Postpartum depression, childbirth-related PTSD and maternal bonding: The role of social support in a psychosocial rerspective

Postpartum depression, childbirth-related PTSD and maternal bonding: The role of social support in a psychosocial rerspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Postpartum depression, childbirth-related PTSD and maternal bonding: The role of social support in a psychosocial rerspective Renáta Kovács-Berta, Lilla Sándor, Fanni Dudok, Norbert Pásztor, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6620032/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Feb, 2026 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract This study provides a comprehensive analysis of psychosocial factors influencing postpartum mental health, with a focus on depression, childbirth-related PTSD (CB-PTSD), maternal-infant bonding, sexual dysfunction, and perceived partner support. Data from a large Hungarian sample (N = 675) revealed that 29.6% of mothers reported clinically significant depressive symptoms, and 32.1% reported sexual dysfunction. The prevalence of CB-PTSD was 4.6%, with strong comorbidity observed between depression and PTSD. Impaired bonding was significantly associated with higher levels of depressive symptoms, lower self-efficacy, and reduced social support. Self-efficacy emerged as a central protective factor, negatively predicting bonding impairments across all subscales. Regression analyses also highlighted the importance of perceived partner care and relationship satisfaction in fostering maternal well-being. Unexpectedly, emotional and instrumental support showed a negative association with relationship satisfaction, suggesting complex dynamics in postpartum support needs. Sociodemographic and birth-related variables, such as emergency cesarean and high-risk pregnancies, were linked to higher psychological distress. These findings underscore the multidimensional nature of postpartum adjustment and emphasize the need for integrated psychosocial screening and intervention strategies that address not only individual but relational factors, including trauma-informed support and couple-based therapy. Our results deepen understanding of maternal mental health and offer actionable insights for perinatal care. Health sciences/Diseases/Psychiatric disorders/Depression Health sciences/Diseases/Psychiatric disorders/Anxiety Health sciences/Risk factors postpartum depression childbirth-related PTSD maternal-infant bonding sexual dysfunction social support maternal self-efficacy Introduction Postpartum depression (PPD) is a prevalent global mental health concern, affecting 17–22% of women and significantly impairing maternal well-being and family functioning 1 , 2 . While its average prevalence within the first six months postpartum is estimated at 13% 3 , a meta-analysis 4 reported a global prevalence of 17.22%, with national rates ranging from 3% in Singapore to 38% in Chile 5 . Risk factors include prior depression, antenatal anxiety, chronic stress, low social support, and socioeconomic inequality 4 , 5 . Rates are higher in low- (25.8%) and middle-income countries (20.8%) compared to high-income countries (13–19%) 2,6 . During the COVID-19 pandemic, the prevalence of PPD significantly increased in both high-income (30.5%) and low- and middle-income countries (31.5%), compared to pre-pandemic rates of approximately 12–15% 7 . In Hungary, classified as a high-income country 8 , national studies estimate the prevalence of PPD to range between 7.1% and 10.8%. Key risk factors include substandard living conditions, lack of emotional support, and antenatal depression 9 , 10 . In high-income countries, routine screening supports early detection and treatment of PPD, while limited healthcare access contributes to higher prevalence in low- and middle-income countries, where risk factors include financial insecurity, low education, and preterm birth 6 , 11 , 12 . Despite attending antenatal care, many women with perinatal depression avoid seeking help due to stigma and fear of judgment 13 . This reluctance is particularly common in communities with low mental health literacy and persistent misconceptions about PPD symptoms 10 , 14 , 15 , 16 , 17 . Mothers may fear being perceived as inadequate, and self-stigma (e.g., shame or guilt) can further reduce help-seeking behavior 18 . Additional barriers include poor healthcare infrastructure and the false belief that PPD symptoms are a normative part of postpartum adjustment 19 . PPD adversely affects not only maternal quality of life but also intimate relationships and mother–infant bonding 20 , 21 . Bonding is shaped by psychosocial factors 22 , and difficulties may arise from early separation, PPD symptoms, or traumatic birth experiences 23 , 24 , 25 . Traumatic birth experiences can impair maternal responsiveness and hinder the interpretation of infant cues 26 . A moderate comorbidity (r = 0.63) has been identified between postpartum PTSD and depression 27 , 28 , with PTSD symptoms compromising bonding and relationship functioning 29 , 30 . Low social support further exacerbates these conditions 29 , 31 . According to Ayers et al., the prevalence of postpartum post-traumatic stress disorder (PTSD) ranges from 0–7%, although most studies suggest a more typical prevalence of around 1–2% 32 . Sexual dysfunction is another consequence of PPD. Chivers et al. found that 40% of women with PPD reported issues with desire, arousal, or orgasm, and symptoms may persist even after depression remits 21 . Szöllősi et al. identified high EPDS scores, perineal pain, and low relationship satisfaction as key risk factors 33 . Chang et al. also reported that sexual dysfunction may precede depression, while higher income and sexual satisfaction can serve as protective factors 34 . However, a recent review by Kelley suggests that relationship quality and subjective sexual experience are stronger predictors of postpartum sexual well-being than PPD alone 35 . Social support plays a critical protective role in mitigating the development and severity of PPD, its absence elevates risk 2 , 36 , while its presence can reduce stress and improve outcomes for both mother and infant 37 , 38 . Prenatal social support is associated with lower PPD incidence and better bonding 3 , 37 , 39 , 40 . Furthermore, Liu et al. found that perceived social support and being an only child may buffer against both PPD and postpartum PTSD 4 . The present study aims to investigate the associations between postpartum depression, childbirth-related PTSD (CB-PTSD), maternal bonding difficulties, sexual dysfunction, and perceived partner support. Specifically, we examine how these psychological and relational factors influence the quality of mother–infant bonding, which is essential for the child’s emotional development and long-term well-being. We also explore how relationship dynamics and perceived partner care affect maternal mental health and help-seeking behavior during the postpartum period. By focusing on these interrelated but underexplored dimensions, our study contributes to a deeper understanding of the psychosocial determinants of maternal well-being and bonding, with implications for clinical screening and targeted interventions. Methods The study was approved by the Ethics Committee of the University of Szeged (reference number: 133/2021-SZTE RKEB) and was conducted in accordance with the principles of the Declaration of Helsinki. Sample Participants were recruited online through convenience sampling. Inclusion criteria required women to be over 18 years old, fluent in Hungarian, and to have given birth within the past two years. Of the 685 respondents who completed the full questionnaire, 10 were excluded for having given birth more than two years prior, resulting in a final sample of 675 participants. Measures Sociodemographic and obstetric data The questionnaire collected maternal age, education level, marital status, relationship duration, parity, number of children, pregnancy planning, mode of delivery, obstetric complications, and pregnancy risk status, the latter documented by the attending physician. The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item screening tool assessing depressive and anxiety symptoms postpartum, scored on a 0–3 scale. In Hungary, 8–12 points indicate mild, and scores ≥ 13 indicate major depression 41 , 42 , 43 . The Beck Depression Inventory (BDI) is a 21-item self-report instrument measuring depressive symptoms on a 0–3 scale. Scores from 10–18 indicate mild, 19–25 moderate, and ≥ 26 severe depression 44 , 45 . The City Birth Trauma Scale (City BiTS) : assesses childbirth-related PTSD symptoms across 29 items, grouped into general and birth-related subscales. It has high reliability (α = 0.92) 32 . The Intimate Bond Measure (IBM-HU) captures perceptions of partner caregiving and control through 24 items, rated on a 0–3 Likert scale. The original IBM was developed by Wilhelm and Parker 46 . The Hungarian adaptation demonstrated strong internal consistency (Care α = 0.94; Control α = 0.91) 47 . The Relationship Assessment Scale (RAS-H) evaluates subjective relationship satisfaction through seven items on a 1–5 Likert scale. The original scale was developed by Hendrick et al. 48 , and the Hungarian version also showed high internal reliability (α = 0.843–0.897) 49 . The Self-Efficacy Scale (Hungarian version) consists of 10 items assessing perceived competence in stress situations, rated on a 1–4 scale. Higher scores indicate greater self-efficacy; internal consistency is good (α = 0.88) 50 . The Satisfaction with Life Scale (SWLS-H) is a 5-item measure of general life satisfaction rated on a 1–7 scale, with higher scores reflecting greater satisfaction (α = 0.84) 51 . The WHO-5 Well-Being Index (WBI-5) (Hungarian version) evaluates subjective well-being via five items using a 0–3 Likert scale; total scores range from 0–15, with higher scores indicating better well-being. The original WHO-5 was developed by the WHO 52 and its Hungarian validation showed good internal consistency (α = 0.85) 53 . The Female Sexual Function Index (FSFI-H) assesses sexual functioning across six domains (desire, arousal, lubrication, orgasm, pain, satisfaction) using 19 items. Scores range from 2 to 36; lower scores indicate more dysfunction. A cut-off of 26.55 indicates clinically significant dysfunction 54 . The Hungarian version was validated by Hock et al. with excellent reliability (α = 0.963) 55 . The Postpartum Bonding Questionnaire (PBQ) is a 25-item scale measuring mother–infant bonding across four domains: impaired bonding, rejection/anger, caregiving anxiety, and risk of abuse. Items are rated from 0 (always) to 5 (never); higher scores reflect greater bonding difficulties (Cronbach’s α = 0.83) 56 . The MOS Social Support Survey (MOS-SSS-H) includes 20 items measuring emotional/informational support, tangible support, and positive social interaction. Items are rated on a 1–5 scale. The original scale was developed by Sherbourne and Stewart 57 , and the Hungarian adaptation showed strong psychometric properties (α = 0.89 to 0.95) 58 . Both the City BiTS and PBQ questionnaires were translated and culturally adapted for use in Hungarian postpartum samples. The Hungarian adaptation followed a rigorous translation protocol based on Sousa and Rojjanasrirat's seven-step method, including initial translation, expert review, and back-translation with cultural and linguistic adjustments 59 . Pretesting with a small group of mothers (N = 12) confirmed the clarity and readability of the translated items. Detailed information on the translation process, factor structure, and psychometric validation of the City BiTS in Hungarian is available in a completed manuscript submitted for editorial review. The PBQ was applied up to two years postpartum, consistent with emerging evidence on the prolonged nature of the bonding process 60 . Procedure Participants were eligible if they were over 18 years of age, fluent in Hungarian, and had given birth within the previous two years. Due to pandemic-related constraints, data collection was conducted online between November 2021 and November 2022. The questionnaire link was disseminated through the health visitor network and targeted social media groups specifically addressing maternal and postpartum topics. Participation was voluntary, with no financial compensation provided. Before beginning the survey, respondents received detailed information about the study, including the possibility of encountering sensitive or distressing topics. Contact information for psychological support services was provided. Informed consent was obtained electronically, and participants were reminded they could withdraw at any point without consequence. The survey took approximately 20–25 minutes to complete, and all responses were collected anonymously to ensure confidentiality. During the data collection period (2021–2022), Hungary was classified by the World Bank as a high-income country 8 . Statistical analysis All statistical analyses were conducted using SPSS version 22.0, with the significance level set at p < 0.05 (two-tailed). Descriptive statistics (means, standard deviations, frequencies) were used to characterize the sample and questionnaire responses. Pearson’s correlation coefficients were calculated to assess associations between continuous psychological and relational variables. Independent-samples t -tests were used to compare groups based on parity, time since childbirth, and presence of pregnancy complications. Multivariate analyses of variance (MANOVA) were employed to examine the combined effects of depression, bonding disturbances, and sexual dysfunction on caregiving perceptions and quality of life indicators. Additionally, linear regression models were used to identify key predictors of postpartum bonding (PBQ), perceived social support (MOS-SSS), and relationship satisfaction (RAS-H), including psychological and demographic variables as independent predictors. Assumptions of normality and homogeneity of variance were checked and met where applicable. Results Sample Characteristics The final sample consisted of 675 mothers (M_age = 32.02 years, SD = 4.72). Most participants lived in urban areas (60.4%), had higher education (53.6%), and were married (87.1%). The majority were multiparous (89.2%), and 88.7% reported planned pregnancies. A spontaneous vaginal delivery was reported by 55.3%, while 42.1% had cesarean births (31.3% planned, 10.8% emergency). Pregnancy complications were present in 36%, and 44.3% required additional specialist visits. The mean gestational age at delivery was 39 weeks (SD = 1.84), with an average birth weight of 3401g (SD = 553.31). Prevalence of Psychological Distress Based on the EPDS, 26.4% of participants showed mild depressive symptoms, and 29.6% met the threshold for major depression. According to the BDI, 30.4% reported mild, 13.2% moderate, and 8.9% severe depression. The mean CB-PTSD score was 11.60 (SD = 10.42), and 4.6% met DSM-5 criteria for CB-PTSD. Severe bonding disturbances were present in 1.6% of participants. Regarding sexual functioning, 32.1% of women met criteria for clinically significant sexual dysfunction. Table 1 presents the mean values and standard deviations of the completed questionnaires, providing an overview of the participants' responses on each measure. Table 1 Descriptive statistics of psychological and relational measures in the postpartum sample (N = 675) Scale/Questionnaire/Dimension Mean SD 95% CI Lower -Upper BDI 12,09 8,759 11,43 − 12,81 EPDS 9,38 6,147 8,94 − 9,88 City BiTS 11,598 10,42 10,86 − 12,44 IBM Care 27,21 8,397 26,65 − 27,826 IBM Control 8,34 7,187 7,82 − 8,88 RAS-H 28,767 5,921 28,33 − 29,22 Self-efficacy 31,232 5,424 30,85 − 31,64 SWLS-H 26,63 5,908 26,15–27,08 WBI-5 9,62 3,693 9,34 − 9,9 FSFI-H 21,757 11,11 20,82 − 22,54 PBQ Sum 7,481 9,403 6,81 − 8,21 PBQ1 Impaired bonding 4,155 5,049 3,77 − 4,55 PBQ2 Rejection and anger 1,413 2,649 1,22 − 1,62 PBQ3 Anxiety about care 1,843 2,328 1,67 − 2,01 PBQ4 Risk of abuse 0,069 0,504 0,035 − 0,11 MOS-SSS-H Sum 82,124 6,011 80,796 − 83,305 MOS-SSS-H size of the social network 5,07 3,985 4,77 − 5,38 MOS-SSS-H 1. Emotional/informational support 34,578 7,48 33,942 − 35,132 MOS-SSS-H 2. Positive social interaction support 30,689 5,95 30,202 − 31,146 MOS-SSS-H 3. Instrumental support 16,857 3,905 16,548 − 17,15 Mean values and standard deviations (SD) for each scale and subscale used in the study. 