siu et al³³33 Siu BW, Chow HM, Kwok SS, Li OL, Koo ML, Cheung EF et al. Impairment of mother-infant relationship: validation of the Chinese version of postpartum bonding questionnaire. J Nerv Ment Dis 2010;198:174-9.	PV: Total PBQ: S=74% and Sp=100%; S1: S=84% and Sp=90%; S2: any rejection by the mother of the baby: S=89% and Sp=94%; and pathological rage: S=77% and Sp=68%; S3: S=59% and Sp=90%; S4: rage of any intensity: S=41% and Sp=93%; and moderate to severe: S=50% and Sp=94%.
MIBS	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	CV: total MIBS - MPAS: (immediately after birth) - ρ=-0.50 and (2 to 4 days after birth) - ρ=-0.45.
	Wittkowski et al³⁴34 Wittkowski A, Wieck A, Mann S. An evaluation of two bonding questionnaires: a comparison of the mother-to-infant bonding scale with the postpartum bonding questionnaire in a sample of primiparous mothers. Arch Womens Ment Health 2007;10:171-5.	CV: MIBS - PBQ immediately after birth and 2 to 4 days after birth.
	Taylor et al³⁶36 Taylor A, Atkins R, Kumar R, Adams D, Glover V. A new motherto-infant bonding scale: links with early maternal mood. Arch Womens Ment Health 2005;8:45-51.	Construct validity: FA: two-factor structure.
	Bienfait M et al³⁷37 Bienfait M, Maury M, Haquet A, Faillie JL, Franc N, Combes C et al. Pertinence of the self-report mother-to-infant bonding scale in the neonatal unit of a maternity ward. Early Hum Dev 2011;87:281-7.	PV: S=0.90 to detect alterations in the mother-baby bonding and Sp=0.80.
PAQ	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	CV: PAQ - PBQ (ρ=-0.67 and ρ=-0.63); total PAQ - MIBS (ρ=-0.50 and ρ=-0.45).
	Scapesi et al³⁹39 Scapesi A, Viterbori P, Sponza S, Zuchinetti P. Assessing motherto-infant attachment: the Italian Adaptation of a self-report questionnaire. J Reprod Infant Psychol 2004;22:99-109.	FA - Italian version: six-factor model: time with the baby, competence, anxiety, workload activities, indifference, and pleasure with closeness.
	Feldstein et al⁴⁰40 Feldstein S, Hane AA, Morrison BM, Huangi KY. Relation of the Postnatal attachment questionnaire to the attachment Q-Set. J Reprod Infant Psychol 2004;22:111-21.	CV: PAQ - AQS (r=0.39).
	Condon et al⁴¹41 Condon JT, Corkindale CJ, Boyce P. Assessment of postnatal patern-infant attachment: development of a questionnaire instrument. J Reprod Infant Psychol 2008; 26:195-210.	FA: 3-factor model for parents of babies aged 6 and 12 months.
MAI	Shin, Kim¹³13 Shin H, Kim YH. Maternal attachment inventory: psychometric evaluation of the Korean version. J Adv Nurs 2007;59:299-307.	CV: MAI - MFAS: r=0.46 (p<0.01); MSS: r=0.62 (p<0.01).
MAI		FA: 3-factor model. Correlation of total MAI with the three factors ranged from r=0.52 to r=0.92.
	Damato¹⁶16 Damato EG. Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 2004;4:274-91.	CV: PAI - MAI (r=0.38).

