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The Mother-Infant Relationship and Infant Attachment in a South African Peri-Urban Settlement

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Title: The Mother-Infant Relationship and Infant Attachment in a South African Peri-Urban Settlement
Language: English
Authors: Tomlinson, Mark, Cooper, Peter, Murray, Lynne
Source: Child Development. Sep-Oct 2005 76(5):1044-1054.
Availability: Journal Customer Services, Blackwell Publishing, 350 Main Street, Malden, MA 02148. Tel: 800-835-6770 (Toll Free); Fax: 781-388-8232; e-mail: subscrip@bos.blackwellpublishing.com.
Peer Reviewed: Y
Page Count: 11
Publication Date: 2005
Document Type: Journal Articles
Reports - Evaluative
Education Level: Early Childhood Education
Descriptors: Infants, Predictor Variables, Depression (Psychology), Attachment Behavior, Parent Child Relationship, Mothers, Urban Areas, Foreign Countries, Parenting Styles, Cultural Differences
Geographic Terms: South Africa (Cape Town)
DOI: 10.1111/j.1467-8624.2005.00896.x
ISSN: 0009-3920
Abstract: A sample of 147 mother-infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2- and 18-months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2-month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother-infant relationship remained important, but maternal depression was no longer predictive. Cross-cultural differences and consistencies in the development of attachment are discussed.
Abstractor: Author
Number of References: 48
Entry Date: 2005
Accession Number: EJ718209
Database: ERIC
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  Value: <anid>AN0018155867;cdv01sep.05;2019May30.12:39;v2.2.500</anid> <title id="AN0018155867-1">The Mother–Infant Relationship and Infant Attachment in a South African Peri-Urban Settlement. </title> <p>A sample of 147 mother–infant dyads was recruited from a peri‐urban settlement outside Cape Town and seen at 2‐ and 18‐months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2‐month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother–infant relationship remained important, but maternal depression was no longer predictive. Cross‐cultural differences and consistencies in the development of attachment are discussed.</p> <p>In contrast to the considerable volume of research on child development in the developed world, rather less attention has been paid to infant and child development in the developing world. While 90% of the 135 million infants born in the world each year live in low income or developing countries ([<reflink idref="bib32" id="ref1">32</reflink>]), in a recent survey only 4% of the articles in 12 major international infancy and developmental journals were found to address the experience of infants living in the developing world ([<reflink idref="bib38" id="ref2">38</reflink>]). Yet, in conditions of extreme poverty and instability, conditions characteristic of much of the developing world, the pressures on parents differ markedly from those facing parents in communities that are typically the focus of research in child development. The question arises of what the effects of such adversity may have on parenting and child development.</p> <p>South Africa is a developing country characterized by high levels of poverty and inequality. As in most of the developing world, the proportion of the population comprised of young children is considerably higher than that in developed countries ([<reflink idref="bib34" id="ref3">34</reflink>]). As a result of its apartheid past, conditions of adversity disproportionately affect the Black South African population. The effects of poverty and the inequalities in South Africa are evident across all aspects of child development, and are apparent in the high infant mortality rate, stunted growth, high rates of early drop out from school and general low levels of educational attainment, high rates of homelessness, and criminality. Many children have lost either one or both parents to AIDS. The occurrence of such hardship is associated with high rates of child psychological disturbance. Indeed, a recent study of children living in Khayelitsha, a peri‐urban settlement on the outskirts of Cape Town, found that as many as 40% of the children exposed to community violence were found to have one or more psychiatric disorders ([<reflink idref="bib22" id="ref4">22</reflink>]).</p> <p>An important question in seeking to understand the development of children growing up in conditions such as those obtaining in settlements like Khayelitsha concerns the nature of the parenting that is possible under conditions of pervasive adversity. Preoccupation with external problems (e.g. poverty, lack of partner support), as well as more immediate difficulties (e.g. trauma and losses), may directly affect the parent's capacity to be responsive to their child. This difficulty may be further compounded by maternal mental health problems, and, in particular, by the occurrence of depression. Indeed, we found the point prevalence of maternal depression in Khayelitsha at 2‐months postpartum to be 34.7% ([<reflink idref="bib12" id="ref5">12</reflink>]), a rate almost 3 times the rate in Western samples ([<reflink idref="bib31" id="ref6">31</reflink>]). With regard to the mother–infant relationship, we found that depressed mothers in Khayelitsha were significantly less sensitive to their infants in early face‐to‐face interactions than were non‐depressed mothers; and the infants of depressed mothers were less positively engaged with their mothers ([<reflink idref="bib12" id="ref7">12</reflink>]). These findings are consistent with those of several studies from the developed world that have demonstrated how maternal depression results in less optimal maternal behaviors, such as unresponsiveness, insensitivity, intrusiveness, a lowered ability to assist infant affect regulation, and lower levels of stimulation ([<reflink idref="bib8" id="ref8">8</reflink>], [<reflink idref="bib10" id="ref9">10</reflink>], [<reflink idref="bib14" id="ref10">14</reflink>], [<reflink idref="bib30" id="ref11">30</reflink>], [<reflink idref="bib39" id="ref12">39</reflink>]). One of the consequences of such disturbances in the mother–infant relationship is an irritable and withdrawn infant who may be more likely to develop an insecure attachment to its remote or intrusive mother ([<reflink idref="bib8" id="ref13">8</reflink>], [<reflink idref="bib41" id="ref14">41</reflink>]).