A primary care setting screening for risk factors to attachment security
Patricia Ann Reardon (2001)
Prenatal care is recommended for all women in the United States, although most pregnancies would proceed to delivery without complications. Standard prenatal care has focused on monitoring physical health and providing patient education. Minimal attention has been directed toward mental health. The central purpose of this study was to design and explore a prenatal protocol that assessed each mother's mental health and screened for risk factors known to affect attachment. The incidence of risk factors was higher than predicted by questionnaire norms. The majority of participants were identified as needing further evaluation or treatment. These results justify this screening protocol for a general maternity population. The principles of both Bowlby's Attachment Theory 1969, 1973, 1988) and those of family-centered care (Shelton & Stepanek, 1994) guided this investigation. Participants (n = 21) were recruited from private obstetrical practices between 26 and 32 weeks gestation. Questionnaires provided data on demographics, attachment patterns (Attachment Style Questionnaire-ASQ, Reciprocal-Avoidant Attachment Questionnaire-RAAQ), and risk factors. The risk factors included the following: lack of social support (NETHELP), depression (Beck Depression Index-II), similarities to known child abusing populations (Child Abuse Potential Inventory VI), mental health symptoms (SCL-9OR Symptom Checklist), and chemical dependency (Substance Abuse Subtle Screening Inventory-2). One goat of the study was to use the attachment questionnaires to classify the participants according to their attachment patterns and compare the number of risk factors across the attachment groups. The second study goal was to explore the relationships between attachment security measures and both risk factors and demographic variables. Measures that promote attachment were negatively correlated to high child abuse potential (p < .001) and mental health symptoms (p < .01). Confidence (a secure attachment measure) increased with age. Married couples were least likely to regard relationships as secondary in importance. This study has implications for the benefits of establishing parity between physical and mental health assessment and treatment in the primary care setting.