Relationships between maternal depressive symptoms, maternal satisfaction with motherhood, and affectionate attachment: a PLS-SEM approach

Abstract

Background

The transition to motherhood represents a critical period marked by profound psychological, emotional, and relational changes. Maternal mental health and satisfaction with the maternal role are considered key determinants of early maternal affectionate attachment to the infant. However, these constructs are often examined separately, and their interrelationships remain insufficiently understood.

Methods

This cross-sectional, correlational study included 231 mothers with infants aged 1–4 months who attended pediatric outpatient clinics at two hospitals in the Marmara Region of Turkey. Data were collected using the Family and Child Descriptive Information Form, the Patient Health Questionnaire-9 (PHQ-9), the Being a Mother Scale (BaM-13), and the Maternal Attachment Inventory (MAI). Relationships among variables were examined using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 3.

Results

Maternal satisfaction was moderately and positively correlated with maternal depressive symptoms (r = 0.568, p < 0.05) and moderately and negatively correlated with maternal attachment (r = − 0.316, p < 0.05). A weak negative correlation was observed between maternal depressive symptoms and maternal attachment (r = − 0.217, p < 0.05). Structural equation modeling revealed that maternal satisfaction had a statistically significant negative effect on maternal attachment (β = −0.533, p < 0.05), whereas maternal depressive symptoms did not show a direct effect on attachment within the model.

Conclusion

The findings suggest that maternal satisfaction plays a central role in early postpartum maternal attachment. While maternal depressive symptoms were associated with lower maternal satisfaction, maternal satisfaction emerged as the primary factor linked to maternal attachment. These results highlight the importance of supporting mothers’ subjective experiences of the maternal role to promote healthy mother–infant attachment during the early postpartum period.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-026-04993-6.

Background

Becoming a mother represents a significant developmental transition in a woman’s life, involving profound psychological, emotional, and relational changes [1–4]. The transition to motherhood is shaped by knowledge, skills, attitudes, and behaviors acquired throughout the life course. According to Mercer’s theory of becoming a mother, pregnancy constitutes a critical period of commitment and preparation, representing the first stage in the development of maternal identity [5]. Following childbirth, this process continues through the acquisition of motherhood skills, the perception of oneself as a competent mother, and the formation of a new identity [5]. The attainment of the maternal role is a complex and multifaceted process influenced by various psychological and contextual factors [6]. Successful adaptation to the maternal role facilitates the management of parenting stress, whereas role incompatibility may hinder this process [7]. In this context, higher levels of maternal satisfaction and related psychosocial and care-related factors have been associated with more positive mother–infant relationships and stronger maternal affectionate attachment [8–11]. Furthermore, intervention-based studies have shown that improving maternal satisfaction through supportive care approaches may also contribute to enhanced maternal attachment [12, 13]. Attachment theory, first conceptualized by Bowlby, emphasizes that attachment develops in early life, demonstrates continuity over time, and influences psychosocial functioning across the lifespan [14]. Maternal affectionate attachment, as conceptualized by Müller [1994], encompasses maternal attitudes, perceptions, and feelings toward the infant and plays a crucial role in the physiological, psychological, and emotional well-being of both mother and infant [1, 15, 16]. Evidence suggests that the foundations of attachment are established during the prenatal period and are further strengthened through mother–infant interaction in the postnatal period [17, 18]. Attachment styles formed in infancy are known to influence individuals’ social relationships and psychosocial adjustment in childhood, adolescence, and adulthood [19]. Accordingly, maternal attachment has become an increasingly important focus in efforts aimed at promoting maternal and child mental health.

