Early exclusive breastfeeding cessation and postpartum depression: Assessing the mediating and moderating role of maternal stress and social support

Abstract

Background Early termination of exclusive breastfeeding (EBF) and postpartum depression (PPD) are both recognized as global health problems. Recent literature reviews demonstrate a notable link between PPD and breastfeeding outcomes, however, the underlying mechanisms linking the two remain unclear. Objectives The aim of the study is to: 1) explore the comparative risk for PPD among new mothers who terminated EBF before the 6-month mark, compared to those who did not; and 2) test whether maternal stress and social support operate to mediate and/or moderate the relationship between EBF and PPD. Methods Between October 2015 and January 2016, a cross-sectional study was carried out among 426 new mothers of Bangladesh who were six months postpartum. Results Based on the multivariate logistic regression model, non-exclusively breastfeeding mothers were 7.58-fold more likely to experience PPD (95% CI [3.94, 14.59]) than exclusively breastfeeding mothers. Additionally, maternal stress and social support not only partially mediate the relationship between EBF and PPD but also substantially moderate this relationship. Specifically, the odds of PPD are significantly higher among mothers who had early EBF interruption in conjunction with increased stress levels and limited social support. Conclusions Current evidence suggests that concurrent screening for EBF difficulties and maternal stress are important red flags that might hint at complications even before mother’s screen positive for PPD. Support and care from family members can provide assistance in overcoming this issue.

Postpartum Depressive Symptoms and Their Selected Psychological Predictors in Breast-, Mixed and Formula-Feeding Mothers

“…According to Toledo et al (9) and Gila-Diaz et al (10), women who currently breastfed their infants or breastfed them for a more extended time expressed significantly lower PPD risk. In line with this finding are the results from the study by Islam et al (11) that have pointed to the role of early cessation of exclusive breastfeeding for the increased risk of PPD. The mixed-feeding method might also be related to increased depression symptoms postpartum (12,13).…”

“…These results seem to differ from some of those published so far, which indicate that the infant feeding method may be related to a maternal mood where breastfeeding mothers are less depressed (9, 10) or formula feeding women have higher rates of depression than women who breastfeed (36). Islam et al (11) analysis show that non-exclusively breastfeeding mothers were more likely to experience depressive symptoms than exclusively breastfeeding mothers. Similarly, in the study conducted by Takashori (37), there was a significant difference in the prevalence of alleviated EPDS scores between breastfeeding and non-breastfeeding mothers (2.5 and 19.4%, respectively).…”

Association between Breastfeeding Attitudes and Postpartum Depression among Mothers with Premature Infants during COVID-19 Pandemic

“…Not engaging in breastfeeding reduces the attenuating cortisol stress response, a factor that is related to higher depressive symptoms [44]. This relationship is evidenced by a recent study that showed that mothers with early negative breastfeeding experiences were 7.58-fold more likely to suffer from postpartum depression [45]. Furthermore, Khalifa et al [46] demonstrated that an exclusive breastfeeding practice reduced the odds of postpartum depression by 80% among a sample of 300 Sudanese women.…”

Common Complications of Breastfeeding and Lactation: An Overview for Clinicians

“…Individuals with depression are no more or less likely to intend to breastfeed but are known to have earlier cessation 6. Breastfeeding complications and early cessation are also established risk factors for new postpartum depression among individuals without a history of depression 7. However, high levels of stress, low social support, and high anxiety are all associated with early cessation of exclusive breastfeeding and appear to mediate the relationship between breastfeeding patterns and postpartum mood disorders, suggesting that the social environment predicts both the breastfeeding practices and the mood symptoms 8–10.…”