Personality and Individual Differences 79 (2015) 5056

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Personality and Individual Differences

journal homepage: www.elsevier.com/locate/paid

The relationship between adult attachment and depression in Korean

mothers during the rst 2 years postpartum: A moderated mediation
model of self-esteem and maternal efcacy
Jong-Sun Lee , Hoon Jung Koo
Department of Psychology, Korea University, Republic of Korea

a r t i c l e

i n f o

Article history:
Received 7 October 2014
Received in revised form 14 January 2015
Accepted 19 January 2015
Available online 14 February 2015
Keywords:
Insecure attachment
Maternal depression
Self-esteem
Parenting efcacy
Moderated mediation model

a b s t r a c t
This study examined a possible pathway to better understand the relationships between attachment
schema and maternal depression through self-esteem and maternal self-efcacy. Questionnaires
regarding attachment style, self-esteem, maternal self-efcacy, and depression were completed by 176
mothers who visited paediatrics centres. The results showed that self-esteem fully mediated the
relationship between preoccupied attachment and maternal depression and partially mediated the association between fearful attachment and maternal depression. The mediating effects of self-esteem in the
relationship between insecure attachments (preoccupied and fearful types) were moderated by the
mothers parenting efcacy. More specically, mothers with high maternal efcacy (scores P 32, upper
10th percentile) were protected from the detrimental impact of attachment insecurity and low selfesteem on maternal depression, compared with mothers with low parenting-efcacy. Maternal depression benets from intervention targeting the mothers parenting efcacy.
2015 Elsevier Ltd. All rights reserved.

1. Introduction
Women of child-rearing age are at high risk for depression, with
a prevalence of 714.5% in the rst 3 months after childbirth and
815% during the rst year (Gavin et al., 2005; Murray & Cooper,
1997; OHara & Swain, 1996). Of mothers who have experienced
postpartum depression, 5060% are twice as likely to experience
subsequent depression over the rst postpartum year, compared
with those without postpartum depression (Cooper & Murray,
1995; see Goodman, 2004 for a review). This implies that attention
to postpartum depression should extend through the rst 2 years
after giving birth.
Insecure attachment in close adult relationships is considered a
risk factor for depressive symptoms (Gotlib & Hammen, 1992;
Hammen et al., 1995; Mickelson, Kessler, & Shaver, 1997). However, only a few studies have examined this relationship in the context of postpartum depression. In a longitudinal study, Bifulco et al.
(2004) found that preoccupied and fearful adult attachment types
signicantly predicted the onset of postpartum depression.
Meredith and Noller (2003) reported that, when measuring adult
attachment style, mothers with a preoccupied attachment type
Corresponding author at: Department of Psychology, Korea University, Seoul,
Republic of Korea. Tel.: +82 02 3290 1636.
E-mail address: sunny597@gmail.com (J.-S. Lee).
http://dx.doi.org/10.1016/j.paid.2015.01.021
0191-8869/ 2015 Elsevier Ltd. All rights reserved.

were more prone to experiencing elevated depressive symptoms

than those with secure attachment styles during their postnatal
periods. Recently, Wilkinson and Mulcahy (2010) found that mothers with preoccupied and fearful attachment styles in their close
adult relationships reported higher levels of depressive symptoms
than did those with secure and dismissive attachment styles.
Insecure attachment might affect psychopathology indirectly
via a mediating effect through self-esteem. For example, Roberts,
Gotlib, and Kassel (1996) found that insecure adult attachment,
mediated by low self-esteem, led to depression in university students. Similarly, Lee and Hankin (2009) showed that self-esteem
mediated the relationship between anxious adult attachment type
(not avoidant) and depression among adolescents. Although selfesteem could be an important psychological characteristic of the
mother, only a few studies have explored the role of global selfesteem on mothers psychological well-being. As postpartum
mothers, compared with non-postpartum individuals, are more
likely to suffer from fewer social contacts and child-rearing stress,
mothers with insecure adult attachment might be more susceptible to low self-esteem, which in turn, affects a mothers depressive
symptoms. Few studies so far have explored the possible role of
mothers self-esteem on her depressive symptoms. For example,
one study found that daily stressors during the postpartum period
affected postpartum depressive symptoms through the mothers
self-esteem (Hall, Kotch, Browne, & Rayens, 1996). Another study

