A Japanese study found that higher postpartum depression scores were associated with greater mother–infant bonding difficulties. Repeated assessments identified varied symptom patterns, including mothers whose bonding difficulties increased during the first three months. The findings suggest that pediatric teams may benefit from monitoring maternal depressive symptoms and bonding repeatedly, rather than relying on a single early assessment, to recognize mothers who may need closer support, consultation, or referral to mental health services.
Postpartum depression and difficulties forming an emotional bond with the infant can affect maternal well-being and child development, yet the two problems do not always follow the same course. A single assessment may miss mothers whose bonding difficulties persist or increase after childbirth. To explore these patterns in routine pediatric care, researchers examined repeated measures of depressive symptoms and mother–infant bonding during the first three months after delivery in a Japanese clinical cohort.
Addressing this challenge, a research team was led by Associate Professor Takashi X. Fujisawa and Professor Akemi Tomoda from the Research Center for Child Mental Development at the University of Fukui, Japan, along with Dr. Tomomi Yasaka from the Division of Developmental Higher Brain Functions at the United Graduate School of Child Development, Osaka University, Japan. The team analyzed records from 512 mother–infant dyads from a general hospital in Fukuoka City between January 2013 and December 2018. Mothers completed the Edinburgh Postnatal Depression Scale (EPDS) at five days and one, two, and three months postpartum, and the Mother-to-Infant Bonding Scale (MIBS) at one, two, and three months. Their findings were published on September 28, 2026, in Volume 17 of the journal Frontiers in Psychiatry .
The analysis included 509 mothers who contributed 807 paired observations. Using all available paired observations, the researchers found that higher EPDS total scores were significantly associated with higher MIBS total scores across the early postpartum period. The researchers also found no significant time effect or EPDS-by-time interaction, suggesting that the strength of the association did not significantly change across the assessment periods.
“Our findings indicate that depressive symptoms and bonding difficulties are closely connected during the early postpartum period, but the relationship should not be interpreted as proof that one causes the other,” says Dr. Fujisawa.
The researchers then explored whether mothers followed different patterns over time. Among 77 mothers with complete MIBS data, analyses identified three exploratory trajectory-based patterns: low-stable bonding difficulties in 41 mothers (53.2%), high-increasing difficulties in 22 (28.6%), and moderate-decreasing difficulties in 14 (18.2%). For EPDS, FIML-based trajectory analysis of 512 mothers identified four patterns: moderate-improving depression in 171 mothers (33.4%), high-persistent depression in 94 (18.4%), minimal-decreasing depression in 86 (16.8%), and low-decreasing depression in 161 (31.4%). MIBS and EPDS subgroup membership showed a moderate association.
“The increasing bonding-difficulty pattern is particularly important to recognize because it shows why repeated contact can provide information that an early assessment alone may miss ,” says Dr. Fujisawa.
Overall, the study suggests that repeated assessment of maternal depressive symptoms and bonding during pediatric visits may help clinicians recognize mothers who need additional support. The authors emphasize that the trajectory findings are exploratory because the MIBS subgroup analysis involved a small, clinically selected complete-case sample, and the study was conducted at a single hospital. The findings therefore do not establish causality or demonstrate that screening prevents maltreatment. Instead, they support further prospective research and coordinated care involving pediatricians, midwives, public health nurses, and mental health professionals to determine whether repeated assessment can improve support for mothers and children.
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Reference
DOI: 10.3389/fpsyt.2026.1939326
About University of Fukui, Japan
The University of Fukui is a preeminent research institution with robust undergraduate and graduate schools focusing on education, medical and science, engineering, and global and community studies. The university conducts cutting-edge research and strives to nurture human resources capable of contributing to society on the local, national, and global level.
Website: https://www.u-fukui.ac.jp/eng/
About Associate Professor Takashi X. Fujisawa from University of Fukui, Japan
Dr. Takashi X. Fujisawa is an Associate Professor at the Research Center for Child Mental Development, University of Fukui, Fukui, Japan. He has authored 162 publications and earned 2,073 citations throughout his distinguished career. His extensive expertise spans experimental psychology, cognitive neuroscience, and cognitive neuropsychology. Utilizing advanced neuroimaging techniques, such as fMRI, functional neuroimaging, and event-related potentials, his research deeply explores socioemotional mechanisms and brain function. Furthermore, his pioneering work addresses critical areas like autism spectrum disorders. Through these multidisciplinary methodologies, his scientific contributions continue to advance global clinical understanding of child mental development and pediatric neurological health.
Funding information
The author(s) declared that financial support was received for this work and/or its publication. This work was supported by JSPS KAKENHI Scientific Research (A) (grant number 19H00617 to AT), Scientific Research (B) (grant number 23K25644 to TXF), AMED (grant number JP20gk0110052 to AT), a research grant from the Strategic Budget to Realize University Missions (FY 2022 to AT), and the Grant-in-Aid for "Creating a Safe and Secure Living Environment in the Changing Public and Private Spheres" from JST/RISTEX (to AT).
Frontiers in Psychiatry
Observational study
People
Maternal bonding difficulties and postpartum depression in pediatric clinical practice: a longitudinal study in a Japanese cohort
28-Sep-2026
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.