Postpartum depression [PPD] is defined as a depressive disorder that emerges during the peripartum period or within the first year following childbirth, according to the Diagnostic and Statistical Manual of Mental Disorders [DSM-5] criteria [20]. Recent data from the World Health Organization indicate that the prevalence of PPD is approximately 13% in low-income countries and 19.8% in middle- and high-income countries [21]. PPD represents a significant mental health condition that adversely affects not only mothers but also infants and family systems [22]. Maternal depressive symptoms have been associated with disruptions in mother–infant interaction and attachment, potentially compromising the child’s emotional and psychosocial development. Previous studies have reported that postpartum depressive symptoms are associated with impairments in maternal affectionate attachment and mother–infant interaction [4, 23–25]. Despite growing evidence highlighting the importance of maternal mental health, maternal attachment, and adaptation to motherhood, these constructs are often examined independently. Limited research has simultaneously explored the interrelationships between maternal depressive symptoms, maternal satisfaction, and maternal attachment within a comprehensive analytical framework. Therefore, the present study aims to investigate the relationships between maternal depressive symptoms, maternal satisfaction with motherhood, and maternal affectionate attachment using a structural equation modeling approach.

The present study

This study aimed to examine the associations between maternal depressive symptoms, maternal satisfaction with motherhood, and maternal affectionate attachment among mothers of infants aged 1–4 months living in two different provinces in the Marmara region of Turkey, using a structural equation modeling approach. The hypothesized model is presented in Fig. 1.

Fig. 1.

Hypothesized structural equation model of maternal depressive symptoms and maternal satisfaction with motherhood predicting maternal affectionate attachment

Based on the study aims, the following hypotheses were formulated:

• H1: Maternal depressive symptoms are negatively associated with maternal attachment.

• H2: Maternal satisfaction is positively associated with maternal attachment.

Materials and methods

Design and sampling

The present study employed a cross-sectional, and correlational design. The required sample size was calculated using the G*Power 3.1.9.4 software. Based on an assumed small effect size (d = 0.02), a significance level of α = 0.05, and a statistical power of 80%, the minimum sample size was calculated as 193 participants. To compensate for potential data loss and incomplete responses, a total of 231 mothers who met the inclusion criteria and agreed to participate were included in the study, consistent with recommendations in the literature [26].

Participants

The study population consisted of mothers aged 19–45 years who had infants aged 1–4 months and who presented to the Pediatric Outpatient Clinics of two different Training and Research Hospitals located in the Marmara Region of Turkey. The final sample included 231 mothers who met the inclusion criteria and voluntarily participated in the study. The inclusion criteria were as follows: (a) being able to speak and understand Turkish well, having a 1-4-month-old term and healthy infant, and (b) being aged 19 years or older with no diagnosed health problems. Accordingly, mothers with preterm infants, infants with diagnosed health conditions, or mothers with known severe health or psychiatric conditions were not included in the study. Detailed sociodemographic and infant-related characteristics of the participants are presented in Table 1.

Table 1.

Sociodemographic and obstetric characteristics of the participants [N = 231]

		n	%
Education status	Primary school	33	14.3
	Secondary school	44	19,0
	High school	68	29,4
	Bachelor’s degree	77	33,3
	Postgraduate degree	9	3.9
Employment status	Yes	52	22.5
	No	179	77.5
Perceived income level	Income exceeds expenses [good]	58	25.1
	Income equals expenses [moderate]	136	58.9
	Income is less than expenses [poor]	37	16.0
Number of pregnancies	1	76	32.9
	2	76	32.9
	3	40	17.3
	4	24	10.4
	5 or more	15	6.5
Number of living children	1	90	39.0
	2	91	39.4
	3	34	14.7
	4 or more	16	6.9
Infant feeding method	Breastfeeding	174	75.3
	Breastfeeding + Formula	31	13.4
	Formula	26	11.3
Time to first breastfeeding	First hour after birth	193	83.5
	6 h or more after birth	38	16.5
Parity	Primiparous	90	39.1
	Multiparous	141	61.0
Mode of delivery	Normal spontaneous delivery [NSD]	115	49.8
	Cesarean section [C/S]	116	50.2
Planned pregnancy	Yes	166	71.9
	No	65	28.1
Infant sex	Female	116	50.2
	Male	115	49.8
Perceived social support	Yes	63	27.3
	No	168	72.7
Maternal and infant characteristics [Mean ± SD]		[Mean ± SD]
Maternal age [years]		28.47 ± 5.04
Age at marriage		22.73 ± 3.87
Age at first birth		24.67 ± 4.50
Infant age [days]		73.9631.95