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J.-S. Lee, H.J. Koo / Personality and Individual Differences 79 (2015) 5056

reported that, during postpartum period, mothers self-esteem signicantly predicted maternal self-efcacy, which in turn had signicant impact on mothers behaviours under infant-rearing
distress (Leerkes & Crockenberg, 2002). Mothers self-esteem
might therefore play a pivotal role in not only mothers depressive
symptoms but also her own maternal behaviours. In the present
study, we aim to explore the mediating mechanism of self-esteem
in the relationship between insecure adult attachment and
mothers depressive symptoms.
Along with mothers self-esteem, maternal self-efcacy, as
dened as a persons belief in her abilities to carry out various parenting roles (Coleman & Karraker, 1998), has been considered to
play a pivotal role in parenting styles, as well as in the mothers
well-being. There is evidence that higher parental self-efcacy is
associated with positively attuned interactive and sensitive parenting (Ardelt & Eccles, 2001; Bohlin & Hagekull, 1987; Donovan,
Leavitt, & Walsh, 1990; Teti & Gelfand, 1991), whereas lower
parental self-efcacy is related to a hostile and aggressive attitude
in the face of difcult child behaviours (Bondy & Mash, 1999;
Gross, Sambrook, & Fogg, 1999).
Research has found that parental self-efcacy is associated with
maternal depression (Cutrona, 1984; Leahy-Warren, McCarthy, &
Corcoran, 2012; Surkan et al., 2008). For example, Porter and Hsu
(2003) found that the prenatal anticipated maternal self-efcacy
and 1-month maternal efcacy were associated inversely with
concurrent depression. Studies have shown that parental efcacy
mediated the effect of infant difculty or social support on postpartum depression (Cutrona & Troutman, 1986; Haslam, Pakenham, &
Smith, 2006). However, research considering parental efcacy as a
moderator is sparse. Bolten, Fink, and Stadler (2012) found that
high maternal efcacy, measured during the mothers third trimester, buffered the postpartum effect of prenatal stress on the infants
crying, suggesting the importance of intervention on maternal selfefcacy in parenting programs.
In sum, previous studies have shown that insecure attachment,
especially fearful and preoccupied type, was signicantly associated with an increased risk of postpartum depression. The mediating effect of self-esteem in the relationship between attachment
insecurity and depressive symptoms has been reported in university students and adolescents, but not in mothers under a stress
condition of postpartum period. The present study aims to investigate the possible mediating effect of mothers self-esteem in the
link between mothers insecure attachment and depressive symptoms. On the other hand, there has been evidence that mothers
self-esteem signicantly predicts maternal efcacy which has also
been associated with postpartum depression. Following a recent
study that considered maternal efcacy as a moderator (Bolten
et al., 2012), the present study, for the rst time, proposes the
moderated mediation model of self-esteem and maternal efcacy
in the relationship between mothers insecure attachment and
depressive symptoms. More specically, we investigated whether
the mediating effect of self-esteem in the relationship between
insecure attachment and maternal depression would be moderated
by maternal efcacy.
The specic hypotheses examined were as follows:
Hypothesis 1: Self-esteem mediates the relationship between
insecure adult attachment (preoccupied or fearful attachment)
and maternal depression.
Hypothesis 2a: The inverse relationship between self-esteem
and maternal depression is weaker in mothers with high maternal
efcacy than in those with low maternal efcacy.
Hypothesis 2b: Maternal efcacy moderates the positive and
indirect effect of insecure adult attachment (preoccupied and
fearful) on maternal depression via self-esteem. Specically,
self-esteem mediates the relationship between insecure adult

