Background Insecure attachment style relates tomajordepression in women, but its relationship to depression associatedwith childbirth is largely unknown.AnewUK-designedmeasure,

Declaration of interest None. Attachment theory in relation to experiences associated with childbirth has been invoked mainly in relation to the impact of the mother’s interaction with the newborn baby (Stein et al, 1991; Hipwell et al, 2000). Much of the emphasis has been on the child’s development of secure attachment in relation to the mother’s sensitivity as observed in dyadic study (Murray et al, 1996). The development of secure attachment early in life is a key developmental task that influences the child’s representations of self and others. This dictates aspects of the ‘internal working model’ which influences future expectations of self and others, and determines strategies for processing attachment-related thoughts and feelings (Bowlby, 1973, 1980). Insecure attachment strategies primarily involve either minimising the expression of attachment (avoidant styles) or maximising such expression (anxious/enmeshed styles). These strategies relate to maternal behaviours identified, respectively, as distant and withdrawn, or intrusive and punitive – behaviours that are more common in mothers with depression and in those living in conditions of social adversity (Murray et al, 1996). Research into attachment style in relation to adult psychopathological disorder is relatively new and has followed separate strands investigating the influence of attachment on either social interaction or states of mind (Dozier et al, 1999). The former is the focus of the present study. A number of studies using this approach have now explored the association of adult attachment style with depression (Hammen et al, 1995; Gerlsma & Luteijn, 2000), and with vulnerability associated with depression, such as poor support and adverse childhood experience (Muller & Lemieuz, 2000). Investigation of psychosocial risks for postnatal disorder has largely paralleled that for major depression (Brown et al, 1990), with the wider context of the pregnancy and birth examined in terms of maternal life stressors, quality of marriage, and social support (Bernazzani et al, 1997). In addition, interpersonal psychotherapy, proved to aid recovery in major depression, has been shown similarly to effect recovery from postnatal depression (O’Hara et al, 2000). However, such investigation has not yet been extended to studying maternal attachment style in relation to postnatal risk. Given the importance of close adult attachments in the development of depression associated with childbirth, it is highly plausible that attachment style, defined in terms of ability to access and utilise social support, will also play a part in the development of antenatal or postnatal depression. One reason for the slow integration of attachment theory into psychopathology is the limited measurement options. The study of attachment style-related states of mind has relied on assessments of defensive processes such as the Adult Attachment Interview (George et al, 1984). Although this measure has been used for some postnatal studies, for example involving the loss of a child (Hughes et al, 2001), it is labourintensive and its complex, discourse-based scoring methods are potentially problematic for reliability in psychiatric series and in translation. In contrast, the study of attachment style in terms of social interaction has largely relied on self-report questionnaire assessments (Stein et al, 1998), which have been validated in the context of either adolescent development (Bartholomew & Horowitz, 1991) or romantic relationships (Hazan & Shaver, 1994) and mainly in normal populations with little attention to pathological outcomes. This makes the self-report assessments less amenable both to the antenatal context and to cross-cultural settings. The recent development of the Attachment Style Interview (ASI; Bifulco et al, 2002a) has allowed intensive measurement of adult attachment style in psychiatric epidemiological series. Specifically, it has been tested in community-based studies of women and in relation to onset of major depression (Bifulco et al, 2002a,b). The measure has been designed to identify not only attachment profiles (‘enmeshed’, ‘fearful’, ‘angry–dismissive’ and ‘withdrawn’, in addition to ‘secure’) but also the extent to which such styles are dysfunctional (markedly, moderately or mildly