Maternal attachment and perception of motherhood in relation to third-trimester antenatal depression: a cross-sectional analysis

Antenatal depression is a common complication of pregnancy, with consequences spanning maternal mental health, obstetric outcomes, and early mother-infant adaptation. Effective early identification requires integrating psychological and contextual information alongside validated screening. This study examined whether adult attachment style and the perception of motherhood are associated with antenatal depressive severity in late pregnancy, beyond socio-demographic factors. In a cross-sectional analysis of 140 third-trimester women, adult attachment (Revised Adult Attachment Scale, R-AAS) and depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS) were assessed together with psychosocial indicators (pregnancy planning, partner support, and perception of motherhood). Bivariate associations were tested with χ² (Cramér's V), and multivariable effects with penalized logistic regression for EPDS ≥14, using bootstrap 95% CIs (B = 1000). Secure attachment was associated with minimal risk (0% EPDS ≥14), whereas anxious-ambivalent attachment showed increased vulnerability (49.4% EPDS ≥12). A negative perception of motherhood displayed the most severe profile (60.0% EPDS ≥14 vs 0% in the positive group). In adjusted models, negative perception (aOR = 21.07; 95% CI, 7.92-1317.40) and anxious-ambivalent attachment (aOR = 21.67; 95% CI, 1.00-77.96) retained independent associations, while other covariates were not significant. These findings support a pragmatic psychosocial screening approach for late pregnancy in which a single standardized question on the perception of motherhood and a brief attachment typology add clinically useful information to EPDS. Incorporating these elements into routine antenatal care may enhance early detection and facilitate timely referral to perinatal mental-health services, with multicentre validation needed to support wider implementation.