Postpartum Bonding Questionnaire
Postpartum Bonding Questionnaire (PBQ) · Also known as: PBQ, PBQ-25, PBQ-16
The Postpartum Bonding Questionnaire (PBQ) is a 25-item self-report instrument designed to assess disorders of the mother-infant relationship and bonding in the early postpartum period. Developed by Brockington and colleagues in 2001, the PBQ screens for pathological bonding experiences, including impaired attachment, rejection, resentment, and anger toward the infant. A shorter 16-item version (PBQ-16) is also available for rapid screening in clinical settings.
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When to use it
The PBQ is appropriate for universal screening in postpartum clinical settings (obstetric follow-up, child health centers, general practice) within the first 1-3 months postpartum, when bonding disorders are most evident. It is particularly important in high-risk populations: women with history of mental illness, substance use, previous childhood abuse, or current psychosocial stressors. The PBQ-16 is suitable for rapid screening in busy clinics, while the full PBQ-25 is more comprehensive for detailed assessment. The instrument identifies mothers who require maternal-infant psychotherapy, parent coaching, or safeguarding intervention.
Strengths & limitations
- First validated instrument to specifically assess disorders of mother-infant bonding, filling a critical assessment gap.
- Comprehensive subscale structure (general disturbance, rejection/anger, anxiety, incipient abuse) enabling precise identification of the nature of bonding pathology.
- Short-form version (PBQ-16) available for rapid screening in resource-limited or busy clinical settings.
- Identifies risk of infant harm (Incipient Abuse subscale), supporting child safeguarding and prevention.
- Substantial international validation evidence; widely adopted in postpartum mental health protocols across healthcare systems.
- Relies entirely on maternal self-report; response bias or denial of difficulties may underestimate bonding disturbance.
- Scores above cutoff indicate disturbance but do not distinguish underlying etiology (postpartum depression, anxiety, trauma, personality factors, systemic stressors).
- Long version (25 items) may be burdensome in very brief clinical encounters; PBQ-16 may be preferred for screening.
- Cutoff scores are based on relatively small clinical samples; generalizability across diverse populations and cultures requires further validation.
Frequently asked
Is a high PBQ score the same as postpartum depression or postpartum psychosis?
No. Bonding disturbance is distinct from postpartum depression (low mood, guilt, anhedonia) and postpartum psychosis (delusions, hallucinations). However, these conditions may co-occur. A mother with depression may have both depressed mood AND bonding difficulties. Assessment of each domain separately is clinically essential.
Can the PBQ be used if the mother is breastfeeding?
Yes. Breastfeeding status does not affect PBQ validity. Bonding difficulties occur among both breastfeeding and bottle-feeding mothers. Some items in the PBQ refer to caregiving generally, not feeding method specifically.
What should I do if a mother scores above 69 on the PBQ-25?
A score ≥69 indicates severe bonding disturbance requiring urgent clinical evaluation. Steps include: focused clinical interview exploring the nature of the disturbance and risk to the infant; comprehensive mental health assessment; assessment of infant safety (observing mother-infant interaction); referral to maternal-infant mental health specialist; consideration of maternal-infant psychotherapy or intensive parent coaching; and safeguarding assessment if abuse risk is identified. The mother should be supported and informed that bonding difficulties are treatable.
Can the PBQ-16 be used instead of the full PBQ-25?
Yes, the PBQ-16 is a validated short form suitable for screening in busy clinical environments or resource-limited settings. However, the full PBQ-25 is preferable for detailed assessment and for evaluating treatment response, as it provides subscale information that guides intervention.
Sources
- Brockington, I. F., Oates, J., George, S., Turner, D., Vostanis, P., Sullivan, M., Loh, C., & Murdoch, C. (2001). A screening questionnaire for mother-infant bonding disorders. Archives of Women's Mental Health, 3(4), 133-140. DOI: 10.1007/s007370170010 ↗
- Brockington, I. F., Aucamp, H. M., & Fraser, C. (2006). Severe disorders of the mother-infant relationship: sorting out the concepts. Archives of Women's Mental Health, 9(3), 129-138. link ↗
How to cite this page
ScholarGate. (2026, June 3). Postpartum Bonding Questionnaire (PBQ). ScholarGate. https://scholargate.app/en/obstetrics-gynecology/postpartum-bonding-questionnaire
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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- Perinatal Anxiety Screening ScaleObstetrics Gynecology↔ compare