Data collection

Data were collected from mothers attending the Pediatric Outpatient Clinics of the participating hospitals. Prior to data collection, the purpose of the study was explained to all participants and written and verbal informed consent was obtained. The questionnaires were completed by the participants under the supervision of the researcher, and completion required approximately 15 min. Following data collection, responses were entered into Microsoft Excel and subsequently transferred to IBM SPSS Statistics version 25 and SmartPLS 3 software for data analysis.

Data collection tools

Data collection tools were prepared by the researchers based on previous studies and consisted of four sections. The first section included the Family and Child Descriptive Information Form, consisting of 30 questions developed by the researchers. The English version of the form is provided as Supplementary File 1.

In the second section, the 13-item Being a Mother Scale (BaM-13), developed by Matthey (2011) and adapted into Turkish by Sevimli Güler and Çınar (2016), was used to assess maternal satisfaction with the experience of motherhood; the scale is rated on a 4-point Likert scale (0–3), with total scores ranging from 0 to 39, and higher scores indicating lower maternal satisfaction [27, 28]. In the present study, the Cronbach’s alpha coefficient of the BaM-13 was found to be 0.770. Maternal satisfaction with motherhood was operationalized as a unidimensional construct based on the total BaM-13 score to ensure a parsimonious and stable model within the PLS-SEM framework.

In the third section, the Patient Health Questionnaire-9 (PHQ-9), developed by Kroenke et al. [2001] and adapted into Turkish by Sarı et al. (2016), was used [29, 30]. The scale consists of 9 items rated on a 4-point Likert scale [0 = not at all to 3 = nearly every day] and assesses depressive symptoms in line with DSM-5 diagnostic criteria. Total scores range from 0 to 27, with higher scores indicating greater severity of depressive symptoms. Scores of 1–4 indicate minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe depressive symptoms. In the present study, the Cronbach’s alpha coefficient of the PHQ-9 was 0.789.

In the fourth section, the Maternal Attachment Inventory (MAI), developed by Müller (1994) and adapted into Turkish by Kavlak and Şirin (2009), was used [1, 31]. The scale consists of 26 items rated on a 4-point Likert scale (1 = never to 4 = always). Total scores range from 26 to 104, with higher scores indicating stronger maternal affectionate attachment. In the present study, the Cronbach’s alpha coefficient of the MAI was 0.713.

Data analysis

Data analyses were conducted using IBM SPSS Statistics version 25 and SmartPLS 3 software. The normality of the data distribution was assessed using skewness and kurtosis values, with values within ± 1.5 considered acceptable. Accordingly, parametric tests were used in the analyses. Independent samples t-test was applied for comparisons between two groups, and one-way analysis of variance (ANOVA) was used for comparisons among three or more groups. Group comparisons were conducted according to participants’ sociodemographic and obstetric characteristics (e.g., educational status, employment status, and number of living children). Pearson’s correlation analysis was used to examine associations between continuous variables.

Structural equation modeling was employed to examine the relationships between maternal depressive symptoms, maternal satisfaction, and maternal attachment. Partial least squares structural equation modeling (PLS-SEM) was selected due to its suitability for predictive modeling, its robustness to distributional assumptions, and its appropriateness for complex models with multiple latent variables.

Within the measurement model, reliability and validity were assessed using Composite Reliability (CR), Cronbach’s alpha, and rho_A coefficients. Discriminant validity was evaluated using the Heterotrait–Monotrait Ratio (HTMT) [32].