95% confidence intervals (CI) are provided to indicate the precision of the mean estimates. Higher scores reflect greater symptom severity or higher levels of the measured construct, depending on the instrument. See Methods section for interpretation of cut-off scores. Multivariate associations between depression, bonding, and sexual dysfunction MANOVA revealed that bonding difficulties significantly predicted lower perceived partner care (F(2,664) = 3.362, p = 0.035). Depression (BDI) and sexual dysfunction were both independently associated with perceived partner care (F(3,667) = 3.83, p = 0.01; F(1,667) = 48.206, p < 0.001) and partner control (F(1,667) = 13.094, p < 0.001). Bonding difficulties and sexual dysfunction were significant predictors of lower self-efficacy (F(2,669) = 11.851, p < 0.001), life satisfaction (F(2,666) = 11.294, p < 0.001), and subjective well-being (F(2,664) = 15.386, p < 0.001). In the PBQ analysis, depression (EPDS) and sexual dysfunction significantly predicted impaired bonding (F(2,669) = 6.37, p = 0.002; F(1,669) = 29.418, p < 0.001) and caregiving anxiety (F(2,669) = 3.158, p = 0.043; F(1,669) = 21.81, p < 0.001). Sexual dysfunction alone predicted rejection/anger (F(1,669) = 21.054, p < 0.001) and risk of abuse (F(1,669) = 4.908, p = 0.027). Associations between mental health, bonding, and relationship measures The strongest correlations emerged between perceived partner care and relationship satisfaction (r = 0.851), and between PTSD and depressive symptoms (r = 0.665), based on the full sample (N = 675). Additional significant associations between maternal bonding, mental health, and social support variables are reported in Table 2 . Table 2 Pearson correlation coefficients between key psychological, relational, and social support variables (N = 675) Scale/ Questionnaire/ Dimension EPDS City BiTS IBM Care RAS-H SWLS-H WBI-5 FSFI-H total PBQ total PBQ1. PBQ 2. PBQ 3. PBQ 4. MOS 1. MOS 2. MOS 3. MOS total BDI 0,782 0,665 EPDS 0,624 IBM Care -0,125 0,851 0,583 0,414 0,282 -0,272 0,415 0,565 0,431 0,509 IBM Control -0,631 -0,403 -0,254 -0,276 -0,383 -0,291 -0,342 RAS-H 0,64 0,377 0,25 -0,267 0,377 0,55 0,381 0,474 Self efficacy 0,339 0,449 -0,345 -0,32 -0,299 -0,332 0,299 0,321 0,265 0,323 SWLS-H 0,488 -0,304 -0,34 0,473 0,56 0,438 0,536 WBI-5 0,34 -0,459 -0,47 -0,379 -0,371 0,489 0,531 0,421 0,528 PBQ Total 0,956 0,908 0,832 0,461 -0,279 -0,294 -0,295 PBQ 1. 0,812 0,689 0,372 -0,297 -0,317 -0,317 PBQ 2. 0,685 0,378 PBQ 3. 0,407 MOS 1. 0,831 0,698 0,946 MOS 2. 0,264 0,756 0,944 MOS 3. 0,851 Note. Displayed values are Pearson correlation coefficients. Only significant correlations are shown (p < 0.05), and only coefficients above r ≥ 0.25 are included to highlight moderate to strong associations. Depressive symptoms (BDI, EPDS) showed strong positive associations with PTSD symptoms (City BiTS) across all groups (r = 0.534–0.915). Among mothers with one child (N = 73) BDI and EPDS scores were negatively correlated with life satisfaction (r = − 0.29, − 0.237), total social support (r = − 0.238, − 0.275), instrumental support (r = − 0.278, − 0.341), and positively associated with bonding difficulties (PBQ subscales 1 and 3; r = 0.239–0.282). PTSD scores also showed negative associations with self-efficacy, life satisfaction, and perceived social support (r = − 0.235 to − 0.321). Self-efficacy was positively related to life satisfaction (r = 0.468), well-being (r = 0.566), sexual satisfaction (r = 0.343), and social support (r = 0.350), and negatively with bonding difficulties (r = − 0.417 to − 0.401). The IBM Control dimension was negatively associated with relationship satisfaction (r = − 0.643), life satisfaction (r = − 0.392), and social support (r = − 0.418 to − 0.578). Perceived partner care (IBM Care) was strongly positively correlated with relationship satisfaction (r = 0.851), life satisfaction (r = 0.583), and mental well-being (r = 0.414), and negatively associated with bonding disturbances (r = − 0.272). Sexual satisfaction, arousal, and orgasm also showed moderate associations with perceived partner care (r = 0.254–0.378). Moderating role of relationship duration and perinatal risk factors Relationship duration moderated several associations. In couples together for 1–3 years (N = 76), lower perceived partner care, reduced sexual satisfaction, and greater maternal bonding difficulties were associated with higher levels of depressive symptoms (BDI, EPDS; r = − 0.231 to − 0.337). PTSD symptoms in this group were negatively correlated with partner care, orgasm, total sexual function, and social support (r = − 0.234 to − 0.358), and positively with bonding impairments (r = 0.297–0.326). Among women in relationships lasting 11–15 years (N = 148), EPDS scores correlated positively with bonding difficulties across PBQ domains (r = 0.225–0.305). In mothers in relationships longer than 15 years (N = 65), depressive symptoms were associated with reduced sexual satisfaction (r = − 0.252), while PTSD symptoms were negatively linked to relationship satisfaction, sexual functioning, and perceived social support (r = − 0.254 to − 0.333). Among high-risk pregnancies (N = 251), relationship satisfaction (RAS-H) was strongly associated with perceived partner care (r = 0.876), life satisfaction (r = 0.652), and social support (r = 0.445). Bonding difficulties were negatively related to self-efficacy, mental well-being, and partner care (r = − 0.225 to − 0.406). Mode of delivery moderated several psychosocial associations. Among mothers who delivered vaginally (N = 373), relationship satisfaction was strongly associated with perceived partner care (r = 0.847), self-efficacy, well-being, sexual functioning, and social support (r = 0.202–0.629), and was negatively associated with partner control and bonding difficulties (r = − 0.288 to − 0.600). In the cesarean birth group (N = 211), partner control (IBM Control) negatively correlated with relationship satisfaction and social support, while self-efficacy was inversely associated with bonding difficulties and positively with social support (r = − 0.361 to 0.305). Among mothers with emergency cesarean sections (N = 73), depressive symptoms were positively associated with caregiving anxiety (PBQ subscale 3; r = 0.262), while maternal bonding disturbances were linked to lower partner care, relationship satisfaction, self-efficacy, life satisfaction, and well-being (r = − 0.250 to − 0.592), and higher perceived partner control (r = 0.319) (see Table 3 for details). Table 3 Differences in postpartum adjustment indicators by mode of delivery Subgroup Key Variable Associations Vaginal birth (N = 373) RAS-H – IBM Care (r = 0.847), SWLS-H (r = 0.629), FSFI Total (r = 0.259), Self-efficacy (r = 0.202), WBI-5 (r = 0.391), MOS-SSS total (r = 0.546; subscales 1–3: r = 0.454–0.613), IBM Control (r = − 0.600); PBQ Total (r = − 0.242 subscale 1: r = − 0.288) Planned cesarean (N = 211) IBM Control – RAS-H (r = − 0.638), MOS-SSS Total (r = − 0.275, subscale 2 (r = − 0.370).); Self-efficacy – PBQ Subscales 1–3 (r = − 0.334 to − 0.361), MOS-SSS total and subscales (r = 0.268–0.305) Emergency cesarean (N = 73) EPDS – PBQ Subscale 3 (r = 0.262); PBQ Total – IBM Care (r = − 0.443), SWLS-H (r = − 0.571), WBI-5 (r = − 0.592), MOS-SSS Total (r = − 0.378), RAS-H (r = − 0.329), self-efficacy (r = − 0.419), MOS-SSS total (r = − 0.378; subscales 1–3: r = − 0.250 to − 0.474), IBM Control (r = 0.319) Psychological and sexual outcomes by postpartum timing and pregnancy risk Significant differences were found in psychological and sexual health indicators based on time since childbirth, parity, and pregnancy risk status. First-time mothers reported lower depressive symptoms compared to multiparous women in both the total sample (M = 11.28 vs. 12.69; t(673) = 2.085, p = 0.037) and among those who gave birth within the past year (M = 10.72 vs. 12.35; t(428) = 1.964, p = 0.05). Mothers who gave birth within two years postpartum showed higher sexual dysfunction compared to those within one year, including lower FSFI scores in lubrication (M = 3.27 vs. 3.97; t(158.4) = 2.01, p = 0.046), orgasm (M = 2.80 vs. 3.60; t(203) = 2.40, p = 0.017), and pain domains (M = 2.93 vs. 4.08; t(203) = 3.29, p = 0.001). Within the mild BDI depression category, mothers more than one year postpartum reported significantly higher perceived partner care (IBM Care: t(203) = − 2.765, p = 0.006), relationship satisfaction (RAS-H: t(203) = − 2.006, p = 0.046), and life satisfaction (SWLS-H: t(203) = − 2.901, p = 0.004), but lower overall sexual functioning (FSFI total: t(203) = 2.143, p = 0.033). Similar patterns were observed in the moderate depression group, with lower lubrication (t(61.43) = 2.214, p = 0.031) and higher pain scores (t(59.26) = 2.723, p = 0.008) among mothers more than one year postpartum. Additionally, within the normal BDI range, mothers who gave birth within two years showed greater maternal rejection and anger (PBQ subscale 2: t(144.21) = − 2.222, p = 0.028). No significant differences were found in the severe depression category. Depressive symptoms were also higher among women with high-risk pregnancies compared to those without complications (M = 13.10 vs. 11.50; t(673) = − 2.301, p = 0.022). Psychological correlates of pregnancy complications Among mothers diagnosed with threatened preterm birth (N = 21), postpartum depression was strongly associated with bonding disturbances, particularly anxiety about caregiving and risk of abuse (PBQ subscales 3–4; r = 0.462–0.503). PTSD symptoms were negatively correlated with multiple domains of sexual functioning (e.g., arousal, lubrication, orgasm; r = − 0.432 to − 0.474). In the gestational diabetes group (N = 69), depressive symptoms were associated with reduced self-efficacy, life satisfaction, and perceived social support (r = − 0.237 to − 0.304). Perceived partner care (IBM Care) was a strong protective factor across all indicators of relationship quality and bonding (PBQ total and subscales; r = − 0.325 to − 0.531). Among women with hypertensive disorders (N = 30), IBM Care was positively associated with rejection-related bonding difficulties (PBQ subscale 2; r = 0.366), while self-efficacy was negatively correlated with PBQ total and multiple subscales (r = − 0.359 to − 0.393) and positively with psychological well-being (WHO-5; r = 0.449). In mothers with vaginal infections during pregnancy (N = 28), depression correlated with bonding impairments (PBQ subscale 2; r = 0.385), while self-efficacy showed strong negative associations with bonding difficulties (PBQ total and subscales 1–3; r = − 0.432 to − 0.719), and partner control (IBM Control; r = − 0.416). Among women with a history of miscarriage (N = 28), EPDS scores were negatively correlated with sexual lubrication (r = − 0.414), pain (r = − 0.381), and total FSFI scores (r = − 0.375), and positively associated with bonding difficulties (PBQ total: r = 0.372; subscale 1: r = 0.403; subscale 2: r = 0.374). In this group, perceived partner care (IBM Care) showed strong positive associations with relationship satisfaction (RAS-H: r = 0.857), life satisfaction (SWLS-H: r = 0.507), mental well-being (WHO-5: r = 0.601), and sexual satisfaction (r = 0.510), while self-efficacy was positively associated with social support (MOS-SSS total: r = 0.524) and negatively with PBQ subscale 4 (r = − 0.377). Among mothers who were hospitalized during pregnancy (N = 36), EPDS and BDI scores were both positively correlated with bonding disturbances on PBQ subscale 4 (r = 0.374 and r = 0.410, respectively). Regression-based predictors of bonding, social support, and relationship satisfaction Three linear regression models were conducted to identify key predictors of postpartum bonding (PBQ), perceived social support (MOS-SSS), and relationship satisfaction (RAS-H). The PBQ model explained 27.9% of the variance (R² = 0.279; F(33, 583) = 6.828, p < 0.001), with self-efficacy (B = − 0.307, p < 0.001) and mental well-being (WBI-5; B = − 0.826, p < 0.001) emerging as significant negative predictors of bonding difficulties. The MOS-SSS model accounted for 44.6% of the variance (R² = 0.446; F(31, 585) = 15.174, p < 0.001), with perceived partner care (IBM Care; B = 0.491, p < 0.001), life satisfaction (SWLS-H; B = 0.597, p < 0.001), and mental well-being (WBI-5; B = 1.128, p < 0.001) as significant