attachment and maternal depression when maternal efcacy is

low, but not when it is high.
Figure 1 outlines the moderated mediation model proposed
here.
2. Method
2.1. Participants
The participants were recruited from two paediatrics departments in Seoul, Korea. Since previous studies have reported that
many depressed mothers in the early postpartum weeks continue
to experience depression 2 years after delivery, we expanded the
time frame of the study beyond 1 year postpartum. The study
recruited 178 mothers, but two were excluded due to missing data
(e.g., skipping at least one item in a scale or a lack of reliability).
The nal data included 176 primi- and multiparous mothers with
14 children each. The mean age of the mothers was 32.84 3.45
(range 1942) years (mean SD), and that of the children was
9.89 7.08 (range 024) months. The education level of the participants ranged from 9 to 18 years: 1.1% (2/176) completed elementary and middle-school only, 35.8% (63/176) received high-school
educations, 58.0% (102/176) had a university degree, and 5.1% (5/
176) had postgraduate degrees. All mothers were married and
came from the same ethnic background. Of the women, 53.4%
(94/176) worked full or part-time, and 46.6% (82/176) were stay
at home mothers.
2.2. Measures
2.2.1. Demographic information
Demographic information such as the ages of the mothers and
infants, education level, marital status, and job status was obtained
using a brief self-report questionnaire.
2.2.2. Adult attachment style
The mothers attachment styles were assessed using the validated Korean version of the Relationship Questionnaire (K-RQ)
(Jang, 1997), which was developed originally by Bartholomew
and Horowitz (1991). The RQ is a single-item measure consisting
of four short paragraphs, each describing a prototypical attachment
pattern as it applies in close adult relationships. Participants rated
each item on a 7-point scale ranging from 1 (doesnt describe me)
to 7 (describes me very accurately). Prototypes AD correspond to
the secure, fearful-avoidant, preoccupied, and dismissive-avoidant
attachment patterns, respectively. The original and Korean versions
of RQ have been shown to possess good psychometric properties in
correlational analyses in both Western and Asian countries
(Bartholomew & Horowitz, 1991; Grifn & Bartholomew, 1994),
although Cronbachs alpha cannot be calculated due to its singleitem nature.
2.2.3. Self-esteem
The self-esteem of the mother was assessed using the validated
Korean-Rosenberg Self-Esteem Scale (Jeon, 1974), which was

Maternal
efficacy
Selfesteem
Maternal
depression

Insecure
attachment
Fig. 1. Model of moderated mediation.

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J.-S. Lee, H.J. Koo / Personality and Individual Differences 79 (2015) 5056

developed originally by Rosenberg (1965). The RSES consists of 10

items each scored using a 4-point scale ranging from 1 (strongly
disagree) to 4 (strongly agree). Total scores range from 10 to 40,
with higher scores indicative of greater self-esteem. Cronbachs
alpha of the K-RSES was 0.750.87 for a Korean sample (Jeon,
1974; Lee, Nam, Lee, Lee, & Lee, 2009) and 0.78 in this study, indicating good reliability. The K-RSES consisting of a two factor also
showed good construct validity (Bae, Choi, Yu, Lee, & Choi, 2014).
2.2.4. Depressive symptoms
The severity of maternal depressive symptoms was assessed
using the validated Korean-Beck Depression Inventory (Chung
et al., 1995), which was validated originally by (Beck, Ward,
Mendelson, Mock, & Erbaugh, 1961). This measure is a 21-question
multiple-choice self-report inventory that assesses the depression
severity from the previous week, with higher scores indicating
more severe depression. Cronbachs alpha of the K-BDI was 0.93,
indicating good reliability (Chung et al., 1995). Cronbachs alpha
for our sample was 0.86. K-BDI also had good validity: the mean
difference between depressive patients group and non-depressive
one was signicant, and the correlation of K-BDI with MMPI-D
was also signicant (r = .54) (Lee & Song, 1991).
2.2.5. Maternal efcacy
To assess the maternal perceived efcacy in childcare (e.g.,
understanding what the child wants, knowing what the child
enjoys, and soothing the child), the Maternal Efcacy Scale (Teti
& Gelfand, 1991) was used. This measure consists of 10 items each
rated on a 4-point scale from 1 (not good at all) to 4 (very good). The
total score ranges from 10 to 40, with higher scores indicating
greater maternal efcacy. In this study, Cronbachs alpha was
0.79 using the Korean version of the Maternal Efcacy Scale.
2.2.6. Procedures
A clinical psychologist and a trained nurse briey explained the
aim of the study to all of the participants during paediatric centre
visits. The participants were informed that the study purpose was
to examine the relationships between the mothers mood and their
well-being. Mothers who agreed to participate in the study and
provided written informed consent then provided basic demographic information and completed the Beck Depression Inventory,
Rosenberg Self-Esteem Scale, Relationship Questionnaire, and
Maternal Efcacy Scale. The participants were allowed 3040 min
to complete the questionnaires. To ensure participant condentiality, the participants were assigned a numeric identier, and the
data were stored accordingly.
2.2.7. Data analysis
Correlations among the main variables (insecure attachment
types, self-esteem, maternal efcacy, and depression) were analysed using SAS (ver. 9.3; SAS Institute, Cary, NC, USA). Moderated
mediation analyses were executed on the SAS ver. 9.3 macro using