For the structural model, multicollinearity was assessed using variance inflation factor (VIF) values, with values below 3 indicating the absence of multicollinearity [33]. The coefficient of determination (R²) was used to assess the explanatory power of the model, with values of 0.67, 0.33, and 0.19 indicating substantial, moderate, and weak explanatory power, respectively [33–35]. Effect sizes were evaluated using f² values, with thresholds of 0.35 [large], 0.15 [medium], and 0.02 (small) [34]. The significance of path coefficients was assessed using bootstrapping procedures, with t-values of 1.65, 1.96, and 2.58 corresponding to significance levels of 90%, 95%, and 99%, respectively [36]. In our model, we assumed that maternal depressive symptoms and maternal satisfaction directly affected maternal attachment (see Fig. 1).

Results

The sociodemographic and obstetric characteristics of the participants are presented in Table 1. Descriptive statistics (mean, standard deviation, minimum and maximum values) of the study variables are presented in Table 2, and the correlations among these variables are shown in Table 3.

Table 2.

Descriptive statistics of study variables [N = 231]

Variables	N	Minimum	Maximum	Mean	SD
BaM-13	231	0.00	27.00	9.04	5.40
PHQ-9	231	0.00	22.00	6.94	4.47
MAI	231	84.00	104.00	99.62	4.60

Table 3.

Relationships among study constructs

		BaM-13	PHQ-9	MAI
BaM-13	r	1	0.568	-0. 316
	p		0.000*	0.000*
PHQ-9	r	0.568	1	-0.217
	p	0.000*		0.001*
MAI	r	-0.316	-0.217	1
	p	0.000*	0.001*

r: Pearson’s correlation coefficient, *p < 0.05, **p < 0.01

The analysis results are presented in Table 3. According to Cohen (1988), a statistically significant positive strong correlation was identified between maternal satisfaction with motherhood and maternal depressive symptoms (r = 0.568, p < 0.001) [37]. A statistically significant negative moderate correlation was found between maternal satisfaction with motherhood and maternal affectionate attachment (r = − 0.316, p < 0.001). In addition, a statistically significant negative weak correlation was observed between maternal depressive symptoms and maternal affectionate attachment (r = − 0.217, p = 0.001).

Group comparison analyses were conducted to examine differences in maternal depressive symptoms, maternal satisfaction with motherhood, and maternal affectionate attachment according to selected sociodemographic variables. Overall, no statistically significant differences were found across most variables (p > 0.05). However, a statistically significant difference was observed in maternal attachment scores according to the number of living children (p < 0.05), with mothers having one child demonstrating higher maternal attachment scores compared to those with two children. The structural model developed to examine the relationships among maternal depressive symptoms, maternal satisfaction with motherhood, and maternal affectionate attachment is presented in Figure 2.

Fig. 2.

Structural model results with standardized path coefficients

An evaluation of the measurement model is given in Table 4. In this respect, the Composite Reliability (CR) value calculated for composite construct reliability is above the threshold value (0.70< ). The rho_A value and Cronbach’s alpha value measured in the reliability analysis show that the scales used are reliable (0.60< ), which indicates that the internal consistency of the variable used in the study is good.

Table 4.

The concordance validity values and reliability results of the variables with respect to the research model

Scales	CR	rho_A	Cronbach’s Alpha
BaM 13	0.779	0.805	0.770
PHQ-9	0.752	0.878	0.789
MAI	0.759	0.827	0.713

Table 5: Discriminant validity (HTMT values).

Table 5.

Discriminant validity [HTMT values]

	Heterotrait-Monotrait [HTMT] Rate
	BaM 13	PHQ-9	MAI
BaM 13
PHQ-9	0.706
MAI	0.488	0.321

The HTMT (Heterotrait-Monotrait Ratio) value calculated for discriminant validity should be 0.90 or below. The table shows the HTMT values, and all the values are found to be below 0.90.