predictors. Relationship satisfaction (RAS-H) was best predicted by a model explaining 79.1% of the variance (R² = 0.791; F(32, 584) = 69.006, p < 0.001). Significant predictors included higher partner care (IBM Care; B = 0.424, p < 0.001), lower partner control (IBM Control; B = − 0.142, p < 0.001), higher life satisfaction (SWLS-H; B = 0.216, p < 0.001), and mixed effects of social support subdimensions, with positive effects from positive social interaction (B = 0.232, p < 0.001) and negative effects from emotional/informational (B = − 0.108, p < 0.001) and instrumental support (B = − 0.133, p = 0.004) (see Table 4 ). Table 4 Linear regression models predicting bonding, social support, and relationship satisfaction Outcome Variable Predictor Variable B R² Adjusted R² PBQ total score Self-efficacy –0.307 0.279 0,238 Mental well-being (WBI-5) –0.826 MOS-SSS total Partner care (IBM Care) 0.491 0.446 0,416 Life satisfaction (SWLS-H) 0.597 Mental well-being (WBI-5) 1.128 RAS-H total Partner care (IBM Care) 0.424 0.791 0.779 Partner control (IBM Control) –0.142 Life satisfaction (SWLS-H) 0.216 Emotional/Informational support –0.108 Positive social interaction 0.232 Instrumental support –0.133 Note. Results of linear regression analyses predicting postpartum outcomes. All models were statistically significant at p < 0.001. B = unstandardized regression coefficient; R² = proportion of variance explained by the model; Adjusted R² = variance explained adjusted for the number of predictors. PBQ = Postpartum Bonding Questionnaire; MOS-SSS = Medical Outcomes Study Social Support Survey; RAS-H = Relationship Assessment Scale; IBM = Intimate Bond Measure; SWLS-H = Satisfaction with Life Scale; WBI-5 = WHO-5 Well-Being Index. Discussion This study offers a comprehensive examination of postpartum psychological and relational challenges, focusing on the interplay between depressive symptoms, childbirth-related post-traumatic stress disorder (CB-PTSD), mother–infant bonding disturbances, sexual functioning, and the roles of partner and social support. Our findings corroborate previous international research 21 , 27 , 29 and illuminate novel associations, particularly concerning the protective roles of partner relationship dynamics and maternal self-efficacy. The prevalence of depressive symptoms in our sample (29.6% based on the EPDS and 8.9% indicating severe depression based on the BDI) exceeds earlier national estimates from Hungary (7.1–10.8%) 9,10 and is higher than international averages reported for high-income countries (13–19%) 6 . This elevated prevalence is likely influenced by the timing of data collection during the COVID-19 pandemic, a period characterized globally by increased anxiety, social isolation, and limited access to healthcare services, all of which have been linked to heightened postpartum distress 7 . The pandemic-related reduction in perceived social support may have further undermined mothers’ subjective coping resources, potentially contributing to the increased rates of depression and sexual dysfunction observed in our sample. While previous literature suggests that postpartum depression (PPD) is less prevalent in high-income countries 2 , 6 , our findings indicate that, despite Hungary’s classification as a high-income nation, the prevalence of PPD and bonding disturbances remains alarmingly high, with 29.6% of participants exhibiting severe depressive symptoms and 32.1% meeting clinical criteria for sexual dysfunction. These findings suggest that a favorable macroeconomic context alone is insufficient to protect postpartum mental health. Instead, psychosocial factors - particularly the level of partner support, maternal self-efficacy, and the quality of relational dynamics - play a central role in postpartum adjustment. When these protective mechanisms are impaired, or when mothers face barriers to seeking help (e.g., due to stigma, self-blame, or societal expectations), the risk of severe psychological distress may persist even in wealthier societies. The prevalence of childbirth-related post-traumatic stress disorder (CB-PTSD) in our sample was 4.6%, falling within the internationally reported range of 0–7% 30,32 . The strong correlation between PTSD and depression (r = 0.665) supports previously documented comorbidity 27 and reinforces the notion that traumatic childbirth experiences not only impact maternal mental health but also impair the quality of mother–infant bonding and intimate partner relationships 26 . Our findings suggest that CB-PTSD has a direct detrimental effect on both relational and maternal functioning, particularly affecting sexual wellbeing and emotional connectedness with the child. Unprocessed trauma during or surrounding childbirth may lead to long-term emotional consequences that require targeted psychological intervention. Disruptions in postpartum bonding, as reflected in the total score and subscales of the Postpartum Bonding Questionnaire (PBQ), were significantly associated with depressive symptoms, low maternal self-efficacy, reduced subjective well-being, and lower levels of perceived social support. Specifically, elevated scores on the „Impaired bonding” and „Rejection and anger” subscales were observed among mothers reporting low self-efficacy and higher PTSD symptom severity. These findings align with previous research indicating that bonding difficulties may stem from deficits in maternal perceptions of competence 24 , 27 . Our results further indicate that a mother’s internal sense of competence - her belief in her ability to care for her infant and interpret the infant’s needs - has a direct influence on bonding behaviors and maternal affective responses. Maternal self-efficacy emerged as a consistently strong protective factor across all variables examined. It was significantly negatively correlated with the total score and all four subscales of the Postpartum Bonding Questionnaire (PBQ). According to the linear regression analysis, low self-efficacy was among the strongest predictors of bonding disturbances. Mothers with reduced self-efficacy were more likely to experience uncertainty, perceived incompetence, or feelings of failure in their maternal role, which may hinder the development of positive maternal affect and predispose them to attachment difficulties. Importantly, self-efficacy not only reflects psychological well-being but also a realistic sense of control, which appears to be a critical determinant in the successful experience of the maternal role. Clinically significant sexual dysfunction was reported by 32.1% of participants and was closely associated with both depressive symptoms and PTSD. Lubrication, orgasm, pain, and sexual satisfaction scores were significantly lower among women with elevated levels of postpartum depression and PTSD, particularly during the second postpartum year. These findings are consistent with prior research by Chivers et al. 21 and Kelley 35 , which highlights the influence of subjective sexual experience and relationship quality on sexual functioning, beyond the presence of depressive symptoms alone. A novel contribution of our study is the observation that sexual functioning was not only linked to the romantic partnership but also to maternal-infant relational dynamics. Strong positive correlation was observed between relationship satisfaction (RAS-H) and perceived partner care (IBM Care) (r = 0.851), emphasizing the critical role of empathic partner presence in postpartum adjustment. Partner care was positively associated with maternal self-efficacy, life satisfaction, perceived social support, and bonding security, whereas perceived partner control (IBM Control) was negatively associated with these indicators. Regression analyses confirmed that perceived partner care, psychological well-being, and life satisfaction were among the strongest predictors of both social support and relationship quality. Among the dimensions of social support (MOS-SSS-H), „Positive Social Interaction” and „Emotional/Informational Support” showed the strongest associations with relationship satisfaction and maternal psychological well-being. The specific role of positive shared experiences - such as laughing together or spending quality time - as reflected in the „Positive Social Interaction” subscale, underscores the importance of everyday relational exchanges as protective factors in the postpartum period, consistent with previous findings 4 , 37 . Furthermore, delivery-related factors significantly influenced psychological outcomes. Emergency cesarean section, high-risk pregnancy, extended hospitalization, and later stages of the postpartum period (beyond the first year) were all associated with increased levels of psychological and sexual dysfunction. These findings support the view that postpartum adjustment is not a uniform process and is shaped by an interplay of psychosocial, biological, and relational factors 11 , 25 . Limitations and Strengths This study provides a valuable contribution to the understanding of psychosocial factors in the postpartum period; however, several methodological limitations should be considered when interpreting the findings. First, the cross-sectional design precludes causal inferences regarding the relationships among postpartum depression, childbirth-related PTSD (CB-PTSD), bonding difficulties, sexual functioning, and perceived social support. Second, data collection relied on self-report questionnaires, which may be subject to reporting bias due to social desirability or stigma surrounding mental health issues - particularly in relation to depressive symptoms, sexual dysfunction, and relationship dissatisfaction. Moreover, the sample was not fully representative of the broader Hungarian postpartum population, as participants were predominantly urban, highly educated women in stable relationships. This demographic bias may limit the generalizability of our results to more vulnerable groups, such as mothers with lower socioeconomic status or limited support, who are likely to experience even higher levels of psychosocial distress. Additionally, the timing of data collection during the COVID-19 pandemic may have further elevated levels of psychological distress, complicating comparisons with pre-pandemic estimates. Despite these limitations, our study has several notable strengths. To our knowledge, this is the first large-scale investigation in Hungary (N = 675) to comprehensively examine the interrelations among postpartum depression, CB-PTSD, mother–infant bonding, sexual functioning, and perceived partner support using an interdisciplinary and integrative psychosocial framework. The use of multidimensional, validated instruments allowed for an in-depth assessment of psychological, relational, and social domains. Our regression and subgroup analyses yielded novel insights into the protective roles of maternal self-efficacy and perceived partner care. Of particular interest is our finding that emotional and instrumental support were negatively associated with relationship satisfaction in our sample. This result suggests that the quality, context, and subjective experience of support may be as important as its quantity, opening new directions for refining support interventions. Finally, our findings highlight that although Hungary is classified as a high-income country, the observed prevalence rates of severe depression (29.6%) and clinically significant sexual dysfunction (32.1%), as well as the critical role of perceived partner care, align with psychosocial risk patterns commonly reported in lower-income settings 6 , 11 . These results underscore the notion that economic development alone does not safeguard postpartum mental health when relational and psychological needs remain unmet. Implications for Practice Our findings underscore that postpartum mental health and mother–infant bonding are embedded within a complex psychosocial system, in which partner support, maternal self-efficacy, and relationship quality play central roles. Accordingly, postpartum psychological screening and assessment should extend beyond depressive symptoms to include evaluations of couple dynamics, sexual functioning, and the mother's perceived self-efficacy 36 , 38 . Mothers with high levels of self-efficacy are less vulnerable to depression, bonding difficulties, and perceived social isolation 26 , 40 , making the enhancement of self-efficacy - via group-based psychoeducation or targeted support interventions - a key preventive focus. Similarly, fostering partner care and reinforcing relational security may function as important protective factors 35 , 37 . The observed negative association between emotional and instrumental support and relationship satisfaction suggests that supportive efforts may not always alleviate distress if they fail to align with the mother’s actual needs. This highlights the need for a paradigm shift in the design of support systems, emphasizing the quality, timing, and contextual sensitivity of interventions. It is important to note that many mothers do not seek help for postpartum psychological difficulties, often due to fears of maternal inadequacy, guilt, or the normalization of symptoms as a „natural” part of the postpartum period 13 , 14 , 18 . This self-stigma presents a significant barrier to accessing professional support. Reducing stigma, increasing the visibility and acceptance of postpartum mental health care, and expanding mental health education are therefore essential 16 , 17 . Based on our results, psychosocial interventions may be more effective when they not only address the individual mother but also focus on the couple as a unit. Couple therapy, sexological counseling, and trauma-informed psychological support for processing difficult birth experiences represent promising avenues for alleviating sexual dysfunction 21 , 33 , mitigating bonding difficulties, and improving relationship quality. Such a comprehensive approach is particularly warranted for high-risk groups, including mothers with medically complex pregnancies, emergency cesarean deliveries, or first-time motherhood. Given the complexity of the perinatal period, an integrated care model is essential. Collaboration among obstetric, nursing, psychological, and social care providers is required to identify mothers at elevated risk for bonding difficulties, depression, or relational distress. Our findings reinforce the notion that supporting mother–infant