PROCESS (model 14), provided by Hayes (2013). PROCESS was conducted using one independent variable (preoccupied/fearful
attachment), one mediator (self-esteem), one moderator (maternal
efcacy), and one dependent variable (depression). The variables in
the proposed model were mean centred to minimise multicollinearity. The number of bootstrap samples used to determine
bias-corrected bootstrap condence intervals (CI) was 10,000.
The mediation and moderated mediation analyses were repeated
separately for preoccupied and fearful attachment types.

3. Results
3.1. Preliminary correlation analyses
Table 1 presents the Pearson correlations, mean scores, and
standard deviations for each of the variables, i.e., preoccupied
attachment, fearful attachment, dismissive attachment, secure
attachment, self-esteem, maternal efcacy, and depression. Preoccupied attachment was correlated inversely with self-esteem
(r = 0.37, p < 0.001) and positively to depression (r = 0.32,
p < 0.001). Fearful attachment was correlated inversely with selfesteem (r = 0.41, p < 0.001) and positively with depression
(r = 0.35, p < 0.001). The dismissive and secure attachments were
not correlated with depression (dismissive, r = 0.03, ns; secure,
r = 0.15, ns) and were excluded from the subsequent analysis.
Self-esteem was correlated positively with maternal efcacy
(r = 0.42, p < 0.001) and inversely with depression (r = 0.54,
p < 0.001). Maternal efcacy was also related inversely to
depression (r = 0.37, p < 0.001).

3.2. Mediation analyses

The results of the mediating effect of self-esteem between insecure attachment (preoccupied and fearful types) and maternal
depression are presented in Table 2. Preoccupied and fearful
attachments each were related inversely to self-esteem, and selfesteem for both insecure attachment types was correlated negatively with maternal depression. Finally, preoccupied attachment
was not related to maternal depression after controlling for selfesteem, whereas fearful attachment was still related signicantly
to maternal depression. These results indicate that self-esteem
fully mediated the relationship between preoccupied attachment
and maternal depression and partially mediated the association
between fearful attachment and maternal depression. As predicted, preoccupied and fearful attachments each appeared to have
positive indirect effects on depression through self-esteem (0.84
for preoccupied attachment; 0.81 for fearful attachment). The
bootstrapped 95% CI did not include zero (0.481.39 and 0.51
1.26 for the associations of preoccupied and fearful attachments
with maternal depression through self-esteem, respectively),
conrming the indirect effects.

Table 1
Mean, standard deviation, correlation between main variables.

*
***

Variables

Mean

SD

1.
2.
3.
4.
5.
6.
7.

3.90
2.90
3.10
4.17
28.05
27.06
10.41

1.58
1.73
1.53
1.63
3.99
3.97
6.68

Preoccupied
Fearful
Dismissing
Secure
Self-esteem
Maternal efcacy
Depression

p < .05.
p < .001.

