Perinatal maternal mental health and disorganised attachment: A critical systematic review Alexandra G. D. FLOWERS, 1 Jane A. MCGILLIVRAY, 1 Megan GALBALLY 2,3,4,5 and Andrew J. LEWIS 2,5 1 School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria and 2 School of Psychology and Exercise Science, Murdoch University, 4 Fiona Stanley Hospital, Murdoch, Perth and 5 Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth and 3 School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia Key words antenatal depression, child development, disorganised attachment, perinatal mental health, postnatal depression. Correspondence Alexandra Flowers, School of Psychology, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Melbourne, Vic. 3125, Australia. Email: aflowers@deakin.edu.au Received 16 May 2017; accepted 21 November 2017. doi:10.1111/cp.12145 Abstract Background: Disorganised attachment in childhood has been considered an important early marker for the development of socio-emotional and mental health problems. This review critically examines the current evidence and methodology employed to assess the influence of perinatal maternal mental health on disorganised attachment in infancy. Methods: A search revealed 1 149 articles reporting studies examining pre- dictors of disorganised attachment. An additional 564 grey literature articles were identified via bibliographic searches. After screening for inclusion of maternal mental health measures and use of the Strange Situation Procedure, 28 articles met inclusion criteria. Results: Few studies robustly examined clinical levels of maternal mental health over time and the potential effects on infant disorganised attachment. Still, the bulk of current evidence does not support a strong positive associa- tion between disorganised attachment and low to moderate levels of maternal depression. The relationship between disorganised attachment and chronic and/or severe maternal depression is unclear given the dearth of research into the area. Limited research has examined other mental health disorders, with one study suggesting borderline personality disorder is associated with disorganised attachment. A level of bias in the literature was evident, with many studies recruiting non-clinical samples and excluding those with signifi- cant mental health concerns. Conclusions: Most non-significant findings were reported in non-clinical samples, while most positive findings were reported in clinical samples, sug- gesting that severity of mental disorder may be a critical factor. Further research on the relationship between disorganised attachment and chronic and severe maternal depression, psychotic, trauma, bipolar, and personality disorders is required. Key points 1 There is still a dearth of literature examining the impact of severe mental health disorders, including bipolar affective disorder, psychotic and substance use disorders, on infant disorganised attachment, despite this being outlined as a gap in the literature in previous reviews. 2 Considerably more literature has examined the impact of maternal depression on infant disorganisa- tion, with little evidence supporting a strong relation- ship between the two constructs. However, the relationship between chronic and/or severe depression and infant disorganised attachment remains unclear. Funding: None. Conflict of interest: None. Clinical Psychologist 22 (2018) 300–316 300 © 2018 The Australian Psychological Society