bonding cannot be achieved without attention to the partner relationship and the psychosocial resources of the mother. Conclusion The findings of this study support the view that postpartum depressive symptoms, childbirth-related PTSD (CB-PTSD), bonding disturbances, sexual dysfunction, and perceived partner support form a closely interconnected and complex system. Maternal self-efficacy, perceived partner care, and the quality of social support emerged as key predictors of maternal mental well-being, bonding experience, and relationship satisfaction. The unique societal and psychological impacts of the COVID-19 pandemic may have further intensified the prevalence and severity of these difficulties. Our results highlight the need for a multidimensional approach to the prevention and treatment of postpartum psychological disorders, emphasizing the targeted reinforcement of emotional support, relational dynamics, and maternal self-competence - even within high-income societies. This study offers novel perspectives for enhancing perinatal mental health care and for designing interventions aimed at reducing stigma and fostering early identification and support for vulnerable mothers. Abbreviations BDI Beck Depression Inventory EPDS Edinburgh Postnatal Depression Scale City BiTS City Birth Trauma Scale IBM Intimate Bond Measure RAS H-Relationship Assessment Scale SWLS H-Satisfaction With Life Scale WBI 5-WHO-5 Well-Being Index FSFI H-Female Sexual Function Index PBQ Postpartum Bonding Questionnaire MOS SSS-H, Medical Outcomes Study Social Support Survey. Declarations Data Availability Data analysis in the text, these will be made aviable after consultation with the corresponting author. Data accessibility statement The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. Funding Declaration The authors declare that they have no financial interest. They have not received any financial support for the preparation of this study. Funding: University of Szeged Open Access Fund, Grant ID: 7742. Ethics approval statement The University of Szeged approved study protocols of all data collections and data analysis approaches reported in this study (133/2021-SZTE-RKEB). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed consent Prior to the study, informed consent was obtained full all adult participants involved in the research. We have not had prior discussions with a Scientific Reports Editorial Board Member regarding this manuscript. We kindly suggest the following reviewers, whose expertise aligns with the scope of our work: Judit Szigeti F. dr. PhD (Semmelweis University Department of Otorhinolaryngology, Head and Neck Surgery) [email protected] Beáta Bőthe dr. PhD (Département de Psychologie/Department of Psychology Université de Montréal/University of Montreal) [email protected] Xénia Gonda dr. PhD (Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of General Medicine) [email protected] Conflict of interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter of materials discussed in this manuscript. Tha authors did not receive support from any organization for the submitted work. 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While its average prevalence within the first six months postpartum is estimated at 13%\u003csup\u003e3\u003c/sup\u003e, a meta-analysis\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e reported a global prevalence of 17.22%, with national rates ranging from 3% in Singapore to 38% in Chile\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Risk factors include prior depression, antenatal anxiety, chronic stress, low social support, and socioeconomic inequality\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Rates are higher in low- (25.8%) and middle-income countries (20.8%) compared to high-income countries (13\u0026ndash;19%)\u003csup\u003e2,6\u003c/sup\u003e. During the COVID-19 pandemic, the prevalence of PPD significantly increased in both high-income (30.5%) and low- and middle-income countries (31.5%), compared to pre-pandemic rates of approximately 12\u0026ndash;15%\u003csup\u003e7\u003c/sup\u003e. In Hungary, classified as a high-income country\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, national studies estimate the prevalence of PPD to range between 7.1% and 10.8%. Key risk factors include substandard living conditions, lack of emotional support, and antenatal depression\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In high-income countries, routine screening supports early detection and treatment of PPD, while limited healthcare access contributes to higher prevalence in low- and middle-income countries, where risk factors include financial insecurity, low education, and preterm birth\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Despite attending antenatal care, many women with perinatal depression avoid seeking help due to stigma and fear of judgment\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. This reluctance is particularly common in communities with low mental health literacy and persistent misconceptions about PPD symptoms\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Mothers may fear being perceived as inadequate, and self-stigma (e.g., shame or guilt) can further reduce help-seeking behavior\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Additional barriers include poor healthcare infrastructure and the false belief that PPD symptoms are a normative part of postpartum adjustment\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePPD adversely affects not only maternal quality of life but also intimate relationships and mother\u0026ndash;infant bonding\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Bonding is shaped by psychosocial factors\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, and difficulties may arise from early separation, PPD symptoms, or traumatic birth experiences\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Traumatic birth experiences can impair maternal responsiveness and hinder the interpretation of infant cues\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. A moderate comorbidity (r\u0026thinsp;=\u0026thinsp;0.63) has been identified between postpartum PTSD and depression\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, with PTSD symptoms compromising bonding and relationship functioning\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Low social support further exacerbates these conditions\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. According to Ayers et al., the prevalence of postpartum post-traumatic stress disorder (PTSD) ranges from 0\u0026ndash;7%, although most studies suggest a more typical prevalence of around 1\u0026ndash;2%\u003csup\u003e32\u003c/sup\u003e. Sexual dysfunction is another consequence of PPD. Chivers et al. found that 40% of women with PPD reported issues with desire, arousal, or orgasm, and symptoms may persist even after depression remits\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Sz\u0026ouml;llősi et al. identified high EPDS scores, perineal pain, and low relationship satisfaction as key risk factors\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Chang et al. also reported that sexual dysfunction may precede depression, while higher income and sexual satisfaction can serve as protective factors\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. However, a recent review by Kelley suggests that relationship quality and subjective sexual experience are stronger predictors of postpartum sexual well-being than PPD alone\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. Social support plays a critical protective role in mitigating the development and severity of PPD, its absence elevates risk\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, while its presence can reduce stress and improve outcomes for both mother and infant\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Prenatal social support is associated with lower PPD incidence and better bonding\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Furthermore, Liu et al. found that perceived social support and being an only child may buffer against both PPD and postpartum PTSD\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe present study aims to investigate the associations between postpartum depression, childbirth-related PTSD (CB-PTSD), maternal bonding difficulties, sexual dysfunction, and perceived partner support. Specifically, we examine how these psychological and relational factors influence the quality of mother\u0026ndash;infant bonding, which is essential for the child\u0026rsquo;s emotional development and long-term well-being. We also explore how relationship dynamics and perceived partner care affect maternal mental health and help-seeking behavior during the postpartum period. By focusing on these interrelated but underexplored dimensions, our study contributes to a deeper understanding of the psychosocial determinants of maternal well-being and bonding, with implications for clinical screening and targeted interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e The study was approved by the Ethics Committee of the University of Szeged (reference number: 133/2021-SZTE RKEB) and was conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSample\u003c/h2\u003e\u003cp\u003eParticipants were recruited online through convenience sampling. Inclusion criteria required women to be over 18 years old, fluent in Hungarian, and to have given birth within the past two years. Of the 685 respondents who completed the full questionnaire, 10 were excluded for having given birth more than two years prior, resulting in a final sample of 675 participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic and obstetric data\u003c/strong\u003e\u003cp\u003eThe questionnaire collected maternal age, education level, marital status, relationship duration, parity, number of children, pregnancy planning, mode of delivery, obstetric complications, and pregnancy risk status, the latter documented by the attending physician.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eEdinburgh Postnatal Depression Scale (EPDS)\u003c/b\u003e is a 10-item screening tool assessing depressive and anxiety symptoms postpartum, scored on a 0\u0026ndash;3 scale. In Hungary, 8\u0026ndash;12 points indicate mild, and scores\u0026thinsp;\u0026ge;\u0026thinsp;13 indicate major depression\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eBeck Depression Inventory (BDI)\u003c/b\u003e is a 21-item self-report instrument measuring depressive symptoms on a 0\u0026ndash;3 scale. Scores from 10\u0026ndash;18 indicate mild, 19\u0026ndash;25 moderate, and \u0026ge;\u0026thinsp;26 severe depression\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e,\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eCity Birth Trauma Scale (City BiTS)\u003c/b\u003e: assesses childbirth-related PTSD symptoms across 29 items, grouped into general and birth-related subscales. It has high reliability (α\u0026thinsp;=\u0026thinsp;0.92)\u003csup\u003e32\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eIntimate Bond Measure (IBM-HU)\u003c/b\u003e captures perceptions of partner caregiving and control through 24 items, rated on a 0\u0026ndash;3 Likert scale. The original IBM was developed by Wilhelm and Parker\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. The Hungarian adaptation demonstrated strong internal consistency (Care α\u0026thinsp;=\u0026thinsp;0.94; Control α\u0026thinsp;=\u0026thinsp;0.91)\u003csup\u003e47\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eRelationship Assessment Scale (RAS-H)\u003c/b\u003e evaluates subjective relationship satisfaction through seven items on a 1\u0026ndash;5 Likert scale. The original scale was developed by Hendrick et al.\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e, and the Hungarian version also showed high internal reliability (α\u0026thinsp;=\u0026thinsp;0.843\u0026ndash;0.897)\u003csup\u003e49\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eSelf-Efficacy Scale\u003c/b\u003e (Hungarian version) consists of 10 items assessing perceived competence in stress situations, rated on a 1\u0026ndash;4 scale. Higher scores indicate greater self-efficacy; internal consistency is good (α\u0026thinsp;=\u0026thinsp;0.88)\u003csup\u003e50\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eSatisfaction with Life Scale (SWLS-H)\u003c/b\u003e is a 5-item measure of general life satisfaction rated on a 1\u0026ndash;7 scale, with higher scores reflecting greater satisfaction (α\u0026thinsp;=\u0026thinsp;0.84)\u003csup\u003e51\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eWHO-5 Well-Being Index (WBI-5)\u003c/b\u003e (Hungarian version) evaluates subjective well-being via five items using a 0\u0026ndash;3 Likert scale; total scores range from 0\u0026ndash;15, with higher scores indicating better well-being. The original WHO-5 was developed by the WHO\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e and its Hungarian validation showed good internal consistency (α\u0026thinsp;=\u0026thinsp;0.85)\u003csup\u003e53\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eFemale Sexual Function Index (FSFI-H)\u003c/b\u003e assesses sexual functioning across six domains (desire, arousal, lubrication, orgasm, pain, satisfaction) using 19 items. Scores range from 2 to 36; lower scores indicate more dysfunction. A cut-off of 26.55 indicates clinically significant dysfunction\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. The Hungarian version was validated by Hock et al. with excellent reliability (α\u0026thinsp;=\u0026thinsp;0.963)\u003csup\u003e55\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003ePostpartum Bonding Questionnaire (PBQ)\u003c/b\u003e is a 25-item scale measuring mother\u0026ndash;infant bonding across four domains: impaired bonding, rejection/anger, caregiving anxiety, and risk of abuse. Items are rated from 0 (always) to 5 (never); higher scores reflect greater bonding difficulties (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.83)\u003csup\u003e56\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe \u003cb\u003eMOS Social Support Survey (MOS-SSS-H)\u003c/b\u003e includes 20 items measuring emotional/informational support, tangible support, and positive social interaction. Items are rated on a 1\u0026ndash;5 scale. The original scale was developed by Sherbourne and