Psychometric properties of the Urdu version of the Postpartum Bonding Questionnaire (PBQ): a validation study among mothers with prenatal anxiety symptoms in Pakistan.

PURPOSE: Mother-infant bonding is crucial for the child's development and the parent's well-being, but research in this area in low- and middle-income countries is rare. We sought to evaluate the psychometric properties of the Urdu version of the Postpartum Bonding Questionnaire (PBQ) among women with prenatal anxiety symptoms in Pakistan.

METHODS

This validation study used cross-sectional data within the context of a large randomized clinical trial, called Happy Mother, Healthy Baby (HMHB), conducted from April 2019 to October 2022 among women with at least mild prenatal anxiety symptoms receiving antenatal care from a large tertiary care hospital in Rawalpindi, Pakistan. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and analysis of convergent validity were performed.

RESULTS

The analysis included 720 mothers with a mean age of 25.23 years (SD = 4.61). The EFA suggested that 19 items (the five-factor model) out of 25 original items (the four-factor model) provided a good fit for the data, explaining a total variance of 64.7%. The CFA demonstrated poor fit for the four-factor model, but acceptable fit for the five-factor model of the PBQ (i.e., Love and affection [eight-item], Rejection [four-item], Withdrawal [two-items], Anger [three-items], and Irritation [two-items]) (CFI = 0.94, TLI = 0.93, RMSEA = 0.07, SRMR = 0.04), with good reliability (ordinal alpha = 0.71-0.93). A moderate positive correlation between impaired bonding and depressive symptoms supported convergent validity; and a negative correlation between impaired bonding and maternal-infant responsiveness supported convergent validity. Potential limitations are that test-retest validity and cutoff specification were not carried out.

CONCLUSIONS

Findings indicate that the 19-item Urdu version of the PBQ is valid and reliable to assess postpartum bonding among Pakistani women with prenatal anxiety symptoms.