2
1
.30***
09
.14
.37***
.09
.32***

1
.43***
.58***

1
.34***
.28***
.41***
.11
.35***

1
.03
.06
.05
.03

1
.33***
.16*
.15

.37***

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J.-S. Lee, H.J. Koo / Personality and Individual Differences 79 (2015) 5056

Table 2
Mediation effect of self-esteem in the relationship between insecure attachment and depressive symptoms.
Variables

SE

Preoccupied attachment ? self-esteem

Self-esteem ? depression
Preoccupied attachment ? depression

.94
.87
.51

.16
.11
.28

5.84
7.75
1.82

<.001
<.001
.07

Bootstrap

LL 95% CI

Effect
SE
Bootstrap results for direct effect
.51
.28
Bootstrap results for indirect effect
.84
.23

UL 95% CI

.0420

1.0653

.4814

1.3913

Fearful attachment ? self-esteem

Self-esteem ? depression
Fearful attachment ? depression

.94
.87
.55

Bootstrap

LL 95% CI

UL 95% CI

.0370

1.0617

.5071

1.2631

Effect
SE
Bootstrap results for direct effect
.55
.26
Bootstrap results for indirect effect
.81
.19

.16
.11
.26

5.84
7.75
2.12

<.001
<.001
<.05

Table 3
Moderated mediation analysis.
Predictors

Attachment: preoccupied
b (SE)

Mediator variable model

Attachment

*
**
***

Attachment: fearful
t

b (SE)

Outcome variable: self-esteem

5.29***

.94(.18)

Outcome variable: maternal depression

Attachment
Self-esteem
Maternal efcacy
Self-esteem  maternal efcacy

.60(.27)
.71(.12)
.33(.12)
.07(.02)
SE
.30
.21
.18
.18
.20

1.05
.80
.67
.48
.35

Outcome variable: maternal depression

2.21*
5.93***
2.97**
3.05**

21.00
25.00
27.00
30.00
32.00

LLCI
.5345
.4432
.3760
.1835
.0191

5.84***

.94(.16)

Dependent variable model

Conditional indirect effect at specic levels of the moderator

Moderator: scores of maternal efcacy
Effect

Outcome variable: self-esteem

2.43*
5.74***
2.98*
3.01*

.61(.25)
.70(.12)
.33(.11)
.07(.02)
UCCI

Effect

SE

1.7154
1.2933
1.1265
.9283
.8008

1.02
.78
.65
.46
.34

.26
.19
.17
.18
.20

LLCI
.5727
.4665
.3737
.1580
.0363

UCCI
1.5873
1.2042
1.0471
.8578
.7790

p < .05.
p < .01.
p < .001.

3.3. Moderated meditational analyses

To examine moderated mediation, we examined four conditions: (a) both types of insecure attachment (preoccupied and fearful) have a signicant effect on self-esteem; (b) self-esteem alone
affects maternal depression signicantly; (c) the interaction
between self-esteem and maternal self-efcacy on maternal
depression is signicant; and (d) the conditional indirect effect of
both types of insecure attachment (preoccupied and fearful) on
maternal depression via self-esteem differed at certain levels of
maternal self-efcacy. To demonstrate moderated mediation, the
last condition is essential. As conditions (a) and (b) were already
demonstrated in the meditational analyses, this section focuses
on the results of conditions (c) and (d) (Table 3). As expected, the
interaction of self-esteem and maternal self-efcacy was signicant for both preoccupied and fearful attachments (Table 3).
Importantly, the conditional indirect effects of insecure attachment on maternal depression differed depending on the range of
maternal efcacy. More specically, the indirect effects of selfesteem between insecure attachment (preoccupied and fearful
types) and maternal depression were weaker in the upper 10th
percentile of maternal efcacy, whereas such indirect effects were
signicant up to the 75th percentile of maternal efcacy (the

bootstrapped 95% CI did not include zero). These results indicate

that the more preoccupied or fearful attachment type the mothers
have, the lower their reported self-esteem is, which might render
them susceptible to maternal depression. However, mothers with
high levels of maternal efcacy (upper 10th percentile) can be protected from the risk of developing maternal depression.
Finally, in the context of maternal efcacy, there is the possibility that rst-time mothers may feel less efcacious than more
experienced mothers in child-rearing. As such, we put sibling order
as a control variable and re-performed the mediation and moderated mediation analyses. These yielded the same results.