</p> <p>The attachment status of children in such conditions of adversity has received little research attention. While there have been numerous studies assessing infant attachment cross‐culturally ([<reflink idref="bib45" id="ref15">45</reflink>]), to date there has only been one study conducted in Africa using the Ainsworth strange situation procedure ([<reflink idref="bib40" id="ref16">40</reflink>]). This study was conducted in Mali with the Dogon people. Notably, high levels of both secure attachment (69%) and disorganized attachment (23%) were found. Although a few infants were categorized as resistant (less than 10%), the avoidant classification was entirely absent ([<reflink idref="bib40" id="ref17">40</reflink>]). [<reflink idref="bib40" id="ref18">40</reflink>] measured maternal frightened/frightening behavior, and while maternal sensitivity predicted little of the variance in infant security, the addition of the frightened/frightening variable added significantly to the variance.</p> <p>There is consistent evidence that early parental insensitivity, in the form of intrusiveness and controlling behavior, or under‐involved and unresponsive caregiving, is predictive of infant insecure avoidant ([<reflink idref="bib5" id="ref19">5</reflink>], [<reflink idref="bib29" id="ref20">29</reflink>], [<reflink idref="bib36" id="ref21">36</reflink>], [<reflink idref="bib46" id="ref22">46</reflink>]) and anxious‐resistant attachment patterns ([<reflink idref="bib5" id="ref23">5</reflink>]), respectively. More recently, a number of studies have shown that frightening, or frightened, dissociated, maternal behavior, which is likely to occur in conditions of trauma and loss, is associated with the development of insecure disorganized attachment ([<reflink idref="bib24" id="ref24">24</reflink>], [<reflink idref="bib26" id="ref25">26</reflink>], [<reflink idref="bib27" id="ref26">27</reflink>], [<reflink idref="bib35" id="ref27">35</reflink>], [<reflink idref="bib40" id="ref28">40</reflink>]).</p> <p>To assess the extent to which the early disturbances in mother–infant interactions that we found in Khayelitsha might be related to infant attachment problems, we extended our previous work and assessed mother–infant interactions and infant attachment at 18 months. On the basis of previous research, we predicted that, given the high level of adversity in Khayelitsha, the rate of insecure attachment would be higher than that found in samples in the developed world, and that patterns of insecurity that have been implicated in the development of aggressive behavior and conduct problems (i.e., avoidant and disorganized patterns) would be particularly prevalent. Furthermore, in line with previous research findings, we predicted that certain features of maternal interactions with the child would be related to these attachment patterns; in particular, we focused on coercive‐intrusive behavior and on remote‐disengaged caregiving, behavior patterns which themselves may be experienced by the infant as frightening and frightened‐dissociated, respectively ([<reflink idref="bib14" id="ref29">14</reflink>], [<reflink idref="bib25" id="ref30">25</reflink>]). Although there is consistent evidence linking early insensitivity in interactions to the later development of insecure attachment ([<reflink idref="bib18" id="ref31">18</reflink>], [<reflink idref="bib29" id="ref32">29</reflink>]), there is increasing evidence that concurrent measures of maternal sensitivity (in this case those at 18 months) need to be taken into account, and that they might in fact be more important for infant attachment than early interactions. Thus, it has been shown that instability in attachment status is related to the degree of discontinuity of care, changes in family circumstance, and changes in maternal sensitivity ([<reflink idref="bib6" id="ref33">6</reflink>], [<reflink idref="bib7" id="ref34">7</reflink>]). The importance of changing patterns of care has been further highlighted by [<reflink idref="bib20" id="ref35">20</reflink>], [<reflink idref="bib21" id="ref36">21</reflink>] who argue that it is concurrent experiences, and not developmentally antecedent ones, that are the principal influences on child psychological and behavioral functioning. In the light of this evidence, therefore, we also predicted that, although early interactions would be found to influence later infant attachment, concurrent measures of maternal interactive style would be better predictors. Finally, we examined the influence of wider contextual influences on infant attachment, including the mother's experience of depression (both at 2 and at 18 months), the degree of support she received from her partner and others, and variations in financial hardship and general living conditions.</p> <hd id="AN0018155867-2">Method</hd> <p>The current study was carried out in two adjoining areas of Khayelitsha: SST and Town II. The former is an informal settlement characterized by particularly high levels of unemployment (two‐thirds of the population are estimated to be unemployed) and poverty (predominantly shacks with no electricity or running water); the latter is characterized by a somewhat better standard of living (many of the houses are made of brick and receive basic services).</p> <hd id="AN0018155867-3">Sample</hd> <p>The sample included 147 Black South African women living in extreme poverty. Several strategies were used to obtain a representative sample of mothers (see [<reflink idref="bib12" id="ref37">12</reflink>]), including recruiters going door to door to inquire about the presence of infants in the neighborhood. Recruitment took place between March 1998 and the end of September 1998. Of the 149 mothers invited to participate in the study, only 2 (1.3%) refused. We have previously reported on the association, within this sample, between postpartum depression and aspects of the early mother–infant relationship ([<reflink idref="bib12" id="ref38">12</reflink>]).</p> <hd id="AN0018155867-4">Procedure</hd> <p>Assessments were carried out in a custom‐made prefabricated building adjoining a local women's health project. The building included a playroom with a one‐way mirror and an adjoining observation room for assessment of attachment and mother–infant interactions. Mothers and infants were assessed at 2‐months postpartum, when mother–infant interactions were observed, and then again at 18 months, when mother–infant interactions were again observed and infant attachment to the mother was assessed. Mothers were also interviewed on both occasions to assess maternal mood, and to obtain information concerning their wider circumstances.