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The Role of Mental Health on Maternal-Fetal Attachment in Low-Income Women


  • The authors report no conflict of interest or relevant financial relationships.


Jeanne L. Alhusen, PhD, CRNP, RN, Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD 21205.



To examine and describe the influence of maternal depressive symptoms on maternal-fetal attachment (MFA) in predominantly low-income women.


Mixed method.


Three urban obstetric/gynecologic (OB/GYN) clinics serving predominantly low-income women.


A convenience sample of 166 women participated in the quantitative component and a purposeful subsample of 12 women participated in the qualitative component; all women were between 24 and 28 weeks gestation at the time of data collection.


Linear regression models were used to examine the influence of depressive symptoms and social support on MFA. Individual in-depth interviews were conducted among a subsample of women to explore the influence of maternal depressive symptoms on MFA.


Fifty-nine percent (n = 98) of participants had scores that were clinically significant for depressive symptoms. In the final model of social support and depressive symptoms regressed on MFA, social support (b = .23, 95% CI [0.09, .37], p = .002) and depressive symptoms (b = −1.02, 95% CI [−1.32, −.73], p < 0.001) were significant predictors. This multivariate linear regression model with two variables accounted for 65.2% of the total variance in overall MFA. Qualitative participants discussed the importance of social support in contributing to their mood state and MFA.


Findings from this study highlight the importance of assessing for depressive symptoms during pregnancy given its influence on MFA. By understanding how important it was for these women to have a supportive person to experience their pregnancies with, nurses can improve the pregnancy experience for vulnerable populations.