4. Discussion
This study investigated the moderated mediation model of selfesteem and maternal efcacy in the relationship between adult
attachment and maternal depression. This study had two key ndings. First, self-esteem fully mediates the relationship between
preoccupied attachment and maternal depression and partially
mediates the association between fearful attachment and maternal
depression. This implies that insecure adult attachment
(preoccupied and fearful types) was signicantly related to the

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J.-S. Lee, H.J. Koo / Personality and Individual Differences 79 (2015) 5056

development of maternal depression directly and indirectly via

self-esteem. Second, the pathway mediating the relationship
between attachment insecurity and maternal depression via low
self-esteem was moderated by the maternal parenting efcacy.
More specically, high maternal parenting efcacy buffered the
relationship between attachment insecurity and maternal depression via low self-esteem.
Consistent with our predictions, this study found that attachment insecurity, especially the preoccupied and fearful types, but
not the dismissive type, was signicantly associated with maternal
depression, supporting previous ndings (Bifulco et al., 2004;
Meredith & Noller, 2003; Wilkinson & Mulcahy, 2010). Our results
might be accounted for by the categorical models of self, proposed
by Bartholomew and Horowitz (1991).1 Both preoccupied and fearful types hold negative-self models, whereas the dismissive type has
a positive-self model. Given that negative perceptions and beliefs
about self have been considered as pivotal factors in the maintenance of depression (Kobak, Sudler, & Gamble, 1991; Murphy &
Bates, 1997), it is reasonable to interpret that fearful and preoccupied attachment types holding negative-self models, but not the dismissive type, are susceptible to an increased risk of maternal
depression. Perhaps mothers holding negative-self models tend to
perceive themselves as unworthy and unlovable, which prevents
them from seeking support and help from others, thereby
developing depressive symptoms under child-rearing stress. On the
other hand, the dismissive types holding a positive-self model might
be protected from the development of depressive symptoms.
Our ndings demonstrated the mechanism by which insecure
adult attachment (fearful/preoccupied) is related to depression:
self-esteem mediated the relationship between insecure attachment and depressive symptoms, thus supporting hypothesis 1.
Attachment theory posits that caregiving experiences during the
early developmental period contribute to forming ones selfconcept. That is, a positive/negative concept of self (self-esteem)
can be obtained from close interpersonal relationships (e.g.,
attachment to a primary caregiver) during childhood and such an
attachment formed at an early stage is assumed to be stable
throughout the lifespan. In this context, several studies explored
the relationship between early attachment (e.g., motherchild relationship) and self-esteem can be replicated at other developmental
stages (e.g., adolescences, young adults). Two studies have shown
the mediating effect of low self-esteem on the relationship
between adult insecure attachment and depressive symptoms in
adolescents and university students (Lee & Hankin, 2009; Roberts
et al., 1996). Our ndings support and expand on prior studies by
demonstrating that fearful/preoccupied adult attachment styles
are related to depressive symptoms via a low self-esteem mediating mechanism in mothers during the rst 2 years postpartum. In
the present study, we included only adult attachment. Investigating whether motherchild attachment (e.g., being a secure base)
would have a positive impact on mothers self-esteem is of interest
in a future study.
On the other hand, a preoccupied style (negative selfpositive
others) appeared to be related to depressive symptoms via an
indirect route involving self-esteem, whereas a fearful style (negative selfnegative others) showed a direct relationship with
depressive symptoms apart from an indirect link with low selfesteem. During the rst 2 years postpartum, support or help from
close others is of great importance for the well-being of the mother
(Cutrona & Troutman, 1986; OHara & Swain, 1996), while high
levels of avoidance of interpersonal relationships due to a fear of
1
Bartholomew and Horowitz (1991) categorised attachment style based on a selfand-other model: secure (positive selfpositive other); preoccupied (negative self
positive other); dismissing (positive selfnegative other); and fearful (negative self
negative other).