</p> <hd id="AN0018155867-5">Measures</hd> <p> <bold>Maternal mood and adversity. </bold> Mothers were interviewed by a trained Black South African Xhosa‐speaking researcher, using the Major Depression section of the Structured Clinical Interview for DSM–IV diagnoses (SCID, [<reflink idref="bib15" id="ref39">15</reflink>]). The interview had been translated and then back translated. The interviewer and the first author, both of whom had received formal training in SCID administration (from the second author and others), reviewed each assessment, using both tape recordings and the interviewer's notes. A collective decision was made about each of the relevant SCID symptoms, on which the decision about the presence or absence of a DSM–IV major depressive disorder was based ([<reflink idref="bib3" id="ref40">3</reflink>]). On each occasion, a structured schedule was also used to record details of the mother's circumstances, such as obstetric factors (planned pregnancy, mode of delivery), housing conditions, maternal age, maternal education level, and marital status.</p> <p> <bold>Mother–child interactions. </bold> At 2 months, the mothers and infants were filmed in a standard interaction, as described by [<reflink idref="bib30" id="ref41">30</reflink>]. This involved the mother being asked to play with or talk to her infant, face‐to‐face, for a 5 min period. These interactions were rated using an established rating scheme comprising a series of 5‐point scales. Maternal behavior was rated on a general measure of sensitivity (including responsiveness, acceptance, and warmth), and for the presence of coercive‐intrusive behavior, and remote‐disengaged behavior. These scales have been found to be reliable, and to be sensitive to a range of maternal psychiatric disorders, as well to as the presence of social and economic adversity ([<reflink idref="bib16" id="ref42">16</reflink>], [<reflink idref="bib30" id="ref43">30</reflink>], [<reflink idref="bib33" id="ref44">33</reflink>]). [<reflink idref="bib16" id="ref45">16</reflink>], for example, have reported reliability figures (κs) ranging from.70 to.89 for these scales. The videotaped interactions were rated by a native Xhosa‐speaking research assistant who was unaware of all information concerning the mothers. She had been trained to reliability by members of the Winnicott Research Unit of the University of Reading (on a sample of 12 interactions rated by the research assistant and her trainer (Melanie Gunning), at least 50% of the ratings were exactly the same as the criterion and 90% within 1 rating point).</p> <p>At 18 months, the mother and child were observed in a structured play situation, as described by [<reflink idref="bib37" id="ref46">37</reflink>]. The play session involved two episodes, each lasting 3 min. The first consisted of a task in which a number of colored plastic rings were required to be stacked onto a tapering pole in order of size; and the second involved a somewhat more complex game in which the child could hammer different colored balls through holes in a platform, and then retrieve them as they emerged at the base. The instructions to the mother were to play with the infant using the toys. Each typically requires the adult to give some support to infants of this age, and therefore they provide an opportunity to observe how well the mother is able to facilitate the child's play. Training in the administration and scoring of this assessment was provided to the first author by Professor Stein's group. With the assistance of the native Xhosa‐speaking research assistant, the first author rated maternal behavior on the dimensions of sensitivity, intrusive‐coercive control, and emotional tone. Each episode was rated on a 5‐point scale and then summed to provide a score out of 10 for the two episodes. Reliability was assessed by checking agreement between the first author and the trainer on a sub‐sample of 18 mother–infant play sessions. κs were.91 for sensitivity,.96 for coerciveness, and.93 for emotional tone. As there was no measure of maternal remoteness at 18 months, the dimension of emotional tone was used as an indicator of maternal remoteness in interaction.</p> <p> <bold>Infant attachment. </bold> Infant attachment was assessed using the strange situation procedure developed by [<reflink idref="bib2" id="ref47">2</reflink>]. Filming took place through a one‐way mirror from the observation room. The videotapes were rated by the first author, who was blind to all other information about the infants, using the ABCD system ([<reflink idref="bib28" id="ref48">28</reflink>]). Checks were made on reliability with a trained and reliable coder based at the Winnicott Research Unit. Based on 16 tapes coded by both the first author and the reliable coder at the Winnicott Unit, inter‐rater reliability was extremely good (κ=.96).</p> <hd id="AN0018155867-6">Data Analytic Strategy</hd> <p>First, univariate analyses were conducted examining the associations between infant attachment security and a range of factors, including demographic variables, maternal mood, and the quality of maternal interactions at 2 and 18 months (Table 1 shows the inter‐correlations between these variables). The outcome then informed the subsequent multivariate analyses. Using stepwise logistic or multiple regressions, we first examined the relative contribution to attachment of any relevant contextual factors (i.e. demographic characteristics and maternal mood). In particular, we were concerned to address the issue of whether any links between insecure attachment and particular features of social and economic adversity in the community could be accounted for by maternal depression. Next, we examined the role of maternal interactions with the infant, first, determining the relative contribution to infant attachment of different aspects of the mother's engagement, and second, examining whether any associations between attachment and demographic variables and maternal mood could be accounted for by the influence of maternal interactions. These analyses were conducted for the 2‐ and 18‐month variables separately. In a final analysis, the contribution of the 2‐ and 18‐month influences was considered jointly, enabling us to determine whether any apparent impact on infant attachment of early experience could be better accounted for by the influence of current circumstances.</p> <p>1 