Stewart\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e, and the Hungarian adaptation showed strong psychometric properties (α\u0026thinsp;=\u0026thinsp;0.89 to 0.95)\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBoth the City BiTS and PBQ questionnaires were translated and culturally adapted for use in Hungarian postpartum samples. The Hungarian adaptation followed a rigorous translation protocol based on Sousa and Rojjanasrirat's seven-step method, including initial translation, expert review, and back-translation with cultural and linguistic adjustments\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e. Pretesting with a small group of mothers (N\u0026thinsp;=\u0026thinsp;12) confirmed the clarity and readability of the translated items. Detailed information on the translation process, factor structure, and psychometric validation of the City BiTS in Hungarian is available in a completed manuscript submitted for editorial review. The PBQ was applied up to two years postpartum, consistent with emerging evidence on the prolonged nature of the bonding process\u003csup\u003e\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eParticipants were eligible if they were over 18 years of age, fluent in Hungarian, and had given birth within the previous two years. Due to pandemic-related constraints, data collection was conducted online between November 2021 and November 2022. The questionnaire link was disseminated through the health visitor network and targeted social media groups specifically addressing maternal and postpartum topics. Participation was voluntary, with no financial compensation provided. Before beginning the survey, respondents received detailed information about the study, including the possibility of encountering sensitive or distressing topics. Contact information for psychological support services was provided. Informed consent was obtained electronically, and participants were reminded they could withdraw at any point without consequence. The survey took approximately 20\u0026ndash;25 minutes to complete, and all responses were collected anonymously to ensure confidentiality. During the data collection period (2021\u0026ndash;2022), Hungary was classified by the World Bank as a high-income country\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll statistical analyses were conducted using SPSS version 22.0, with the significance level set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-tailed). Descriptive statistics (means, standard deviations, frequencies) were used to characterize the sample and questionnaire responses. Pearson\u0026rsquo;s correlation coefficients were calculated to assess associations between continuous psychological and relational variables. Independent-samples \u003cem\u003et\u003c/em\u003e-tests were used to compare groups based on parity, time since childbirth, and presence of pregnancy complications. Multivariate analyses of variance (MANOVA) were employed to examine the combined effects of depression, bonding disturbances, and sexual dysfunction on caregiving perceptions and quality of life indicators. Additionally, linear regression models were used to identify key predictors of postpartum bonding (PBQ), perceived social support (MOS-SSS), and relationship satisfaction (RAS-H), including psychological and demographic variables as independent predictors. Assumptions of normality and homogeneity of variance were checked and met where applicable.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Characteristics\u003c/h2\u003e\n \u003cp\u003eThe final sample consisted of 675 mothers (M_age\u0026thinsp;=\u0026thinsp;32.02 years, SD\u0026thinsp;=\u0026thinsp;4.72). Most participants lived in urban areas (60.4%), had higher education (53.6%), and were married (87.1%). The majority were multiparous (89.2%), and 88.7% reported planned pregnancies. A spontaneous vaginal delivery was reported by 55.3%, while 42.1% had cesarean births (31.3% planned, 10.8% emergency). Pregnancy complications were present in 36%, and 44.3% required additional specialist visits. The mean gestational age at delivery was 39 weeks (SD\u0026thinsp;=\u0026thinsp;1.84), with an average birth weight of 3401g (SD\u0026thinsp;=\u0026thinsp;553.31).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePrevalence of Psychological Distress\u003c/h3\u003e\n\u003cp\u003eBased on the EPDS, 26.4% of participants showed mild depressive symptoms, and 29.6% met the threshold for major depression. According to the BDI, 30.4% reported mild, 13.2% moderate, and 8.9% severe depression. The mean CB-PTSD score was 11.60 (SD\u0026thinsp;=\u0026thinsp;10.42), and 4.6% met DSM-5 criteria for CB-PTSD. Severe bonding disturbances were present in 1.6% of participants. Regarding sexual functioning, 32.1% of women met criteria for clinically significant sexual dysfunction. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the mean values and standard deviations of the completed questionnaires, providing an overview of the participants\u0026apos; responses on each measure.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive statistics of psychological and relational measures in the postpartum sample (N\u0026thinsp;=\u0026thinsp;675)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale/Questionnaire/Dimension\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI Lower -Upper\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8,759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,43\u0026thinsp;\u0026minus;\u0026thinsp;12,81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,94\u0026thinsp;\u0026minus;\u0026thinsp;9,88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCity BiTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11,598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10,42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,86\u0026thinsp;\u0026minus;\u0026thinsp;12,44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIBM Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27,21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8,397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,65\u0026thinsp;\u0026minus;\u0026thinsp;27,826\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIBM Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,82\u0026thinsp;\u0026minus;\u0026thinsp;8,88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRAS-H\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28,767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28,33\u0026thinsp;\u0026minus;\u0026thinsp;29,22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31,232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,85\u0026thinsp;\u0026minus;\u0026thinsp;31,64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSWLS-H\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26,63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,15\u0026ndash;27,08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBI-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,34\u0026thinsp;\u0026minus;\u0026thinsp;9,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFSFI-H\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21,757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,82\u0026thinsp;\u0026minus;\u0026thinsp;22,54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePBQ Sum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9,403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,81\u0026thinsp;\u0026minus;\u0026thinsp;8,21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePBQ1 Impaired bonding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4,155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,77\u0026thinsp;\u0026minus;\u0026thinsp;4,55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePBQ2 Rejection and anger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,649\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,22\u0026thinsp;\u0026minus;\u0026thinsp;1,62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePBQ3 Anxiety about care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,67\u0026thinsp;\u0026minus;\u0026thinsp;2,01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePBQ4 Risk of abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,035\u0026thinsp;\u0026minus;\u0026thinsp;0,11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMOS-SSS-H Sum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e82,124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80,796\u0026thinsp;\u0026minus;\u0026thinsp;83,305\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMOS-SSS-H size of the social network\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,985\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,77\u0026thinsp;\u0026minus;\u0026thinsp;5,38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMOS-SSS-H 1. Emotional/informational support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34,578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33,942\u0026thinsp;\u0026minus;\u0026thinsp;35,132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMOS-SSS-H 2. Positive social interaction support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30,689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,202\u0026thinsp;\u0026minus;\u0026thinsp;31,146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMOS-SSS-H 3. Instrumental support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16,857\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,548\u0026thinsp;\u0026minus;\u0026thinsp;17,15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eMean values and standard deviations (SD) for each scale and subscale used in the study. 95% confidence intervals (CI) are provided to indicate the precision of the mean estimates. Higher scores reflect greater symptom severity or higher levels of the measured construct, depending on the instrument. See Methods section for interpretation of cut-off scores.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eMultivariate associations between depression, bonding, and sexual dysfunction\u003c/h3\u003e\n\u003cp\u003eMANOVA revealed that bonding difficulties significantly predicted lower perceived partner care (F(2,664)\u0026thinsp;=\u0026thinsp;3.362, p\u0026thinsp;=\u0026thinsp;0.035). Depression (BDI) and sexual dysfunction were both independently associated with perceived partner care (F(3,667)\u0026thinsp;=\u0026thinsp;3.83, p\u0026thinsp;=\u0026thinsp;0.01; F(1,667)\u0026thinsp;=\u0026thinsp;48.206, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and partner control (F(1,667)\u0026thinsp;=\u0026thinsp;13.094, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Bonding difficulties and sexual dysfunction were significant predictors of lower self-efficacy (F(2,669)\u0026thinsp;=\u0026thinsp;11.851, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), life satisfaction (F(2,666)\u0026thinsp;=\u0026thinsp;11.294, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and subjective well-being (F(2,664)\u0026thinsp;=\u0026thinsp;15.386, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the PBQ analysis, depression (EPDS) and sexual dysfunction significantly predicted impaired bonding (F(2,669)\u0026thinsp;=\u0026thinsp;6.37, p\u0026thinsp;=\u0026thinsp;0.002; F(1,669)\u0026thinsp;=\u0026thinsp;29.418, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and caregiving anxiety (F(2,669)\u0026thinsp;=\u0026thinsp;3.158, p\u0026thinsp;=\u0026thinsp;0.043; F(1,669)\u0026thinsp;=\u0026thinsp;21.81, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Sexual dysfunction alone predicted rejection/anger (F(1,669)\u0026thinsp;=\u0026thinsp;21.054, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and risk of abuse (F(1,669)\u0026thinsp;=\u0026thinsp;4.908, p\u0026thinsp;=\u0026thinsp;0.027).\u003c/p\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003eAssociations between mental health, bonding, and relationship measures\u003c/h2\u003e\n \u003cp\u003eThe strongest correlations emerged between perceived partner care and relationship satisfaction (r\u0026thinsp;=\u0026thinsp;0.851), and between PTSD and depressive symptoms (r\u0026thinsp;=\u0026thinsp;0.665), based on the full sample (N\u0026thinsp;=\u0026thinsp;675). Additional significant associations between maternal bonding, mental health, and social support variables are reported in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePearson correlation coefficients between key psychological, relational, and social support variables (N\u0026thinsp;=\u0026thinsp;675)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale/ Questionnaire/ Dimension\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eEPDS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCity BiTS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIBM Care\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRAS-H\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSWLS-H\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWBI-5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFSFI-H total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePBQ total\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePBQ1.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePBQ 2.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePBQ 3.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePBQ 4.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMOS 1.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMOS 2.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMOS 3.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMOS total\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBDI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,665\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEPDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIBM Care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIBM Control\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAS-H\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf efficacy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSWLS-H\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBI-5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,295\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ 1.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ 2.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ 3.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOS 1.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOS 2.