Association between Maternal Postpartum Depression, Stress, Optimism, and Breastfeeding Pattern in the First Six Months

Abstract

Early breastfeeding cessation is a major public health problem. Several factors can affect breastfeeding pattern, and psychological aspects have been poorly explored. We hypothesize that psychological factors and breastfeeding pattern have a relationship. We have assessed in mothers during the first six months of lactation if breastfeeding pattern is associated with maternal stress, postpartum depression, and dispositional optimism, and if these psychological factors play a role on breastfeeding adherence. In total, 711 women participated, answering online the following questionnaires: sociodemographic, perceived stress scale, Edinburgh postpartum depression scale, life orientation test, and breastfeeding adherence score. Women were categorized according to infant feeding practices as exclusive breastfeeding (EBF) or mixed breastfeeding (MBF). The EBF group had a lower score of perceived stress compared to those giving MBF (first month: EBF = 1.5 [1.1; 1.9], MBF = 1.8 [1.5; 2.0]; p-Value = 0.030; third month: EBF = 1.6 [1.2; 2.0], MBF = 1.8 [1.5; 2.4]; p-Value = 0.038) and also had a lower score of postpartum depression (third month: EBF = 8.0 [6.0; 11.0], MBF = 11.0 [9.0; 15.0]; p-Value = 0.001). The breastfeeding adherence score showed a positive correlation with maternal perceived stress (first month: ρ = 0.27; p-Value = 0.018), and postpartum depression (third month: ρ = 0.30; p-Value < 0.001), and a negative correlation with maternal dispositional optimism (second month: ρ = -0.20; p-Value = 0.028). MBF was positively associated with breastfeeding adherence score (odd ratio (OR) = 1.4 [1.2-1.6]; p-Value < 0.001) and with postpartum depression (OR = 1.1 [1.0; 1.1]; p-Value = 0.020). In the third month of breastfeeding, women with MBF exhibited higher perceive stress and postpartum depression compared to those with EBF and no difference in dispositional optimism. The maternal psychological aspects are associated with breastfeeding pattern. Evaluation of maternal psychological concerns and providing support to lactating mothers may help improving breastfeeding adherence.

Keywords: breastfeeding adherence; dispositional optimism; exclusive breastfeeding; perceived stress; postpartum depression.

Figure 1

Flow-chart of the responses of the survey and sample size used in the study that match with the inclusion criteria.

Figure 2

Evolution of psychological factors during the breastfeeding period stratified by infant exclusive breastfeeding (EBF) or mixed breastfeeding (MBF). (A) Perceived Stress Scale (PSS). (B) Edinburgh Postpartum Depression Scale (EPDS). (C) Life Orientation Test (LOT). Data show median and interquartile range. Sample size is shown between brackets. The p-Value was obtained by Wilcoxon sum-rank test.

Figure 3

Evolution of breastfeeding adherence score during the breastfeeding period stratified by infant exclusive breastfeeding (EBF) or mixed breastfeeding (MBF). Data show median and interquartile range. Sample size is shown between brackets. The p-Value was obtained by Wilcoxon sum-rank test.