 Intercorrelations Between the Critical Variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th align="center">1</th><th align="center">2</th><th align="center">3</th><th align="center">4</th><th align="center">5</th><th align="center">6</th><th align="center">7</th><th align="center">8</th><th align="center">9</th><th align="center">10</th></tr></thead><tbody valign="top"><tr><td>1. Attachment security</td><td>−</td><td>.26**</td><td>.23*</td><td>.21*</td><td>.30**</td><td>.35**</td><td>−.04</td><td>.21*</td><td>.30**</td><td>.24*</td></tr><tr><td>2. Maternal depression at 2 months</td><td /><td>−</td><td>.28**</td><td>.18*</td><td>.07</td><td>.11</td><td>.30**</td><td>.31**</td><td>.25*</td><td>.23*</td></tr><tr><td>3. Partner support at 2 months</td><td /><td /><td>−</td><td>.16</td><td>−.07</td><td>.05</td><td>.01</td><td>.34**</td><td>.13</td><td>.03</td></tr><tr><td>4. Maternal sensitivity at 2 months</td><td /><td /><td /><td>−</td><td>.28**</td><td>.19*</td><td>−.01</td><td>.15</td><td>.02</td><td>.04</td></tr><tr><td>5. Maternal intrusiveness at 2 months</td><td /><td /><td /><td /><td>−</td><td>−.06</td><td>−.08</td><td>.06</td><td>.22**</td><td>.31**</td></tr><tr><td>6. Maternal remoteness at 2 months</td><td /><td /><td /><td /><td /><td>−</td><td>.13</td><td>.30**</td><td>−.04</td><td>−.19</td></tr><tr><td>7. Maternal depression at 18 months</td><td /><td /><td /><td /><td /><td /><td>−</td><td>.24**</td><td>−.03</td><td>−.04</td></tr><tr><td>8. Partner support at 18 months</td><td /><td /><td /><td /><td /><td /><td /><td>−</td><td>−.06</td><td>−.18</td></tr><tr><td>9. Maternal sensitivity at 18 months</td><td /><td /><td /><td /><td /><td /><td /><td /><td>−</td><td>.69**</td></tr><tr><td>10. Maternal coercive control at 18 months</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>−</td></tr></tbody></table> </ephtml> </p> <p>1 ** <emph>p</emph><.01</p> <p>2 * <emph>p</emph><.05.</p> <p>Distributions of scores on the rating scales were all skewed, apart from those for 2‐month sensitivity, which were normally distributed; therefore, with the exception of the latter, scale scores were converted to binary variables reflecting the presence or absence of high levels of the behavior in question.</p> <hd id="AN0018155867-7">Results</hd> <p></p> <hd id="AN0018155867-8">Sample Characteristics</hd> <p>Between the 2‐month interview and the 18‐month follow‐up, 49 of the 147 women were lost to follow‐up, leaving 98 women (66.3% of the original sample), which is consistent with the known high mobility of this community ([<reflink idref="bib17" id="ref49">17</reflink>]). The demographic characteristics of the sample seen at the 18‐month assessment are shown in Table 2. Participant attrition was not systematically related to any of the demographic variables or to early postpartum depression.</p> <p>2 
 Sample Characteristics at 18 Months (n=98)</p> <p> <ephtml> <table><tbody valign="top"><tr><td align="left">Age (years)</td></tr><tr><td> <20</td><td>15.3%</td></tr><tr><td> 20–24</td><td>26.5%</td></tr><tr><td> 25–29</td><td>32.7%</td></tr><tr><td> 30–39</td><td>25.5%</td></tr><tr><td align="left">Marital status</td></tr><tr><td> Single</td><td>67.3%</td></tr><tr><td> Married/cohabiting</td><td>32.7%</td></tr><tr><td align="left">Infant gender</td></tr><tr><td> Male</td><td>53.1%</td></tr><tr><td> Female</td><td>44.9%</td></tr><tr><td align="left">Education</td></tr><tr><td> Grades 1–7</td><td>54.1%</td></tr><tr><td> Grade 8 or higher</td><td>45.9%</td></tr><tr><td align="left">Obstetric history</td></tr><tr><td> Previous pregnancy</td><td>61.2%</td></tr><tr><td> Primiparous</td><td>36.7%</td></tr><tr><td> >4 children</td><td>19.4%</td></tr><tr><td> Unplanned pregnancy</td><td>50%</td></tr><tr><td> Unwanted pregnancy</td><td>42.7%</td></tr><tr><td> Caesarean section</td><td>8.5%</td></tr><tr><td> Infant under 2500 g</td><td>8.3%</td></tr><tr><td align="left">Housing</td></tr><tr><td> Unserviced shack</td><td>48%</td></tr><tr><td> Serviced shack</td><td>49%</td></tr><tr><td> Serviced house</td><td>3%</td></tr></tbody></table> </ephtml> </p> <hd id="AN0018155867-9">Infant Attachment Security</hd> <p>The distribution of attachment classifications (ABCD categories) is shown in Table 3. It can be seen that 61.9% of the sample were rated as secure (B). The most common insecure category, evident in 25.8%, was disorganized (D). When infants with a D classification were re‐assigned to one of the original three Ainsworth categories by way of a "best fit" ([<reflink idref="bib26" id="ref50">26</reflink>]), 72.2% of the sample were found to be secure (B or B/D). The main analyses, which follow, concern the prediction of insecure (A, C, or D) vs. secure (B) attachment. In addition, in view of the possibility that disorganized attachment may be particularly important in the pathway to longer‐term adverse outcomes in this community, further exploratory analyses were conducted to investigate predictors of disorganization, and, in particular, the possible role of "frightened/frightening" maternal behavior.</p> <p>3 
 Infant Attachment Status at 18 Months</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th align="center">Avoidant</th><th align="center">Secure</th><th align="center">Resistant</th><th align="center">Total disorganized</th></tr></thead><tbody valign="top"><tr><td>Disorganized and secondary "best fit" classification</td><td>12 (D/A)</td><td>10 (D/B)</td><td>3 (D/C)</td><td>25 (25.8%)</td></tr><tr><td>Not disorganized</td><td>4 (4.1%)</td><td>60 (61.9%)</td><td>8 (8.2%)</td><td /></tr><tr><td>Total (three‐way classification)</td><td>16 (16.5%)</td><td>70 (72.2%)</td><td>11 (11.3%)</td><td /></tr></tbody></table> </ephtml> </p> <hd id="AN0018155867-10">Socio‐Demographic Factors and Infant Attachment</hd> <p>Of the variables measured at 2 months, a number were considered to pose a particular risk to attachment security: an unplanned pregnancy, an unwanted infant, and lack of partner support (all related to early maternal depression; [<reflink idref="bib12" id="ref51">12</reflink>]). However, univariate chi‐square analyses showed only the last of these to be associated with infant security: regular emotional support from the partner was reported at 2‐months postpartum by 68% of the women with a securely attached infant compared with only 40.9% of those with an insecurely attached infant (χ<sups>2</sups>=5.29, <emph>df</emph>=1, <emph>p</emph><.05). Similarly, at 18 months, more mothers of secure than insecure children reported that they felt they were supported by their partner (68.3% and 46.7%, respectively; χ<sups>2</sups>=3.99, <emph>df</emph>=1, <emph>p</emph><.05).</p> <hd id="AN0018155867-11">Maternal Depression and Infant Attachment</hd> <p>The point prevalence of DSM–IV major depression was 34.7% at 2‐months postpartum (see [<reflink idref="bib12" id="ref52">12</reflink>]) and 12.4% at 18 months. This sharp drop in the prevalence of depression from 2 to 18 months is striking, but we could find no predictors of either remission or persistence. In the group of insecurely attached infants, 54.1% (<emph>n</emph>=37) of mothers had experienced depression at 2‐months postpartum compared with only 28.3% (<emph>n</emph>=60) of the mothers of securely attached infants (χ<sups>2</sups>=6.42, <emph>df</emph>=1, <emph>p</emph><.05). No association was found between maternal mood at 18 months and infant attachment classification (χ<sups>2</sups>=.18, <emph>df</emph>=1). With regard to stability of maternal depression only 4 women were depressed both at 2 and 18 months.