Increased risk of postpartum depression in women with lactational mastitis: a cross-sectional study

Abstract

Background: A high incidence of lactational mastitis mainly occurs during the first month of breastfeeding. It may cause severe pain, frustration, fatigue, stress, and breastfeeding concerns. However, few studies investigated the effects of lactational mastitis on postpartum depression. This study investigated the potential association between lactational mastitis and postpartum depression.

Methods: We examined the associations of lactational mastitis with postpartum depression in 1,551 Chinese women. Lactational mastitis was diagnosed by breast specialists. The presence of depression symptoms was evaluated by the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire 9 (PHQ9) at 6 weeks after delivery. Multiple linear regression analysis and multivariable log-binomial regression analysis were performed to estimate the association between lactational mastitis and postpartum depression.

Results: Among the 1,551 mothers, 147 (9.5%) experienced lactational mastitis diagnosed by breast specialists during the postpartum period. Compared with women without lactational mastitis, the proportion of women with depression symptoms was significantly higher (38.1% vs. 27.4%, p = 0.008), and the risk of postpartum depression increased by 68% (RR = 1.68, 95% CI, 1.18, 2.40) in women who had experienced lactational mastitis. In addition, the risk of self-harm or suicidal ideation increased by 89% (RR = 1.89, 95% CI, 1.08, 3.29) in women who experienced lactational mastitis. In stratified analysis, the associations of lactational mastitis with postpartum depression appeared stronger among women aged ≥35 years, with maternal comorbidities, and who delivered a female neonate.

Conclusion: The study results suggest that lactational mastitis is a risk factor for depression during the postpartum period. The impact of lactational mastitis on maternal mental health requires further attention.

Clinical trial registration: chictr.org.cn, ChiCTR2000041519.

Keywords: breastfeeding; cross-sectional study; depression; lactational mastitis; postpartum period.

Figure 1

Forest plot of the RR for lactational mastitis associated with postpartum depressive symptoms stratified by influence factors. The stratified analysis indicated that the association of lactational mastitis with postpartum depressive symptoms were stronger in women aged ≥35 years, employed during the perinatal period, with nulliparity, with maternal comorbidities, delivered a female neonate, or exclusively breastfed. Blue squares indicate the RR for influencing factors. Horizontal black lines indicate 95% CI. RR, relative risk; CI, confidence interval.