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,944\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOS 3.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,851\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"17\"\u003e\u003cstrong\u003eNote.\u003c/strong\u003e Displayed values are Pearson correlation coefficients. Only significant correlations are shown (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and only coefficients above r\u0026thinsp;\u0026ge;\u0026thinsp;0.25 are included to highlight moderate to strong associations.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eDepressive symptoms (BDI, EPDS) showed strong positive associations with PTSD symptoms (City BiTS) across all groups (r\u0026thinsp;=\u0026thinsp;0.534\u0026ndash;0.915). Among mothers with one child (N\u0026thinsp;=\u0026thinsp;73) BDI and EPDS scores were negatively correlated with life satisfaction (r = \u0026minus;\u0026thinsp;0.29, \u0026minus;\u0026thinsp;0.237), total social support (r = \u0026minus;\u0026thinsp;0.238, \u0026minus;\u0026thinsp;0.275), instrumental support (r = \u0026minus;\u0026thinsp;0.278, \u0026minus;\u0026thinsp;0.341), and positively associated with bonding difficulties (PBQ subscales 1 and 3; r\u0026thinsp;=\u0026thinsp;0.239\u0026ndash;0.282). PTSD scores also showed negative associations with self-efficacy, life satisfaction, and perceived social support (r = \u0026minus;\u0026thinsp;0.235 to \u0026minus;\u0026thinsp;0.321). Self-efficacy was positively related to life satisfaction (r\u0026thinsp;=\u0026thinsp;0.468), well-being (r\u0026thinsp;=\u0026thinsp;0.566), sexual satisfaction (r\u0026thinsp;=\u0026thinsp;0.343), and social support (r\u0026thinsp;=\u0026thinsp;0.350), and negatively with bonding difficulties (r = \u0026minus;\u0026thinsp;0.417 to \u0026minus;\u0026thinsp;0.401). The IBM Control dimension was negatively associated with relationship satisfaction (r = \u0026minus;\u0026thinsp;0.643), life satisfaction (r = \u0026minus;\u0026thinsp;0.392), and social support (r = \u0026minus;\u0026thinsp;0.418 to \u0026minus;\u0026thinsp;0.578).\u003c/p\u003e\n \u003cp\u003ePerceived partner care (IBM Care) was strongly positively correlated with relationship satisfaction (r\u0026thinsp;=\u0026thinsp;0.851), life satisfaction (r\u0026thinsp;=\u0026thinsp;0.583), and mental well-being (r\u0026thinsp;=\u0026thinsp;0.414), and negatively associated with bonding disturbances (r = \u0026minus;\u0026thinsp;0.272). Sexual satisfaction, arousal, and orgasm also showed moderate associations with perceived partner care (r\u0026thinsp;=\u0026thinsp;0.254\u0026ndash;0.378).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eModerating role of relationship duration and perinatal risk factors\u003c/h2\u003e\n \u003cp\u003eRelationship duration moderated several associations. In couples together for 1\u0026ndash;3 years (N\u0026thinsp;=\u0026thinsp;76), lower perceived partner care, reduced sexual satisfaction, and greater maternal bonding difficulties were associated with higher levels of depressive symptoms (BDI, EPDS; r = \u0026minus;\u0026thinsp;0.231 to \u0026minus;\u0026thinsp;0.337). PTSD symptoms in this group were negatively correlated with partner care, orgasm, total sexual function, and social support (r = \u0026minus;\u0026thinsp;0.234 to \u0026minus;\u0026thinsp;0.358), and positively with bonding impairments (r\u0026thinsp;=\u0026thinsp;0.297\u0026ndash;0.326). Among women in relationships lasting 11\u0026ndash;15 years (N\u0026thinsp;=\u0026thinsp;148), EPDS scores correlated positively with bonding difficulties across PBQ domains (r\u0026thinsp;=\u0026thinsp;0.225\u0026ndash;0.305). In mothers in relationships longer than 15 years (N\u0026thinsp;=\u0026thinsp;65), depressive symptoms were associated with reduced sexual satisfaction (r = \u0026minus;\u0026thinsp;0.252), while PTSD symptoms were negatively linked to relationship satisfaction, sexual functioning, and perceived social support (r = \u0026minus;\u0026thinsp;0.254 to \u0026minus;\u0026thinsp;0.333).\u003c/p\u003e\n \u003cp\u003eAmong high-risk pregnancies (N\u0026thinsp;=\u0026thinsp;251), relationship satisfaction (RAS-H) was strongly associated with perceived partner care (r\u0026thinsp;=\u0026thinsp;0.876), life satisfaction (r\u0026thinsp;=\u0026thinsp;0.652), and social support (r\u0026thinsp;=\u0026thinsp;0.445). Bonding difficulties were negatively related to self-efficacy, mental well-being, and partner care (r = \u0026minus;\u0026thinsp;0.225 to \u0026minus;\u0026thinsp;0.406).\u003c/p\u003e\n \u003cp\u003eMode of delivery moderated several psychosocial associations. Among mothers who delivered vaginally (N\u0026thinsp;=\u0026thinsp;373), relationship satisfaction was strongly associated with perceived partner care (r\u0026thinsp;=\u0026thinsp;0.847), self-efficacy, well-being, sexual functioning, and social support (r\u0026thinsp;=\u0026thinsp;0.202\u0026ndash;0.629), and was negatively associated with partner control and bonding difficulties (r = \u0026minus;\u0026thinsp;0.288 to \u0026minus;\u0026thinsp;0.600). In the cesarean birth group (N\u0026thinsp;=\u0026thinsp;211), partner control (IBM Control) negatively correlated with relationship satisfaction and social support, while self-efficacy was inversely associated with bonding difficulties and positively with social support (r = \u0026minus;\u0026thinsp;0.361 to 0.305). Among mothers with emergency cesarean sections (N\u0026thinsp;=\u0026thinsp;73), depressive symptoms were positively associated with caregiving anxiety (PBQ subscale 3; r\u0026thinsp;=\u0026thinsp;0.262), while maternal bonding disturbances were linked to lower partner care, relationship satisfaction, self-efficacy, life satisfaction, and well-being (r = \u0026minus;\u0026thinsp;0.250 to \u0026minus;\u0026thinsp;0.592), and higher perceived partner control (r\u0026thinsp;=\u0026thinsp;0.319) (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e for details).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDifferences in postpartum adjustment indicators by mode of delivery\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSubgroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eKey Variable Associations\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaginal birth (N\u0026thinsp;=\u0026thinsp;373)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAS-H \u0026ndash;\u003c/strong\u003e IBM Care (r\u0026thinsp;=\u0026thinsp;0.847), SWLS-H (r\u0026thinsp;=\u0026thinsp;0.629), FSFI Total (r\u0026thinsp;=\u0026thinsp;0.259), Self-efficacy (r\u0026thinsp;=\u0026thinsp;0.202), WBI-5 (r\u0026thinsp;=\u0026thinsp;0.391), MOS-SSS total (r\u0026thinsp;=\u0026thinsp;0.546; subscales 1\u0026ndash;3: r\u0026thinsp;=\u0026thinsp;0.454\u0026ndash;0.613), IBM Control (r = \u0026minus;\u0026thinsp;0.600); PBQ Total (r = \u0026minus;\u0026thinsp;0.242 subscale 1: r = \u0026minus;\u0026thinsp;0.288)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlanned cesarean (N\u0026thinsp;=\u0026thinsp;211)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIBM Control\u003c/strong\u003e \u0026ndash; RAS-H (r = \u0026minus;\u0026thinsp;0.638), MOS-SSS Total (r = \u0026minus;\u0026thinsp;0.275, subscale 2 (r = \u0026minus;\u0026thinsp;0.370).);\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-efficacy\u003c/strong\u003e \u0026ndash; PBQ Subscales 1\u0026ndash;3 (r = \u0026minus;\u0026thinsp;0.334 to \u0026minus;\u0026thinsp;0.361), MOS-SSS total and subscales (r\u0026thinsp;=\u0026thinsp;0.268\u0026ndash;0.305)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmergency cesarean (N\u0026thinsp;=\u0026thinsp;73)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEPDS\u003c/strong\u003e \u0026ndash; PBQ Subscale 3 (r\u0026thinsp;=\u0026thinsp;0.262);\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ Total\u003c/strong\u003e \u0026ndash; IBM Care (r = \u0026minus;\u0026thinsp;0.443), SWLS-H (r = \u0026minus;\u0026thinsp;0.571), WBI-5 (r = \u0026minus;\u0026thinsp;0.592), MOS-SSS Total (r = \u0026minus;\u0026thinsp;0.378), RAS-H (r = \u0026minus;\u0026thinsp;0.329), self-efficacy (r = \u0026minus;\u0026thinsp;0.419), MOS-SSS total (r = \u0026minus;\u0026thinsp;0.378; subscales 1\u0026ndash;3: r = \u0026minus;\u0026thinsp;0.250 to \u0026minus;\u0026thinsp;0.474), IBM Control (r\u0026thinsp;=\u0026thinsp;0.319)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003ePsychological and sexual outcomes by postpartum timing and pregnancy risk\u003c/h2\u003e\n \u003cp\u003eSignificant differences were found in psychological and sexual health indicators based on time since childbirth, parity, and pregnancy risk status. First-time mothers reported lower depressive symptoms compared to multiparous women in both the total sample (M\u0026thinsp;=\u0026thinsp;11.28 vs. 12.69; t(673)\u0026thinsp;=\u0026thinsp;2.085, p\u0026thinsp;=\u0026thinsp;0.037) and among those who gave birth within the past year (M\u0026thinsp;=\u0026thinsp;10.72 vs. 12.35; t(428)\u0026thinsp;=\u0026thinsp;1.964, p\u0026thinsp;=\u0026thinsp;0.05). Mothers who gave birth within two years postpartum showed higher sexual dysfunction compared to those within one year, including lower FSFI scores in lubrication (M\u0026thinsp;=\u0026thinsp;3.27 vs. 3.97; t(158.4)\u0026thinsp;=\u0026thinsp;2.01, p\u0026thinsp;=\u0026thinsp;0.046), orgasm (M\u0026thinsp;=\u0026thinsp;2.80 vs. 3.60; t(203)\u0026thinsp;=\u0026thinsp;2.40, p\u0026thinsp;=\u0026thinsp;0.017), and pain domains (M\u0026thinsp;=\u0026thinsp;2.93 vs. 4.08; t(203)\u0026thinsp;=\u0026thinsp;3.29, p\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eWithin the \u003cstrong\u003emild\u003c/strong\u003e BDI depression category, mothers more than one year postpartum reported significantly higher perceived partner care (IBM Care: t(203) = \u0026minus;\u0026thinsp;2.765, p\u0026thinsp;=\u0026thinsp;0.006), relationship satisfaction (RAS-H: t(203) = \u0026minus;\u0026thinsp;2.006, p\u0026thinsp;=\u0026thinsp;0.046), and life satisfaction (SWLS-H: t(203) = \u0026minus;\u0026thinsp;2.901, p\u0026thinsp;=\u0026thinsp;0.004), but lower overall sexual functioning (FSFI total: t(203)\u0026thinsp;=\u0026thinsp;2.143, p\u0026thinsp;=\u0026thinsp;0.033). Similar patterns were observed in the \u003cstrong\u003emoderate\u003c/strong\u003e depression group, with lower lubrication (t(61.43)\u0026thinsp;=\u0026thinsp;2.214, p\u0026thinsp;=\u0026thinsp;0.031) and higher pain scores (t(59.26)\u0026thinsp;=\u0026thinsp;2.723, p\u0026thinsp;=\u0026thinsp;0.008) among mothers more than one year postpartum. Additionally, within the \u003cstrong\u003enormal\u003c/strong\u003e BDI range, mothers who gave birth within two years showed greater maternal rejection and anger (PBQ subscale 2: t(144.21) = \u0026minus;\u0026thinsp;2.222, p\u0026thinsp;=\u0026thinsp;0.028). No significant differences were found in the \u003cstrong\u003esevere\u003c/strong\u003e depression category. Depressive symptoms were also higher among women with high-risk pregnancies compared to those without complications (M\u0026thinsp;=\u0026thinsp;13.10 vs. 11.50; t(673) = \u0026minus;\u0026thinsp;2.301, p\u0026thinsp;=\u0026thinsp;0.022).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003ePsychological correlates of pregnancy complications\u003c/h2\u003e\n \u003cp\u003eAmong mothers diagnosed with threatened preterm birth (N\u0026thinsp;=\u0026thinsp;21), postpartum depression was strongly associated with bonding disturbances, particularly anxiety about caregiving and risk of abuse (PBQ subscales 3\u0026ndash;4; r\u0026thinsp;=\u0026thinsp;0.462\u0026ndash;0.503). PTSD symptoms were negatively correlated with multiple domains of sexual functioning (e.g., arousal, lubrication, orgasm; r = \u0026minus;\u0026thinsp;0.432 to \u0026minus;\u0026thinsp;0.474). In the gestational diabetes group (N\u0026thinsp;=\u0026thinsp;69), depressive symptoms were associated with reduced self-efficacy, life satisfaction, and perceived social support (r = \u0026minus;\u0026thinsp;0.237 to \u0026minus;\u0026thinsp;0.304). Perceived partner care (IBM Care) was a strong protective factor across all indicators of relationship quality and bonding (PBQ total and subscales; r = \u0026minus;\u0026thinsp;0.325 to \u0026minus;\u0026thinsp;0.531). Among women with hypertensive disorders (N\u0026thinsp;=\u0026thinsp;30), IBM Care was positively associated with rejection-related bonding difficulties (PBQ subscale 2; r\u0026thinsp;=\u0026thinsp;0.366), while self-efficacy was negatively correlated with PBQ total and multiple subscales (r = \u0026minus;\u0026thinsp;0.359 to \u0026minus;\u0026thinsp;0.393) and positively with psychological well-being (WHO-5; r\u0026thinsp;=\u0026thinsp;0.449). In mothers with vaginal infections during pregnancy (N\u0026thinsp;=\u0026thinsp;28), depression correlated with bonding impairments (PBQ subscale 2; r\u0026thinsp;=\u0026thinsp;0.385), while self-efficacy showed strong negative associations with bonding difficulties (PBQ total and subscales 1\u0026ndash;3; r = \u0026minus;\u0026thinsp;0.432 to \u0026minus;\u0026thinsp;0.719), and partner control (IBM Control; r = \u0026minus;\u0026thinsp;0.416). Among women with a history of miscarriage (N\u0026thinsp;=\u0026thinsp;28), EPDS scores were negatively correlated with sexual lubrication (r = \u0026minus;\u0026thinsp;0.414), pain (r = \u0026minus;\u0026thinsp;0.381), and total FSFI scores (r = \u0026minus;\u0026thinsp;0.375), and positively associated with bonding difficulties (PBQ total: r\u0026thinsp;=\u0026thinsp;0.372; subscale 1: r\u0026thinsp;=\u0026thinsp;0.403; subscale 2: r\u0026thinsp;=\u0026thinsp;0.374). In this group, perceived partner care (IBM Care) showed strong positive associations with relationship satisfaction (RAS-H: r\u0026thinsp;=\u0026thinsp;0.857), life satisfaction (SWLS-H: r\u0026thinsp;=\u0026thinsp;0.507), mental well-being (WHO-5: r\u0026thinsp;=\u0026thinsp;0.601), and sexual satisfaction (r\u0026thinsp;=\u0026thinsp;0.510), while self-efficacy was positively associated with social support (MOS-SSS total: r\u0026thinsp;=\u0026thinsp;0.524) and negatively with PBQ subscale 4 (r = \u0026minus;\u0026thinsp;0.377). Among mothers who were hospitalized during pregnancy (N\u0026thinsp;=\u0026thinsp;36), EPDS and BDI scores were both positively correlated with bonding disturbances on PBQ subscale 4 (r\u0026thinsp;=\u0026thinsp;0.374 and r\u0026thinsp;=\u0026thinsp;0.410, respectively).