The Mediating Role of Maternal Postpartum Depression Symptoms in the Relationship Between Mother–Fetus Bonding and Mother–Baby Bonding: A Prospective Cohort Study in Brazil

Abstract This research investigates the role of maternal postpartum depression (PPD) as a mediator in the relationship between mother-fetus bonding (MFB) and mother-baby bonding (MBB) in Brazil, a middle/low-income country. A cohort study was conducted involving 366 women from pregnancy through the postpartum period. Structural equation modeling (SEM) was utilized to estimate the direct, indirect, and total effects of the pathways between the variables, as well as the mediating effects. The standardized coefficients, standard errors, and p-values were calculated using a bootstrap strategy with 5,000 samples. The weighted least squares means variance (WLSMV) estimator and the theta parameterization were employed in the SEM analyses. Results: The SEM analyses revealed that the indirect effect between MFB and MBB, mediated by PPD, was significant (b = -0.128; p-value = 0.006). Both pathways for the indirect effect were statistically significant. However, the direct effect from MFB to MBB was found to be non-significant (b = -0.098; p-value = 0.152). This study demonstrates that postpartum depression (PPD) fully mediates the relationship between MFB and MBB. This finding is novel and underscores the importance of addressing maternal PPD as a critical target for interventions in clinical settings aimed at reducing the prevalence of MBB issues.