</p> <hd id="AN0018155867-12">Mother–Infant Interactions and Infant Attachment</hd> <p>We examined the associations between infant attachment and the quality of maternal interactions with the infant at 2 and 18 months. At 2 months, compared with mothers whose infants were secure, mothers of insecurely attached infants were significantly less sensitive (mean 2.56 (<emph>SD</emph>=.59) and 2.82 (<emph>SD</emph>=.40); <emph>t</emph>=2.47, <emph>df</emph>=92, <emph>p</emph><.05), more often highly intrusive‐coercive (47.2% vs. 19%, χ<sups>2</sups>=8.48, <emph>df</emph>=1, <emph>p</emph><.01), and more often highly remote‐disengaged (30.6% vs. 5.2%, χ<sups>2</sups>=11.29, <emph>df</emph>=1, <emph>p</emph><.01). Similarly, at 18 months, mothers of insecure infants were more likely than mothers of secure infants to be rated as insensitive (57.1% vs. 26.9%, χ<sups>2</sups>=8.03, <emph>df</emph>=1, <emph>p</emph><.01), and as highly intrusive‐coercive (54.3% vs. 30.8%, χ<sups>2</sups>=4.81, <emph>df</emph>=1, <emph>p</emph><.05). The occurrence of remote‐disengaged behavior (maternal emotional tone) at 18 months, by contrast, was infrequent (11.5% vs. 13.8%) and was not found to be related to attachment security (χ<sups>2</sups>=0.33, <emph>df</emph>=1).</p> <hd id="AN0018155867-13">Multivariate Analyses</hd> <p> <bold>Two‐month measures. </bold> First, we examined the contribution to attachment status of the demographic and mood variables found to be significant in the univariate analyses; that is, partner support and maternal depression. Using the forward likelihood ratio method (with a <emph>p</emph><.05 criterion for variable retention), only postpartum depression at 2 months contributed significantly to the prediction of attachment security at 18 months (see Table 4, model 1). Early partner support was, therefore, dropped from subsequent modeling. Next, in order to assess the relative contribution of the early interaction factors, we examined the joint influence on attachment security of maternal sensitivity, remote‐disengaged behavior, and maternal intrusive‐coercion. Both maternal remote‐disengagement and intrusive‐coercion emerged as significant independent predictors of infant attachment, while the effect of maternal sensitivity was no longer significant (see Table 4, model 2). We then addressed the question of whether the quality of the mother–infant interactions at 2 months accounted for the association between early maternal depression and 18‐month infant insecurity. Depression at 2 months was entered in the first block, and then, in the second block, maternal remote‐disengagement and maternal intrusive‐coercion. All three variables emerged as significant independent predictors of infant attachment (see Table 4, model 3).</p> <p>4 
 Multiple Regression Results of Infant Attachment Security at 18 Months by 2‐Month Variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th align="center"><italic>B</italic></th><th align="center">Wald</th><th align="center"><italic>df</italic></th><th align="center"><italic>p</italic></th><th align="center">OR</th><th align="center">95% CI</th></tr><tr><th align="center">Lower</th><th align="center">Upper</th></tr></thead><tbody valign="top"><tr><td align="left">Model 1</td></tr><tr><td> Maternal depression at 2 months</td><td>1.09</td><td>6.23</td><td>1</td><td>.01</td><td>2.98</td><td>1.26</td><td>7.01</td></tr><tr><td> Partner support at 2 months</td><td>0.77</td><td>2.06</td><td>1</td><td>.15</td><td>2.17</td><td>0.75</td><td>6.23</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.09</td></tr><tr><td align="left">Model 2</td></tr><tr><td> Maternal intrusiveness at 2 months</td><td>1.55</td><td>9.22</td><td>1</td><td>.00</td><td>4.70</td><td>1.73</td><td>12.75</td></tr><tr><td> Maternal remoteness at 2 months</td><td>2.32</td><td>10.17</td><td>1</td><td>.00</td><td>10.19</td><td>2.45</td><td>42.45</td></tr><tr><td> Maternal sensitivity at 2 months</td><td>−2.30</td><td>0.19</td><td>1</td><td>.66</td><td>0.80</td><td>0.28</td><td>2.25</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.27</td></tr><tr><td align="left">Model 3</td></tr><tr><td> Maternal depression at 2 months</td><td>1.21</td><td>5.64</td><td>1</td><td>.01</td><td>3.34</td><td>1.24</td><td>9.01</td></tr><tr><td> Maternal intrusiveness at 2 months</td><td>1.59</td><td>9.04</td><td>1</td><td>.00</td><td>4.92</td><td>1.74</td><td>13.91</td></tr><tr><td> Maternal remoteness at 2 months</td><td>2.35</td><td>9.89</td><td>1</td><td>.00</td><td>10.50</td><td>2.42</td><td>45.48</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.34</td></tr></tbody></table> </ephtml> </p> <p> <bold>Eighteen‐month measures. </bold> The role of maternal sensitivity and intrusive coercion, at 18 months, to attachment security was then examined. Only maternal sensitivity emerged as significantly associated with infant attachment (see Table 5, model 1). When the relative contributions of 18‐month maternal sensitivity and partner support were considered, only maternal sensitivity emerged as significant (see Table 5, model 2).</p> <p>5 
 Multiple Regression Results of Infant Attachment Security at 18 Months by 18‐ and 2‐Month Variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th align="center"><italic>B</italic></th><th align="center">Wald</th><th align="center"><italic>df</italic></th><th align="center"><italic>p</italic></th><th align="center">OR</th><th align="center">95% CI</th></tr><tr><th align="center">Lower</th><th align="center">Upper</th></tr></thead><tbody valign="top"><tr><td align="left">Model 1</td></tr><tr><td> Maternal sensitivity   at 18‐months</td><td>1.29</td><td>7.72</td><td>1</td><td>.00</td><td>3.62</td><td>1.46</td><td>8.97</td></tr><tr><td> Maternal coercion   at 18‐months</td><td>0.22</td><td>0.12</td><td>1</td><td>.72</td><td>1.25</td><td>0.36</td><td>4.27</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.12</td></tr><tr><td align="left">Model 2</td></tr><tr><td> Maternal sensitivity   at 18 months</td><td>1.40</td><td>8.73</td><td>1</td><td>.00</td><td>4.07</td><td>1.60</td><td>10.31</td></tr><tr><td> Partner support   at 18‐months</td><td>−0.93</td><td>3.34</td><td>1</td><td>.06</td><td>0.40</td><td>0.14</td><td>1.07</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.14</td></tr><tr><td align="left">Model 3</td></tr><tr><td> Maternal depression  at 2‐months</td><td>1.09</td><td>3.66</td><td>1</td><td>.05</td><td>2.97</td><td>0.97</td><td>9.09</td></tr><tr><td> Maternal sensitivity   at 18‐months</td><td>1.34</td><td>6.02</td><td>1</td><td>.01</td><td>3.83</td><td>1.31</td><td>11.17</td></tr><tr><td> Maternal intrusiveness   at 2‐months</td><td>1.47</td><td>6.82</td><td>1</td><td>.00</td><td>4.36</td><td>1.44</td><td>13.17</td></tr><tr><td> Maternal remoteness   at 2‐months</td><td>2.71</td><td>9.58</td><td>1</td><td>.00</td><td>15.11</td><td>2.71</td><td>84.30</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.43</td></tr></tbody></table> </ephtml> </p> <p> <bold>Relative contribution of 2‐ and 18‐month interactions to infant attachment. </bold> Finally, we addressed the question of whether the effects on infant attachment of maternal mood and interactions at 2 months could be accounted for by the current level of maternal sensitivity at 18 months. In this case, 18‐month maternal sensitivity was entered in the first block, with 2‐month maternal depression, intrusive‐coercion and remote‐disengagement in the second. In the resultant model (see Table 5, model 3), maternal sensitivity at 18 months, and maternal intrusive‐coercion and maternal remote‐disengagement at 2 months were all retained as significant predictors of infant attachment, whereas the effect of early depression was no longer significant.