Table 6: Structural model results.

Table 6.

Structural model results

Hypothesis			VIF	β	t	p	Conclusion
BaM-13 ◊ MAI	0.204	0.248	1.853	-0.533	3.191	0.002*	✔
PHQ-9 ◊ MAI	0.002			0.054	0.306	0.760	✖

*p < 0.05, β = Relationship coefficient, = Effect size, = Coefficient of determination

Table 6 contains the model analysis results. The VIF value checked for linearity at the first stage of the analysis process is below 3, and there seems to be no problem with linearity in our measurements. Upon examining the table, the BaM-13 score is seen to have a statistically significant and negative effect on the MAI score (β=-0.533, p < 0.05). It is observed that maternal attachment increases as maternal satisfaction increases. When the effect value is reviewed, it can be said that the effect of the BaM-13 on the MAI is significant at the level of 99% (t = 3.191).

In the analyses, the explanatory rate of the model is seen to be 24.8% (R² = 0.248). Therefore, a weak explanatory rate can be mentioned. A 1-unit increase in the BaM-13 variable causes a decrease of 0.533 in the MAI variable (β=-0.533). The value of the explanatory rate obtained as a result of the analysis was found to be 0.204 for the BaM-13 variable. Therefore, it can be said that the BaM-13 variable has an effect of medium and large size on the MAI variable.

Discussion

The present study examined the relationships between maternal depressive symptoms, maternal satisfaction with motherhood, and maternal affectionate attachment among mothers of infants aged 1–4 months. The findings indicate that maternal satisfaction with motherhood was significantly associated with maternal affectionate attachment, even in the presence of maternal depressive symptoms. In contrast, maternal depressive symptoms did not demonstrate a significant direct association with maternal affectionate attachment in the structural model. In addition, maternal depressive symptoms were negatively associated with maternal satisfaction. Our primary finding indicates that maternal satisfaction with motherhood is a robust predictor of maternal attachment, outweighing the direct effect of depressive symptoms in the structural model. This finding is consistent with the literature indicating that maternal mental health, attachment, and maternal role-related experiences are interrelated components of the transition to motherhood and can be addressed within a holistic framework [38].

Previous studies have suggested that maternal depressive symptoms may negatively affect maternal attachment through reduced maternal sensitivity and less positive mother–infant interactions [39–42]. Even mild depressive symptoms in the postpartum period have been associated with lower levels of attachment and an increased risk of negative attachment outcomes [41, 43]. Another study on the maternal attachment and depressive symptoms of women at risk of depression found that mothers with prenatal and postnatal depressive symptoms had a 3- and 3.97-times higher risk of negative attachment, respectively, compared to mothers who did not have these symptoms [44]. However, in the present study, maternal depressive symptoms did not demonstrate a significant direct association with maternal affectionate attachment in the structural model. This finding does not indicate that depressive symptoms are unimportant for maternal attachment; rather, it suggests that their effects may be indirect, operating through other mechanisms, particularly maternal satisfaction with motherhood. Notably, when maternal satisfaction was included in the model, the direct effect of depressive symptoms on attachment was no longer significant. This finding indicates that maternal satisfaction may function as a protective psychological mechanism. In other words, when mothers perceive their maternal role as meaningful and fulfilling, the negative impact of depressive cognitions (e.g., feelings of inadequacy and hopelessness) on the attachment process may be attenuated. This interpretation is consistent with theoretical perspectives emphasizing the role of maternal role-related perceptions in shaping attachment processes [5].

