Relationship between Domestic Violence and Mother-Infant Attachment in Mothers Referring to Comprehensive Health Centers affiliated to Iran University of Medical Sciences

Infancy is the most important time for the formation of emotions and emotional development, and mother-infant attachment is of special importance during this period. Domestic violence seems to be one of the factors relating to the mother- infant attachment. In fact, domestic violence is an attack on the mother-child relationship and the child care system. Violent fathers directly and indirectly weaken the emotional bond between mother and child. Those women who are the victims of domestic violence often live in fear and anxiety to protect their childrenchr('39')s mental health and safety, and this fear may be inadvertently transmitted to children, forming undesirable attachment patterns; as some children perceive their mothers as a source of fear and anxiety, and eventually the child will suffer from unresolved trauma by perceiving a threat to its mother. Consequently, unresolved fear and trauma results in disorganized attachment. However, most studies have examined attachment at different stages of life from pregnancy to infancy, childhood, and adulthood, and the emotional relationship in infancy is neglected. Therefore, considering the role of mother-infant behavior and attachment and the effects of fatherchr('39')s violence on the health of mother and child, the present study was conducted to determine the relationship between domestic violence and mother-infant attachment.

This was a cross-sectional study conducted on 320 mothers referring to the comprehensive health centers affiliated to Iran University of Medical Sciences in Tehran in 2019. Multistage sampling method was employed to select the subjects. First, the comprehensive health centers were divided into two groups (west and northwest). The comprehensive health centers located in the west covered four districts (9-18-21-22) and Northwest centers covered three districts (2-5-6). Then, two centers were selected from each district by simple random sampling method and 320 mothers, referring to the health centers, meeting inclusion criteria were selected continuously. Sampling lasted approximately 3.5 months (from November 29, 2019 to February 15, 2019). The inclusion criteria were the Iranian nationality, mothers aged 18 to 45 years, monogamy status, minimum literacy, having a seemingly healthy infant aged one month to one year, infant birth weight more than 2500 grams and wanted pregnancy, no history of severe stress during the last year (death of a first-degree relative, serious illness of mother or father, decision to separate, severe family conflicts), no drug addicted parents, no history of severe psychological disorders in the last year (history of referring to the doctor, medication, or hospitalization), no mother- child separation for more than 24 hours in the early hours following delivery, and no history of parental infertility. Demographic and Fertility Questionnaires, the Maternal Attachment Inventory (MAI), and revised Conflict Tactics Scales (CTS2) were used to collect data. The MAI was used to measure mother- infant attachment. The questionnaire has 26 items and each item has four options rated on the 4- point Likert scale, including almost always (4), usually (3), sometimes (2), and never (1). The scores of the questionnaire range from 26-104. The revised Conflict Tactics Scales used to measure domestic violence had 36 items including the areas of negotiation (6 items), physical violence (12 items), psychological violence (8 items), sexual violence (4 items), and injury (6 items). Each item has eight options rated on a 7- point scale. The scores of the different scales are not added up in this questionnaire, and finally the samples receive zero for the absence of violence and one for the existence of violence, thus the overall prevalence of domestic violence and the relative prevalence of each type of domestic violence or subscales are shown in frequency and percentage. Descriptive statistics were used to describe the data and Chi-square, independent t-test, and analysis of variance were calcualted in the SPSS software version 16 to examine the relationship between the variables. Significance level was considered at P <0.05.

The results showed that the mean of mother- infant attachment was 97.78 ± 7.56. Overall domestic violence in the mothers participated in the study was 42.2%. Among the studied mothers, 53.8% experienced violence in domains of negotiation, 24.7% physical violence, 75.6% psychological violence, 12.5% ​sexual violence, and 31.6% injury. Thus, the areas of psychological violence and negotiation had the highest frequency and the areas of sexual violence and physical violence had the lowest frequency among the dimensions of domestic violence. Based on the overall results of the two groups; abused and non-abused women (P = 0.010), there was a statistically significant difference between the groups in terms of mother- infant attachment in all areas of negotiation (P = 0.014), physical violence (P = 0.043), psychological violence (P = 0.014), and injury (P = 0.010), except sexual violence (P =0/356). None of the demographic variables of mothers was significantly related to mother- infant attachment (P> 0.05) and also domestic violence (P> 0.05).

The findings of the study showed that overal domestic violence was significantly related to mother-infant attachment and mother-infant attachment was lower in mothers experiencing violence. Domestic violence was significantly related to mother-infant attachment in all areas except sexual violence. Therefore, the present study showed that domestic violence against mothers during infancy can undermine the mother-infant attachment. Since the formation of attachment during infancy is a good starting point for improving the role of fathers in building social and emotional relationships with their children and, consequently, the growth and health of emotional relationships and family memberschr('39') attachment, it is necessary that officials and care systems pay more attention to motherschr('39') mental health and family status by identifying, counseling, and adopting timely preventive and supportive strategies through active participation of fathers in physical and emotional wellbeing of their infants to improve mental health of family members and mother-infant attachment by reducing domestic violence. Midwives and healthcare providers can use special tools and perform psychological screening for early and timely referral during postpartum care to reduce all types of domestic violence and harms to families experiencing violence. Also, timely detection of parent-child attachment disorder and the factors affecting it and eliminating it through educational and counseling interventions and parental support in this area can help to prevent the loss of economic and human capital. Also, in terms of the quality of parental attachment, this research can provide the basis for interventional research or subsequent studies to identify other factors affecting attachment. This study suggests that more studies investigate the relationship between the violence of other people, other than the husband, and the mother- infant attachment. It is also recommended to study the relationship between motherchr('39')s violence against the father and the mother-infant attachment. It is suggested to conduct a study that can examine the effect of parentschr('39') violence against each other on the mother- infant attachment. More studies are also needed to be performed on a larger sample size in order to generalize the results. Moreover, this study suggests that an extensive research project be conducted to investigate the relationship between other factors related to mother-infant attachment such as marital satisfaction, social support, and parental personality traits.