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eRegression-based predictors of bonding, social support, and relationship satisfaction\u003c/h2\u003e\n \u003cp\u003eThree linear regression models were conducted to identify key predictors of postpartum bonding (PBQ), perceived social support (MOS-SSS), and relationship satisfaction (RAS-H). The PBQ model explained 27.9% of the variance (R\u0026sup2; = 0.279; F(33, 583)\u0026thinsp;=\u0026thinsp;6.828, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with self-efficacy (B = \u0026minus;\u0026thinsp;0.307, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and mental well-being (WBI-5; B = \u0026minus;\u0026thinsp;0.826, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) emerging as significant negative predictors of bonding difficulties.\u003c/p\u003e\n \u003cp\u003eThe MOS-SSS model accounted for 44.6% of the variance (R\u0026sup2; = 0.446; F(31, 585)\u0026thinsp;=\u0026thinsp;15.174, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with perceived partner care (IBM Care; B\u0026thinsp;=\u0026thinsp;0.491, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), life satisfaction (SWLS-H; B\u0026thinsp;=\u0026thinsp;0.597, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mental well-being (WBI-5; B\u0026thinsp;=\u0026thinsp;1.128, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) as significant predictors. Relationship satisfaction (RAS-H) was best predicted by a model explaining 79.1% of the variance (R\u0026sup2; = 0.791; F(32, 584)\u0026thinsp;=\u0026thinsp;69.006, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Significant predictors included higher partner care (IBM Care; B\u0026thinsp;=\u0026thinsp;0.424, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lower partner control (IBM Control; B = \u0026minus;\u0026thinsp;0.142, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), higher life satisfaction (SWLS-H; B\u0026thinsp;=\u0026thinsp;0.216, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mixed effects of social support subdimensions, with positive effects from positive social interaction (B\u0026thinsp;=\u0026thinsp;0.232, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and negative effects from emotional/informational (B = \u0026minus;\u0026thinsp;0.108, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and instrumental support (B = \u0026minus;\u0026thinsp;0.133, p\u0026thinsp;=\u0026thinsp;0.004) (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eLinear regression models predicting bonding, social support, and relationship satisfaction\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOutcome Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePredictor Variable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eR\u0026sup2;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ePBQ total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,238\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental well-being (WBI-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.826\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eMOS-SSS total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner care (IBM Care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,416\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLife satisfaction (SWLS-H)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental well-being (WBI-5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eRAS-H total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner care (IBM Care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePartner control (IBM Control)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLife satisfaction (SWLS-H)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmotional/Informational support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive social interaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInstrumental support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ndash;0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eNote.\u003c/strong\u003e Results of linear regression analyses predicting postpartum outcomes. All models were statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eB\u0026thinsp;=\u0026thinsp;unstandardized regression coefficient; R\u0026sup2; = proportion of variance explained by the model; Adjusted R\u0026sup2; = variance explained adjusted for the number of predictors. PBQ\u0026thinsp;=\u0026thinsp;Postpartum Bonding Questionnaire; MOS-SSS\u0026thinsp;=\u0026thinsp;Medical Outcomes Study Social Support Survey; RAS-H\u0026thinsp;=\u0026thinsp;Relationship Assessment Scale; IBM\u0026thinsp;=\u0026thinsp;Intimate Bond Measure; SWLS-H\u0026thinsp;=\u0026thinsp;Satisfaction with Life Scale; WBI-5\u0026thinsp;=\u0026thinsp;WHO-5 Well-Being Index.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study offers a comprehensive examination of postpartum psychological and relational challenges, focusing on the interplay between depressive symptoms, childbirth-related post-traumatic stress disorder (CB-PTSD), mother\u0026ndash;infant bonding disturbances, sexual functioning, and the roles of partner and social support. Our findings corroborate previous international research\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e and illuminate novel associations, particularly concerning the protective roles of partner relationship dynamics and maternal self-efficacy.\u003c/p\u003e\u003cp\u003eThe prevalence of depressive symptoms in our sample (29.6% based on the EPDS and 8.9% indicating severe depression based on the BDI) exceeds earlier national estimates from Hungary (7.1\u0026ndash;10.8%)\u003csup\u003e9,10\u003c/sup\u003e and is higher than international averages reported for high-income countries (13\u0026ndash;19%)\u003csup\u003e6\u003c/sup\u003e. This elevated prevalence is likely influenced by the timing of data collection during the COVID-19 pandemic, a period characterized globally by increased anxiety, social isolation, and limited access to healthcare services, all of which have been linked to heightened postpartum distress\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The pandemic-related reduction in perceived social support may have further undermined mothers\u0026rsquo; subjective coping resources, potentially contributing to the increased rates of depression and sexual dysfunction observed in our sample. While previous literature suggests that postpartum depression (PPD) is less prevalent in high-income countries\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, our findings indicate that, despite Hungary\u0026rsquo;s classification as a high-income nation, the prevalence of PPD and bonding disturbances remains alarmingly high, with 29.6% of participants exhibiting severe depressive symptoms and 32.1% meeting clinical criteria for sexual dysfunction. These findings suggest that a favorable macroeconomic context alone is insufficient to protect postpartum mental health. Instead, psychosocial factors - particularly the level of partner support, maternal self-efficacy, and the quality of relational dynamics - play a central role in postpartum adjustment. When these protective mechanisms are impaired, or when mothers face barriers to seeking help (e.g., due to stigma, self-blame, or societal expectations), the risk of severe psychological distress may persist even in wealthier societies.\u003c/p\u003e\u003cp\u003eThe prevalence of childbirth-related post-traumatic stress disorder (CB-PTSD) in our sample was 4.6%, falling within the internationally reported range of 0\u0026ndash;7%\u003csup\u003e30,32\u003c/sup\u003e. The strong correlation between PTSD and depression (r\u0026thinsp;=\u0026thinsp;0.665) supports previously documented comorbidity\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e and reinforces the notion that traumatic childbirth experiences not only impact maternal mental health but also impair the quality of mother\u0026ndash;infant bonding and intimate partner relationships\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Our findings suggest that CB-PTSD has a direct detrimental effect on both relational and maternal functioning, particularly affecting sexual wellbeing and emotional connectedness with the child. Unprocessed trauma during or surrounding childbirth may lead to long-term emotional consequences that require targeted psychological intervention.\u003c/p\u003e\u003cp\u003eDisruptions in postpartum bonding, as reflected in the total score and subscales of the Postpartum Bonding Questionnaire (PBQ), were significantly associated with depressive symptoms, low maternal self-efficacy, reduced subjective well-being, and lower levels of perceived social support. Specifically, elevated scores on the \u0026bdquo;Impaired bonding\u0026rdquo; and \u0026bdquo;Rejection and anger\u0026rdquo; subscales were observed among mothers reporting low self-efficacy and higher PTSD symptom severity. These findings align with previous research indicating that bonding difficulties may stem from deficits in maternal perceptions of competence\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Our results further indicate that a mother\u0026rsquo;s internal sense of competence - her belief in her ability to care for her infant and interpret the infant\u0026rsquo;s needs - has a direct influence on bonding behaviors and maternal affective responses.\u003c/p\u003e\u003cp\u003eMaternal self-efficacy emerged as a consistently strong protective factor across all variables examined. It was significantly negatively correlated with the total score and all four subscales of the Postpartum Bonding Questionnaire (PBQ). According to the linear regression analysis, low self-efficacy was among the strongest predictors of bonding disturbances. Mothers with reduced self-efficacy were more likely to experience uncertainty, perceived incompetence, or feelings of failure in their maternal role, which may hinder the development of positive maternal affect and predispose them to attachment difficulties. Importantly, self-efficacy not only reflects psychological well-being but also a realistic sense of control, which appears to be a critical determinant in the successful experience of the maternal role.\u003c/p\u003e\u003cp\u003eClinically significant sexual dysfunction was reported by 32.1% of participants and was closely associated with both depressive symptoms and PTSD. Lubrication, orgasm, pain, and sexual satisfaction scores were significantly lower among women with elevated levels of postpartum depression and PTSD, particularly during the second postpartum year. These findings are consistent with prior research by Chivers et al.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and Kelley\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e, which highlights the influence of subjective sexual experience and relationship quality on sexual functioning, beyond the presence of depressive symptoms alone. A novel contribution of our study is the observation that sexual functioning was not only linked to the romantic partnership but also to maternal-infant relational dynamics.\u003c/p\u003e\u003cp\u003eStrong positive correlation was observed between relationship satisfaction (RAS-H) and perceived partner care (IBM Care) (r\u0026thinsp;=\u0026thinsp;0.851), emphasizing the critical role of empathic partner presence in postpartum adjustment. Partner care was positively associated with maternal self-efficacy, life satisfaction, perceived social support, and bonding security, whereas perceived partner control (IBM Control) was negatively associated with these indicators. Regression analyses confirmed that perceived partner care, psychological well-being, and life satisfaction were among the strongest predictors of both social support and relationship quality.\u003c/p\u003e\u003cp\u003eAmong the dimensions of social support (MOS-SSS-H), \u0026bdquo;Positive Social Interaction\u0026rdquo; and \u0026bdquo;Emotional/Informational Support\u0026rdquo; showed the strongest associations with relationship satisfaction and maternal psychological well-being. The specific role of positive shared experiences - such as laughing together or spending quality time - as reflected in the \u0026bdquo;Positive Social Interaction\u0026rdquo; subscale, underscores the importance of everyday relational exchanges as protective factors in the postpartum period, consistent with previous findings\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e .\u003c/p\u003e\u003cp\u003eFurthermore, delivery-related factors significantly influenced psychological outcomes. Emergency cesarean section, high-risk pregnancy, extended hospitalization, and later stages of the postpartum period (beyond the first year) were all associated with increased levels of psychological and sexual dysfunction. These findings support the view that postpartum adjustment is not a uniform process and is shaped by an interplay of psychosocial, biological, and relational factors\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations and Strengths\u003c/h2\u003e\u003cp\u003eThis study provides a valuable contribution to the understanding of psychosocial factors in the postpartum period; however, several methodological limitations should be considered when interpreting the findings. First, the cross-sectional design precludes causal inferences regarding the relationships among postpartum depression, childbirth-related PTSD (CB-PTSD), bonding difficulties, sexual functioning, and perceived social support. Second, data collection relied on self-report questionnaires, which may be subject to reporting bias due to social desirability or stigma surrounding mental health issues - particularly in relation to depressive symptoms, sexual dysfunction, and relationship dissatisfaction.\u003c/p\u003e\u003cp\u003eMoreover, the sample was not fully representative of the broader Hungarian postpartum population, as participants were predominantly urban, highly educated women in stable relationships. This demographic bias may limit the generalizability of our results to more vulnerable groups, such as mothers with lower socioeconomic status or limited support, who are likely to experience even higher levels of psychosocial distress. Additionally, the timing of data collection during the COVID-19 pandemic may have further elevated levels of psychological distress, complicating comparisons with pre-pandemic estimates.