In the present study, maternal depressive symptoms were negatively associated with maternal satisfaction with motherhood. This finding is consistent with previous studies indicating that postpartum depressive symptoms are associated with more negative evaluations of maternal role competence and parenting abilities and further supported by evidence showing that maternal satisfaction and psychological flexibility are associated with lower levels of postpartum depressive symptoms [45, 46]. Cognitive patterns commonly observed during depressive episodes, such as feelings of worthlessness, hopelessness, and inadequacy, may undermine mothers’ confidence in fulfilling their parenting role, thereby reducing maternal satisfaction [47]. Consistent with these findings, Lee et al. (2022), who investigated high levels of maternal distress in mothers of young children, reported that depressive symptoms were the primary source of maternal stress and that maternal satisfaction was significantly lower among depressed mothers [48]. In addition, maternal depression has been reported to negatively influence perceptions of infant temperament and maternal role experiences [49].

Taken together, these findings suggest that maternal depressive symptoms may influence maternal satisfaction as a key dimension of maternal role experience. This, in turn, indicates that maternal satisfaction may represent an important pathway through which depressive symptoms affect maternal outcomes in the early postpartum period.

Accordingly, the relationship between maternal depressive symptoms and maternal satisfaction represents an important focus area for nurses when planning interventions to support adaptation to motherhood. These findings further indicate that supporting maternal mental health and enhancing maternal role satisfaction may be important for promoting positive maternal adaptation during the early postpartum period.

In this study, maternal affectionate attachment was found to increase with higher levels of maternal satisfaction with motherhood. Similarly, in a randomized controlled trial by Menekşe et al. (2025) examining virtual visitation in the NICU, maternal attachment increased over time in both the intervention and control groups, with no significant difference observed between groups. In the same study, maternal satisfaction increased over time in the intervention group; however, no significant difference was observed between groups [12]. These findings suggest that maternal attachment may develop not only as a result of specific interventions but also in relation to natural postpartum processes and mothers’ subjective evaluations of their maternal role. The findings obtained support the view that the development of the maternal role is a dynamic process that begins during pregnancy and progresses with the acquisition of maternal identity and competence in the postpartum period [50]. In line with this perspective, Mercer’s [2004] maternal role theory suggests that there is a strong and positive relationship between maternal role competence and attachment, and that both maternal attachment and maternal satisfaction tend to increase during the early postpartum period [5].

Studies have also shown that maternal competence and satisfaction can be enhanced through maternal role training and supportive interventions [51, 52], and that such interventions may contribute to improved maternal attachment outcomes [53, 54]. Taken together, these findings suggest that maternal satisfaction with motherhood plays a central role in the development of maternal attachment during the early postpartum period.

Although maternal depressive symptoms were associated with maternal attachment at the bivariate level, this relationship did not remain significant when maternal satisfaction was included in the structural model. This finding suggests that maternal satisfaction may play a more central role than depressive symptoms alone in explaining maternal attachment during the early postpartum period. In this context, maternal satisfaction emerges as a key psychological mechanism linking maternal emotional well-being to attachment-related processes [45, 55].

These findings can be interpreted within the broader framework of the transition to motherhood as a complex and dynamic process shaped by psychological and contextual factors [2, 3]. From this perspective, maternal attachment appears to be influenced not only by emotional distress but also by mothers’ subjective evaluations of their maternal role, particularly their satisfaction with motherhood. However, some studies suggest that the relationship between maternal psychological well-being, attachment, and maternal satisfaction is not always linear. For instance, a study by Chua et al. [2025] reported that mothers with lower psychological well-being exhibited higher levels of parent–child bonding and maternal satisfaction at certain time points [56]. Similarly, Shorey et al. (2020) found no significant relationship between depression and parenting satisfaction [57]. In addition, Başgöl et al. (2025) reported a significant negative association between psychological well-being and maternal satisfaction among postpartum mothers, while no significant relationship was found between psychological well-being and maternal attachment [58].

On the other hand, there is also evidence in the literature indicating that maternal depression is a risk factor for impaired bonding [59, 60]. Another study reported that mothers with higher levels of anxiety may be more sensitive to their infants’ needs, establish stronger bonds with their children, and experience higher levels of satisfaction during caregiving. This may be related to increased engagement in parenting roles and caregiving processes, which can enhance mothers’ sense of meaning and fulfillment [61].