rejection in fearful type mothers might aggravate their emotional

distress directly.
Importantly, we found that not all mothers are susceptible to
the development of depressive symptoms via low self-esteem:
some mothers with high levels of maternal self-efcacy (maternal
efcacy scores P 32) can be protected from an increased risk of
depressive symptoms via an indirect pathway from insecure
attachment (fearful/preoccupied) to low self-esteem, supporting
hypothesis 2-b. More specically, as predicted in hypothesis 2-a,
the inverse relationship between self-esteem and depressive
symptoms appeared to be weaker in mothers with high maternal
efcacy compared to those with low maternal efcacy: the slope
is increasingly decreased when maternal efcacy increases (see
Fig. 2). These ndings underscore the importance of perceived parenting efcacy as a protective factor against maternal depression
in mothers with attachment insecurity or low self-esteem during
the rst 2 years postpartum. That is, although a mother with insecure attachment may display low-self-esteem, if she feels efcacious in the parenting role, she can be protected from an
increased risk of depressive symptoms. While the bulk of studies
thus far have emphasised the importance of promoting actual
maternal skills or sensitivity for infants and mothers well-being,
the present study explored if it is subjective judgement of ones ability to perform parenting role that contributes to mothers depressive symptoms. Our ndings showing that subjective maternal
efcacy belief has a signicant effect on mothers depressive symptoms will shed light on the development of intervention targeting
for boosting mothers belief in her own parenting abilities in a
more positive way. Investigating whether there would be a unique
effect of maternal efcacy belief even after controlling for actual
maternal skills is also of interest for a future study. On the other
hand, our nding showing that perceived parenting efcacy was
not correlated signicantly with insecure attachment types
suggests that parenting efcacy has an effect independent of the
negative impact of adverse childhood experiences (insecure
attachment). These ndings imply that when boosting a mothers

Fig. 2. Self-esteem as a function of maternal efcacy. This interaction predicts

depressive symptoms. The slope is increasingly decreased as maternal efcacy
scores increases.

J.-S. Lee, H.J. Koo / Personality and Individual Differences 79 (2015) 5056

parenting efcacy (e.g., feelings of competency in the parental role,

feelings of condence in maternal responsiveness toward mother
child relationship), there might be a corrective experience that
negates the detrimental impact of insecure attachment and negative cognition of self on depressive symptoms.
This study has several limitations that should be noted. The
cross-sectional design of this study limited its ability to conrm
a causal relationship between the variables investigated. Therefore,
future longitudinal and experimental studies are needed to clarify
the direction of any causal relationship between the variables. Second, this study relied on self-report questionnaires. Future studies
utilising standardised interviews or observational methods would
provide more accurate and detailed information. Third, our ndings might not be generalizable to young, single, and less-educated
mothers, who might be more likely to be susceptible to maternal
depression. Finally, although previous studies have consistently
documented the reliability and validity of a forced-choice categorical measure of attachment style used in current studies (Reese,
Kieffer, & Briggs, 2002; Sperling, Foelsch, & Grace, 1996), some
argue that measurement along a continuous scale or multiple
choice provides a more precise picture of the participants attachment (Feeney, Noller, & Hanrahan, 1994). Despite the shortcomings of the attachment scale used in this study, including four
categories of attachment style based on self- and other models is
useful for understanding the complex mechanism underlying the
relationship between attachment and maternal depression. Future
studies should explore other factors implicated in the pathways
connecting insecure attachment and maternal depression. For
example, social support from close others and the mothers coping
strategies are key factors, especially under high levels of child-rearing stress.
Despite these limitations, this study is the rst to explore a
potential mediator (self-esteem) and moderator (parental
self-efcacy) in the relationship between insecure attachment
and depressive symptoms in the context of mothers during the
rst 2 years postpartum, using moderated mediation. The model
presented here might be helpful for understanding those at high
risk for maternal depression and the factors that should be targeted to prevent the development of maternal depression. Based
on these ndings, clinical interventions, especially those that bolster parenting efcacy, might protect mothers with fearful/preoccupied attachment and low self-esteem from an increased risk of
maternal depression.
Acknowledgements
We are very grateful to Dr. Chang-Han Lee, Dr. Hyung-Suk Oh,
Dr. Myoung-Jae Chey, and Eun-Kyeung Choi for their cooperation
in collecting data. We also extend our appreciation to all the participating mothers in this study.
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