</p> <p> <bold>Frightening/frightened maternal behavior and disorganized attachment. </bold> As we were concerned to identify precursors of infant disorganization, we conducted secondary, exploratory analyses to investigate this issue. In particular, we wished to examine the role of maternal behaviors that could be considered either "frightening" or "frightened". In order to approximate the coding systems used by [<reflink idref="bib35" id="ref53">35</reflink>] and by [<reflink idref="bib24" id="ref54">24</reflink>], we established a proxy for this, and classed as "frightened" instances of extreme remote‐disengaged behavior by the mother; and as "frightening" instances of extreme maternal intrusive‐coercive behavior. Univariate correlations were examined between infant disorganization and the occurrence of either frightened or frightening behavior, maternal mood disorder, and interaction variables previously found to predict overall infant security. Significant associations with infant disorganization were identified as follows: frightening/frightened behavior <emph>r</emph>=.308, <emph>p</emph><.01; maternal depression at 2 months <emph>r</emph>=.217, <emph>p</emph><.05; maternal sensitivity at 2 months <emph>r</emph>=−.206, <emph>p</emph><.02; and maternal sensitivity at 18 months <emph>r</emph>=−.214, <emph>p</emph><.05. Following the procedure for overall security of attachment, regression analyses were then conducted to assess the relative contribution of these variables to infant disorganization (see Table 6). In the first model, 2‐month variables were considered: maternal frightened/frightening behavior and depression at 2 months emerged as significant predictors of infant disorganization, while the effects of maternal sensitivity were no longer significant (Table 6, model 1). At 18 months, instances of extreme remote‐disengaged behavior by the mother and extreme maternal intrusive‐coercive behavior (18‐month frightening/frightened variable) were not related to infant disorganization. As a result, in the second model only the 18‐month measure of maternal sensitivity was included, along with 2‐month frightening/frightened behavior and maternal depression at 2 months. In the resultant model, maternal depression at 2 months, and the mother's behavior at 18 months were no longer significant, with only frightening/frightened behavior at 2 months predicting infant disorganized behavior (Table 6, model 2).</p> <p>6 
 Multiple Regression Results of Infant Disorganization at 18 Months by 2‐ and 18‐Month Variables</p> <p> <ephtml> <table><thead valign="bottom"><tr><th /><th align="center"><italic>B</italic></th><th align="center">Wald</th><th align="center"><italic>df</italic></th><th align="center"><italic>p</italic></th><th align="center">OR</th><th align="center">95% CI</th></tr><tr><th align="center">Lower</th><th align="center">Upper</th></tr></thead><tbody valign="top"><tr><td align="left">Model 1</td></tr><tr><td> Frightening/frightened   behavior (2‐months)</td><td>1.13</td><td>4.16</td><td>1</td><td>.04</td><td>3.10</td><td>1.04</td><td>9.20</td></tr><tr><td> Maternal sensitivity   at 2‐months</td><td>−0.56</td><td>1.20</td><td>1</td><td>.27</td><td>0.57</td><td>0.21</td><td>1.56</td></tr><tr><td> Maternal depression   at 2‐months</td><td>1.01</td><td>4.21</td><td>1</td><td>.04</td><td>2.75</td><td>1.05</td><td>7.22</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.13</td></tr><tr><td align="left">Model 2</td></tr><tr><td> Maternal depression   at 2‐months</td><td>0.82</td><td>2.38</td><td>1</td><td>.12</td><td>2.27</td><td>0.80</td><td>6.42</td></tr><tr><td> Frightening/frightened   behavior (2‐months)</td><td>1.32</td><td>5.19</td><td>1</td><td>.02</td><td>3.73</td><td>1.20</td><td>11.60</td></tr><tr><td> Maternal sensitivity   at 18‐months</td><td>0.74</td><td>1.95</td><td>1</td><td>.16</td><td>0.48</td><td>0.17</td><td>1.35</td></tr><tr><td align="left">   <italic>R</italic><sup>2</sup>=0.08</td></tr></tbody></table> </ephtml> </p> <hd id="AN0018155867-14">Discussion</hd> <p>The current study was a prospective longitudinal study carried out in South Africa to examine systematically the contribution to infant attachment to the mother of early as well as concurrent aspects of the mother–infant relationship, maternal mood, and aspects of social adversity. Given the high levels of postpartum depression and associated disturbances in the mother–infant relationship, as well as the high levels of socioeconomic adversity that obtain in this community, our first hypothesis was that rates of insecure attachment would be high. Contrary to our expectations, almost two thirds of the sample was securely attached, in line with proportions in many cross‐cultural studies of infant attachment ([<reflink idref="bib45" id="ref55">45</reflink>]). We hypothesized further that the influence of the mother–infant relationship would account for associations between attachment quality and factors such as partner support and maternal depression. This was supported by the data: maternal intrusive‐coercion and remote‐disengagement at 2 months, and sensitivity at 18 months, predicted infant attachment security; when account was taken of these patterns of maternal interaction, the mother's depression and lack of partner support were no longer significant factors. Finally, we hypothesized that aspects of the mother–infant relationship assessed at the same time as infant attachment (i.e. at 18 months) would be more predictive of attachment status than early interactive patterns between mother and infant (at 2‐months postpartum). Our findings indicated, however, that both early, as well as concurrent, aspects of the mother–infant relationship were important determinants of infant attachment.