Taken together, these seemingly contradictory findings suggest that maternal attachment and maternal satisfaction cannot be explained by a single psychological variable, but are instead shaped by multidimensional and context-dependent processes.

In addition, the present study found that maternal attachment differed significantly according to the number of living children, with higher levels observed among first-time mothers. Indeed, the acquisition of the maternal role and the development of maternal identity are particularly pronounced during the first experience of motherhood and are closely associated with attachment processes [5, 50]. However, as most sociodemographic variables were not significantly associated with the study variables, these findings further support the notion that maternal attachment in the early postpartum period may be more strongly influenced by psychological factors than by demographic characteristics.

Conclusion

The findings of this study indicate that maternal satisfaction is a central factor associated with maternal attachment in the early postpartum period. While maternal depressive symptoms were associated with lower maternal satisfaction, maternal satisfaction emerged as the primary variable associated with maternal attachment in the structural equation model. These results suggest that maternal attachment may be more closely linked to mothers’ subjective experiences and evaluations of their maternal role than to depressive symptoms alone.

Implications for nursing practice

The findings of this study suggest that maternal depressive symptoms and maternal satisfaction with motherhood are important factors associated with maternal affectionate attachment. Hence, in line with our study findings and the literature results, we think that risky pregnant women should be monitored from the antenatal period onward, and basic training and counseling services should be planned and implemented to improve maternal skills. In the structural equation model analysis, maternal satisfaction was found to have a statistically significant effect on maternal attachment. Nurses and other healthcare professionals can focus on plans to improve maternal satisfaction while planning interventions. In this sense, collaboration with the mother and her social support network can be established. Elective courses and seminars on factors affecting maternal attachment, maternal satisfaction, and maternal depressive symptoms can be given in undergraduate and graduate nursing education. In Pediatric Health and Diseases Nursing courses and practices, more emphasis can be placed on training student nurses on the maternal role and practices and approaches that support maternal attachment. For nursing research, longitudinal studies examining maternal satisfaction, maternal attachment, and maternal depressive symptoms with different samples and investigating how they affect each other should be carried out.

Limitations

The findings of this study are limited to mothers with infants aged 1–4 months from a single geographic region and therefore cannot be generalized to other populations or postpartum periods. In addition, maternal satisfaction, maternal depressive symptoms, and maternal affectionate attachment were assessed using self-report scales, which may be subject to response and social desirability bias. The cross-sectional design of the study limits the ability to draw causal inferences between the variables. Furthermore, potential confounding variables such as social support, marital satisfaction, and prior mental health history were not controlled. Maternal depressive symptoms were assessed using a screening tool rather than a clinical diagnostic instrument. Additionally, the structural model is limited to the variables included and does not capture all possible determinants of maternal attachment. Future research using longitudinal designs and incorporating broader psychosocial variables is recommended to provide a more comprehensive understanding of these relationships, particularly across different postpartum periods (e.g., beyond the first 4 months) to examine potential changes in maternal attachment and related processes over time.

Authors’ contributions

ST and NÇ conceived and designed the study. ST collected the data. ST performed the statistical analysis. ST drafted the manuscript. NÇ critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Sakarya University Medical Ethics Committee (Date: 30 June 2021; Approval No: E-71522473-050.01.04-39860-346). The study was conducted at Sakarya Training and Research Hospital and Derince Training and Research Hospital. Institutional permissions were obtained from the participating hospitals, and written approval was received from the Scientific Research Department of the General Directorate of Health Services of the Ministry of Health of the Republic of Turkey. The study was conducted in accordance with the ethical principles of the World Medical Association Declaration of Helsinki. All participants were informed that participation was voluntary and that they had the right to withdraw from the study at any time without any consequences. Written informed consent was obtained from all participants prior to data collection, and the confidentiality of all collected data was ensured.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.