\u003c/p\u003e\u003cp\u003eDespite these limitations, our study has several notable strengths. To our knowledge, this is the first large-scale investigation in Hungary (N\u0026thinsp;=\u0026thinsp;675) to comprehensively examine the interrelations among postpartum depression, CB-PTSD, mother\u0026ndash;infant bonding, sexual functioning, and perceived partner support using an interdisciplinary and integrative psychosocial framework. The use of multidimensional, validated instruments allowed for an in-depth assessment of psychological, relational, and social domains. Our regression and subgroup analyses yielded novel insights into the protective roles of maternal self-efficacy and perceived partner care.\u003c/p\u003e\u003cp\u003eOf particular interest is our finding that emotional and instrumental support were negatively associated with relationship satisfaction in our sample. This result suggests that the quality, context, and subjective experience of support may be as important as its quantity, opening new directions for refining support interventions.\u003c/p\u003e\u003cp\u003eFinally, our findings highlight that although Hungary is classified as a high-income country, the observed prevalence rates of severe depression (29.6%) and clinically significant sexual dysfunction (32.1%), as well as the critical role of perceived partner care, align with psychosocial risk patterns commonly reported in lower-income settings\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. These results underscore the notion that economic development alone does not safeguard postpartum mental health when relational and psychological needs remain unmet.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eImplications for Practice\u003c/h2\u003e\u003cp\u003eOur findings underscore that postpartum mental health and mother\u0026ndash;infant bonding are embedded within a complex psychosocial system, in which partner support, maternal self-efficacy, and relationship quality play central roles. Accordingly, postpartum psychological screening and assessment should extend beyond depressive symptoms to include evaluations of couple dynamics, sexual functioning, and the mother's perceived self-efficacy\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMothers with high levels of self-efficacy are less vulnerable to depression, bonding difficulties, and perceived social isolation\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e, making the enhancement of self-efficacy - via group-based psychoeducation or targeted support interventions - a key preventive focus. Similarly, fostering partner care and reinforcing relational security may function as important protective factors\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. The observed negative association between emotional and instrumental support and relationship satisfaction suggests that supportive efforts may not always alleviate distress if they fail to align with the mother\u0026rsquo;s actual needs. This highlights the need for a paradigm shift in the design of support systems, emphasizing the quality, timing, and contextual sensitivity of interventions.\u003c/p\u003e\u003cp\u003eIt is important to note that many mothers do not seek help for postpartum psychological difficulties, often due to fears of maternal inadequacy, guilt, or the normalization of symptoms as a \u0026bdquo;natural\u0026rdquo; part of the postpartum period\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. This self-stigma presents a significant barrier to accessing professional support. Reducing stigma, increasing the visibility and acceptance of postpartum mental health care, and expanding mental health education are therefore essential\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eBased on our results, psychosocial interventions may be more effective when they not only address the individual mother but also focus on the couple as a unit. Couple therapy, sexological counseling, and trauma-informed psychological support for processing difficult birth experiences represent promising avenues for alleviating sexual dysfunction\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, mitigating bonding difficulties, and improving relationship quality. Such a comprehensive approach is particularly warranted for high-risk groups, including mothers with medically complex pregnancies, emergency cesarean deliveries, or first-time motherhood.\u003c/p\u003e\u003cp\u003eGiven the complexity of the perinatal period, an integrated care model is essential. Collaboration among obstetric, nursing, psychological, and social care providers is required to identify mothers at elevated risk for bonding difficulties, depression, or relational distress. Our findings reinforce the notion that supporting mother\u0026ndash;infant bonding cannot be achieved without attention to the partner relationship and the psychosocial resources of the mother.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study support the view that postpartum depressive symptoms, childbirth-related PTSD (CB-PTSD), bonding disturbances, sexual dysfunction, and perceived partner support form a closely interconnected and complex system. Maternal self-efficacy, perceived partner care, and the quality of social support emerged as key predictors of maternal mental well-being, bonding experience, and relationship satisfaction. The unique societal and psychological impacts of the COVID-19 pandemic may have further intensified the prevalence and severity of these difficulties.\u003c/p\u003e\u003cp\u003eOur results highlight the need for a multidimensional approach to the prevention and treatment of postpartum psychological disorders, emphasizing the targeted reinforcement of emotional support, relational dynamics, and maternal self-competence - even within high-income societies. This study offers novel perspectives for enhancing perinatal mental health care and for designing interventions aimed at reducing stigma and fostering early identification and support for vulnerable mothers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBDI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBeck Depression Inventory\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEPDS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCity BiTS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCity Birth Trauma Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIBM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntimate Bond Measure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eRAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eH-Relationship Assessment Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSWLS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eH-Satisfaction With Life Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWBI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003e5-WHO-5 Well-Being Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFSFI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eH-Female Sexual Function Index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePBQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePostpartum Bonding Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMOS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSSS-H, Medical Outcomes Study Social Support Survey.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis in the text, these will be made aviable after consultation with the corresponting author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData accessibility statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial interest.\u003c/p\u003e\n\u003cp\u003eThey have not received any financial support for the preparation of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eUniversity of Szeged Open Access Fund, Grant ID: 7742.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Szeged approved study protocols of all data collections and data analysis approaches reported in this study (133/2021-SZTE-RKEB). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to the study, informed consent was obtained full all adult participants involved in the research.\u003c/p\u003e\n\u003cp\u003eWe have not had prior discussions with a Scientific Reports Editorial Board Member regarding this manuscript. We kindly suggest the following reviewers, whose expertise aligns with the scope of our work:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eJudit Szigeti F. dr. PhD\u003c/strong\u003e (Semmelweis University Department of Otorhinolaryngology, Head and Neck Surgery) [email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBe\u0026aacute;ta Bőthe dr. PhD\u003c/strong\u003e (D\u0026eacute;partement de Psychologie/Department of Psychology Universit\u0026eacute; de Montr\u0026eacute;al/University of Montreal) [email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eX\u0026eacute;nia Gonda dr. PhD\u003c/strong\u003e (Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of General Medicine) [email protected]\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter of materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003eTha authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution declaration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRen\u0026aacute;ta, Kov\u0026aacute;cs-Berta: Conceptualization, Methodology, Investigation, Writing \u0026ndash; Original Draft, designed the study and wrote the protocol, managed the literature searches and analyses; Lilla, S\u0026aacute;ndor: Writing \u0026ndash; Review \u0026amp; Editing; contributed to the literature review and the drafting of the Introduction section; Fanni, Dudok: Visualization, Data Curation, advised on the statistical analysis; Norbert, P\u0026aacute;sztor: Data Curation, Supervision, Project administration, co-designed the study and supervised the protocol development and implementation; Edina, Dombi: Validation, Investigation, co-designed the study and supervised the protocol development and implementation.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang, Z. et al. 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Validation of the postpartum bonding questionnaire: A cross-sectional study among Flemish mothers. \u003cem\u003eMidwifery\u003c/em\u003e \u003cb\u003e107\u003c/b\u003e, 103280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.midw.2022.103280\u003c/span\u003e\u003cspan address=\"10.1016/j.midw.2022.103280\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"postpartum depression, childbirth-related PTSD, maternal-infant bonding, sexual dysfunction, social support, maternal self-efficacy","lastPublishedDoi":"10.21203/rs.3.rs-6620032/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6620032/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study provides a comprehensive analysis of psychosocial factors influencing postpartum mental health, with a focus on depression, childbirth-related PTSD (CB-PTSD), maternal-infant bonding, sexual dysfunction, and perceived partner support. Data from a large Hungarian sample (N\u0026thinsp;=\u0026thinsp;675) revealed that 29.6% of mothers reported clinically significant depressive symptoms, and 32.1% reported sexual dysfunction. The prevalence of CB-PTSD was 4.6%, with strong comorbidity observed between depression and PTSD. Impaired bonding was significantly associated with higher levels of depressive symptoms, lower self-efficacy, and reduced social support. Self-efficacy emerged as a central protective factor, negatively predicting bonding impairments across all subscales. Regression analyses also highlighted the importance of perceived partner care and relationship satisfaction in fostering maternal well-being. Unexpectedly, emotional and instrumental support showed a negative association with relationship satisfaction, suggesting complex dynamics in postpartum support needs. Sociodemographic and birth-related variables, such as emergency cesarean and high-risk pregnancies, were linked to higher psychological distress. These findings underscore the multidimensional nature of postpartum adjustment and emphasize the need for integrated psychosocial screening and intervention strategies that address not only individual but relational factors, including trauma-informed support and couple-based therapy. Our results deepen understanding of maternal mental health and offer actionable insights for perinatal care.\u003c/p\u003e","manuscriptTitle":"Postpartum depression, childbirth-related PTSD and maternal bonding: The role of social support in a psychosocial rerspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-06 18:56:26","doi":"10.21203/rs.3.rs-6620032/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T19:10:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-04T17:02:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-01T19:19:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336539163853401216034808621821732098670","date":"2025-09-23T06:52:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1252875724155207099181317787619823140","date":"2025-08-27T15:29:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96571593942344701850882233172276368486","date":"2025-08-26T13:17:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T08:54:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78214251561751997658545784687423572177","date":"2025-08-18T08:26:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-04T08:02:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-28T03:48:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-26T03:25:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-08T11:06:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"140a78ba-608a-4d0d-b193-485b8c03beed","owner":[],"postedDate":"August 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":52620602,"name":"Health sciences/Diseases/Psychiatric disorders/Depression"},{"id":52620603,"name":"Health sciences/Diseases/Psychiatric disorders/Anxiety"},{"id":52620604,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-03-02T16:01:25+00:00","versionOfRecord":{"articleIdentity":"rs-6620032","link":"https://doi.org/10.1038/s41598-026-41725-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-02-27 15:58:16","publishedOnDateReadable":"February 27th, 2026"},"versionCreatedAt":"2025-08-06 18:56:26","video":"","vorDoi":"10.1038/s41598-026-41725-7","vorDoiUrl":"https://doi.org/10.1038/s41598-026-41725-7","workflowStages":[]},"version":"v1","identity":"rs-6620032","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6620032","identity":"rs-6620032","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}