</p> <p> <bold>High rates of secure attachment. </bold>[<reflink idref="bib42" id="ref56">42</reflink>], in a meta‐analysis, found that when using the original Ainsworth ABC classifications, 67% of infants are classified as secure, while a later study ([<reflink idref="bib44" id="ref57">44</reflink>]) found a secure rate of 55%. The proportion of secure attachments in Khayelitsha falls between these two figures. This was unexpected given the extreme levels of social adversity. Nevertheless, results of other studies of developing world populations are consistent with our own. Thus, [<reflink idref="bib48" id="ref58">48</reflink>] found similar rates of secure attachment in a high risk Indonesian sample, and argue that, despite adverse living conditions, mothers of secure children were able to create a sufficiently good personal environment for the healthy emotional development of their children. Similarly, [<reflink idref="bib40" id="ref59">40</reflink>] found high levels of secure attachment in Mali, in a community characterized by extremely high levels of adversity. Together, these studies suggest that the mechanisms operating in indigent communities in the developed and developing world (where rates of insecure attachment are typically high) may be different. [<reflink idref="bib5" id="ref60">5</reflink>], commenting on the fact that rates of secure attachment seldom fall below 50%, argues that a basic level of security is a prerequisite for a community to be able to survive. While this might well be the case, in each instance an account is required of how this level is achieved. One possible explanation for the high rate of secure attachments in Khayelitsha is the protective contribution of Xhosa social and cultural organization (even in the midst of extreme poverty). Despite the extreme levels of adversity and the legacy of the apartheid system that systematically attempted to destroy family structures and community cohesion, there still exists a humanity and compassion in Khayelitsha for neighbors and the wider community. In African parlance, this notion of community spirit and compassion for others is known as "Ubuntu." Infants and young children are seen as belonging, to some extent, to the community, and responsibility for their safety and well‐being is seen as a collective responsibility. In addition, the combination of extremely close dwellings and small houses facilitates a great deal of social interaction in the narrow portions of space in front of houses or in the street. This high‐density living, and the communal nature of much of Xhosa culture ([<reflink idref="bib9" id="ref61">9</reflink>]), combined with the survival imperatives of living in extreme poverty (many mothers depend at times on the assistance of friends and neighbors to, quite literally, feed their children), may mean that some of the more negative social consequences of poverty that are often present in more developed societies do not arise.</p> <p> <bold>Disorganized attachment. </bold> A quarter of the attachments in Khayelitsha were found to be disorganized, compared with 15% in the [<reflink idref="bib44" id="ref62">44</reflink>] meta‐analysis. While these rates of disorganized attachment are high, they are consistent with rates of disorganized infants in other low‐income samples ([<reflink idref="bib43" id="ref63">43</reflink>]). In the Mali study, [<reflink idref="bib40" id="ref64">40</reflink>] also found a high proportion of disorganized infant attachments (25%), together with a complete absence of avoidant attachment. In both Mali and in Khayelitsha, mothers of disorganized infants had significantly higher levels of frightened or frightening behaviors than other mothers. In the light of this, it is worth noting the possible preoccupations that many of the women in Khayelitsha experience, and how these might contribute to a frightening interaction style. [<reflink idref="bib23" id="ref65">23</reflink>] noted that disorganized infant attachment behaviors occur predominantly in the context of maternal childhood experiences of family abuse or violence, and that the severity of this violence is related to hostile and intrusive maternal behavior. Levels of family violence, rape, and sexual and physical abuse are high in South Africa ([<reflink idref="bib13" id="ref66">13</reflink>]). In addition, the impact of HIV/AIDS as a factor in the preoccupations of women is crucial. HIV/AIDS prevalence rates are high in South Africa (around 10%), and are a common source of concern in communities like Khayelitsha. Given the similar distributions of disorganized attachment found in Mali and in Khayelitsha, it is possible that it is the high level of psychosocial stress that obtains in both samples that, by virtue of its impact on maternal preoccupations, accounts for the predominance of disorganization in these samples.</p> <p> <bold>Low rates of avoidant attachment. </bold> In Khayelitsha, only 4.1% of the infants were classified as avoidant (compared with 22% in the [<reflink idref="bib44" id="ref67">44</reflink>] meta‐analysis). Both the [<reflink idref="bib40" id="ref68">40</reflink>] and the [<reflink idref="bib48" id="ref69">48</reflink>] studies found similar low levels of the avoidant pattern in Mali and Indonesia, respectively. [<reflink idref="bib40" id="ref70">40</reflink>] argue that the caregiving practices associated with infant avoidance, such as rejection of attachment bids and the lack of close physical contact or tender holding, infant avoidance, are not found in the Dogon ([<reflink idref="bib40" id="ref71">40</reflink>]). [<reflink idref="bib48" id="ref72">48</reflink>] make a similar argument in accounting for the low rate of infant avoidance in their sample: the Indonesian norm of responding to crying, they argue, makes a rejecting or neglecting attitude of the mother more difficult to develop. A similar argument could be made mor Khayelitsha where many of the homes in Khayelitsha consist of only one room, resulting in all the mother's daily activities occurring in the presence of the infant. Together with demand feeding and close sleeping arrangements (in our sample 96% of the infants were still sharing a bed with their mother at 18 months), this contributes to high levels of maternal physical availability. This close proximity makes maternal rejection of infant attachment bids during distress less likely. Furthermore, just as in Mali and Indonesia, the norm in Khayelitsha is to respond to the crying of the infant with feeding. Much like [<reflink idref="bib1" id="ref73">1</reflink>] description of the Ganda infants, infants in Khayelitsha breast feed on demand, making the attachment figure and the source of nourishment the same. In addition, weaning usually takes place between a year and 2 years, once an attachment has already been established. [<reflink idref="bib40" id="ref74">40</reflink>] argue that in a context where mothers "often enough" respond to hunger and distress signals with breastfeeding, nursing operates as an intermittent reinforcer of the infant's attachment bids. In their work with the Gusii in East Africa, using a home‐based separation–reunion procedure, [<reflink idref="bib19" id="ref75">19</reflink>] found that the only infants in their sample who were classified as avoidant were those who were not breast fed by their mothers.