Tools	Studies	Psychometric properties: measures of reliability
PBQ	Reck et al²⁹29 Reck C, Klier CM, Pabst K, Stehle E, Steffenelli U, Struben K et al. The german version of the postpartum bonding instrument: psychometric properties and association with postpartum depression. Arch Womens Ment Health 2006;9:265-71.	IC: version with 25 items: α=0.85; WB: α=0.78; RR: α=0.68; A: α=0.34; and RA: α=0.20.
		IC: version with 16 items: α=0.85; WB: α=0.81; RR: α=0.75; A: α=0.32; RA: α=0.34.
	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	IC: total PBQ (8^th-12^th week) α=0.87 and α=0.78 (20^th-25^th)
	Wittkowski et al³²32 Wittkowski A, Williams J, Wieck A. An examination of the psychometric properties and factor structure of the postpartum bonding questionnaire in a clinical inpatient sample. Br J Clin Psychol 2010;49:163-72.	IC - PBQ: factor 1-α=0.94; factor 2-α=0.93; and factor 3-α=0.72.
	Wittkowski et al³⁴34 Wittkowski A, Wieck A, Mann S. An evaluation of two bonding questionnaires: a comparison of the mother-to-infant bonding scale with the postpartum bonding questionnaire in a sample of primiparous mothers. Arch Womens Ment Health 2007;10:171-5.	IC of PBQ: total: α=0.76 and α=0.77; S1-α=0.79; S2 and S3 - α=0.63.
	Moehler et al³⁵35 Moehler E, Brunner R, Wiebel A, Reck C, Resch F. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Arch Womens Ment Health 2006;9:273-8.	IC of PBQ: α=0.79.
MIBS	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	IC: total MIBS (immediately after birth) α=0.67 and α=0.58 (2 to 4 days after birth).
	Wittkowski et al³⁴34 Wittkowski A, Wieck A, Mann S. An evaluation of two bonding questionnaires: a comparison of the mother-to-infant bonding scale with the postpartum bonding questionnaire in a sample of primiparous mothers. Arch Womens Ment Health 2007;10:171-5.	IC: α=0.55 (immediately after birth) and α=0.49 (2 to 4 days after birth).
	Taylor et al³⁶36 Taylor A, Atkins R, Kumar R, Adams D, Glover V. A new motherto-infant bonding scale: links with early maternal mood. Arch Womens Ment Health 2005;8:45-51.	Version with 8 items (α=0.71).
	Figueiredo et al³⁸38 Figueiredo B, Marques A, Costa R, Pacheco A, Pais A. Bonding: scale to evaluate parents' emotional involvement with their infant. Psychologica 2005;40:133-54.	IC total scale: α=0.44; S1: α=0.69; S2: α=0.57; and S3: α=0.23. Total scale - split-half (r)=0.52; S1 r=0.52; S2 r=0.45; and S3 r=0.28. Correlation test-retest (Spearman): ρ=0.49.
PAQ	Van Bussel et al³¹31 Van Bussel JC, Spitz B, Demyttenare K. Three self-report questionnaires of the early mother-to-infant bond: reliability and validity of the Dutch version of the MPAS, PBQ and MIBS. Arch Womens Ment Health 2010;13:373-84.	IC: total PAQ: (8^th-12^th weeks after birth) α=0.75 and (20^th-25^th weeks after birth) α=0.68.
	Scapesi et al³⁹39 Scapesi A, Viterbori P, Sponza S, Zuchinetti P. Assessing motherto-infant attachment: the Italian Adaptation of a self-report questionnaire. J Reprod Infant Psychol 2004;22:99-109.	IC: total PAQ: α=0.77.
	Feldstein et al⁴⁰40 Feldstein S, Hane AA, Morrison BM, Huangi KY. Relation of the Postnatal attachment questionnaire to the attachment Q-Set. J Reprod Infant Psychol 2004;22:111-21.	IC: MPAQ - α=0.79; PPAQ - α=0.85.
	Condon et al⁴¹41 Condon JT, Corkindale CJ, Boyce P. Assessment of postnatal patern-infant attachment: development of a questionnaire instrument. J Reprod Infant Psychol 2008; 26:195-210.	IC: Overall: 6 months of baby (?) - α=0.81; 12 months - α=0.78.
MAI	Shin, Kim¹³13 Shin H, Kim YH. Maternal attachment inventory: psychometric evaluation of the Korean version. J Adv Nurs 2007;59:299-307.	IC: total MAI: α=0.94; Factor 1 (MAI): α=0.94; Factor 2 (MAI): α=0.91; and Factor 3 (MAI): α=0.65.
MAI	Damato¹⁶16 Damato EG. Prenatal attachment and other correlates of postnatal maternal attachment to twins. Adv Neonatal Care 2004;4:274-91.	IC (MAI): α=0.92 and α=0.93.

Sociedade de Pediatria de São Paulo R. Maria Figueiredo, 595 - 10o andar, 04002-003 São Paulo - SP - Brasil, Tel./Fax: (11 55) 3284-0308; 3289-9809; 3284-0051 - São Paulo - SP - Brazil
E-mail: rpp@spsp.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail: jaquelinealbuquerqueufpe@gmail.com (J.G.A. Perrelli).

Brasil

Brasil

Mother-child bonding assessment tools☆ ☆ Study conducted at Universidade Federal de Pernambuco, Recife, PE, Brazil.

Objective:

Data source:

Data synthesis:

Conclusions:

Mother-child bonding assessment tools^☆ ☆ Study conducted at Universidade Federal de Pernambuco, Recife, PE, Brazil.