</p> <p>An additional factor that may contribute to the low level of avoidant attachment in Khayelitsha is the practice of infant carrying. Infants are frequently carried on their mothers' backs. Notably, [<reflink idref="bib4" id="ref76">4</reflink>] found that increased physical contact between mother and infant (by way of a baby carrier) promoted secure attachment amongst infants of low income, inner‐city mothers; and that the rate of avoidant infant attachment was significantly lower among those who used the baby carriers.</p> <hd id="AN0018155867-15">Implications for Future Work</hd> <p>The results of longitudinal research on the sequelae of insecure, and particularly disorganized, attachments in the context of poor communities ([<reflink idref="bib25" id="ref77">25</reflink>], [<reflink idref="bib47" id="ref78">47</reflink>]) suggest that the processes we have identified in the current study may account, in part, for the types of difficulties and social problems that youth in South Africa are experiencing. Longer term follow‐up is required to elucidate this issue. Our findings that early difficulties in maternal interactions with the infant were significantly associated with adverse infant outcome, even when current maternal circumstances and interaction patterns were taken into account, highlight the potential importance of early intervention. In a preliminary intervention study conducted in Khayelitsha we have shown that it is possible to improve the quality of mother–infant interactions by providing mothers with support through pregnancy and the first 6 postpartum months ([<reflink idref="bib11" id="ref79">11</reflink>]). The reliability of this finding, and the implications for infant attachment and general development, await the outcome of controlled clinical trials.</p> <ref id="AN0018155867-16"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref73" type="bt">1</bibl> <bibtext> This study was conducted with the support of the Wellcome Trust of Great Britain (Grant number 053442/Z/98/Z). 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  Label: Title
  Group: Ti
  Data: The Mother-Infant Relationship and Infant Attachment in a South African Peri-Urban Settlement
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  Data: English
– Name: Author
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  Data: <searchLink fieldCode="AR" term="%22Tomlinson%2C+Mark%22">Tomlinson, Mark</searchLink><br /><searchLink fieldCode="AR" term="%22Cooper%2C+Peter%22">Cooper, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Murray%2C+Lynne%22">Murray, Lynne</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Child+Development%22"><i>Child Development</i></searchLink>. Sep-Oct 2005 76(5):1044-1054.
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  Data: Journal Customer Services, Blackwell Publishing, 350 Main Street, Malden, MA 02148. Tel: 800-835-6770 (Toll Free); Fax: 781-388-8232; e-mail: subscrip@bos.blackwellpublishing.com.
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  Label: Page Count
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  Data: 11
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  Label: Publication Date
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  Data: 2005
– Name: TypeDocument
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  Data: Journal Articles<br />Reports - Evaluative
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  Label: Education Level
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  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Infants%22">Infants</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Attachment+Behavior%22">Attachment Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Child+Relationship%22">Parent Child Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Mothers%22">Mothers</searchLink><br /><searchLink fieldCode="DE" term="%22Urban+Areas%22">Urban Areas</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Parenting+Styles%22">Parenting Styles</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Differences%22">Cultural Differences</searchLink>
– Name: Subject
  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22South+Africa+%28Cape+Town%29%22">South Africa (Cape Town)</searchLink>
– Name: DOI
  Label: DOI
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  Data: 10.1111/j.1467-8624.2005.00896.x
– Name: ISSN
  Label: ISSN
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  Data: 0009-3920
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: A sample of 147 mother-infant dyads was recruited from a peri-urban settlement outside Cape Town and seen at 2- and 18-months postpartum. At 18 months, 61.9% of the infants were rated as securely attached (B); 4.1% as avoidant (A); 8.2% as resistant (C); and 25.8% disorganized (D). Postpartum depression at 2 months, and indices of poor parenting at both 2 and 18 months, were associated with insecure infant attachment. The critical 2-month predictor variables for insecure infant attachment were maternal intrusiveness and maternal remoteness, and early maternal depression. When concurrent maternal sensitivity was considered, the quality of the early mother-infant relationship remained important, but maternal depression was no longer predictive. Cross-cultural differences and consistencies in the development of attachment are discussed.
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  Data: 2005
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  Data: EJ718209
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        Value: 10.1111/j.1467-8624.2005.00896.x
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 1044
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      – SubjectFull: Infants
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Attachment Behavior
        Type: general
      – SubjectFull: Parent Child Relationship
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      – SubjectFull: Mothers
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      – SubjectFull: Urban Areas
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Parenting Styles
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      – SubjectFull: Cultural Differences
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      – SubjectFull: South Africa (Cape Town)
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      – TitleFull: The Mother-Infant Relationship and Infant Attachment in a South African Peri-Urban Settlement
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