OBJECTIVE: To study the relationship between breast-feeding cessation and the onset of postpartum depression. METHOD: The association between. In addition to the high correlation between breastfeeding and depression in studies, there is a possible effect of these variables on the functioning of the HPA . The conventional wisdom is that breastfeeding reduces postpartum depression — yet we see tremendous overlap between moms who struggle with.
Results suggest that breastfeeding might promote a tighter regulation of diurnal basal cortisol secretion, 8—12 and the stability of diurnal cortisol secretion lowers the risk of postpartum depression.
In addition to the high correlation between breastfeeding and depression in studies, there is a possible effect of these variables on the functioning of the HPA axis. Breastfeeding and psychological protection from postpartum depression Another important associated change during breastfeeding relates to the regulation of sleep and wake patterns for both the mother and the child, helping the mother to feel less tired, which could also prevent symptoms of depression.
Parents of infants who were exclusively breastfed slept an average of minutes more and self-reported less sleep disturbance than parents of infants given formula. Maternal self-efficacy, a condition inversely associated with postpartum depression, 72 is improved in mothers who breastfeed.
The impact of breastfeeding on the maternal attention sensitivity towards infant distress was also recently shown. The psychological benefits for the mother are still in need of further research.
Despite the high rate of breastfeeding initiation, a large decrease in the number of mothers who breastfeed from the first few weeks postpartum is observed. Maternal mental health may be one of the reasons behind this reality.
A recent empirical study conducted in Portugal suggests that screening for depression symptoms during pregnancy can help identify women at risk for early cessation of exclusive breastfeeding.
While some suggest a negative association between breastfeeding and postpartum depression, 40—43 others point to a negative association between postpartum depression and breastfeeding. Moreover, few studies have defined breastfeeding according to standardized categories, few studies included a clinical diagnosis of postpartum depression, and few studies were prospective and completed adequate statistical analysis to capture a sequential relationship between depressive symptoms and breastfeeding initiation and duration.
These may be some of the reasons for equivocal results in the literature. Data, in a general way, demonstrate that breastfeeding failure is unequivocally associated with the presence of depression during pregnancy and postpartum. Some recent prospective studies clarify that depression during pregnancy is a risk factor for unsuccessful breastfeeding, and that breastfeeding is a protective factor for postpartum depression.
Research is also starting to clarify which biological and psychological processes may explain this protection. However, there are still equivocal results in the literature that may be explained by the methodological limitations presented by some studies. Breastfeeding Dose-Response Effect A dose-response effect of breastfeeding on postpartum depression has been proposed. In a large study of women evaluated between 8 and 12 weeks postpartum, Thome et al.
Relatedly, Ystrom [ 80 ] found that, at six months postpartum, both partially breastfeeding and exclusively bottle-feeding were significantly related to higher levels of depressive symptoms in postpartum women compared to those who exclusively breastfed.
Furthermore, bottle-feeding was related to postpartum depression to a greater degree than partial breastfeeding.
Also, when the investigator adjusted for baseline prenatal anxiety and depression measured at 30 weeks of gestation the relationship persisted, indicating that breastfeeding may reduce depressive symptoms or depressive symptoms may result in breastfeeding titration. One other study compared exclusive breastfeeding to exclusive bottle-feeding [ 81 ].
These investigators found an inverse association between postpartum depression and exclusive breastfeeding continuation. Also, it has been found that as early as one week postpartum levels of depressive symptoms are inversely related to exclusive breastfeeding [ 82 ].
Moreover, Kendall-Tackett et al. These investigators reported a relationship between exclusive breastfeeding and fewer reported sleep difficulties and depressive symptoms compared to women who partially breastfed or bottle-fed their infant. Unfortunately these results are based on analyses of cross-sectional data, making the direction of the relationship in each case unclear.PostPartum Depression F*ckd Up My Relationship #THETRUTH
Reciprocal Relational Findings In light of conflicting reports that postpartum depression leads to early breastfeeding cessation e. Specifically, it has been proposed that postpartum depression can lead to early breastfeeding cessation but breastfeeding continuation may also reduce levels of postpartum depressive symptoms [ 28 ].
For example, results of a study by Hamdan and Tamim [ 31 ] support the reciprocal relationship hypothesis. These investigators found that women who were breastfeeding at two months postpartum had a lower risk of postpartum depression at four months postpartum. On the other hand, women who had postpartum depression at two months postpartum were less likely to be breastfeeding at four months postpartum. Also, Hahn-Holbrook et al. These researchers also found that more frequent breastfeeding at three months postpartum was associated with greater subsequent declines in depressive symptom levels up to two years postpartum.
No Association or Nonsignificant Trends A number of studies have reported no significant relationship between postpartum depression and breastfeeding status [ 323985 — 91 ]. However, two of these studies did report finding a nonsignificant trend suggestive of an inverse association [ 8689 ].
- Postpartum Depression and Difficulty Breast-Feeding May Go Hand in Hand
- Breast-feeding and postpartum depression: is there a relationship?
In any case, most of these findings were incidental; the primary purpose of those investigations was not to evaluate the association between breastfeeding and postpartum depression. However, recent data analyzed in our lab also failed to find support for a relationship between breastfeeding intention and initiation when controlling for other risk factors for postpartum depression.
Conflicting Research Findings A majority of studies do report some association between breastfeeding and postpartum depression; however the direction of the relationship is unclear and some of the findings conflict with one another. This is likely a reflection of both the complex processes responsible for the association between breastfeeding and postpartum depression and the differences between the study designs and the samples used.
Dennis and McQueen [ 92 ] suggested that the contrasting findings may be due to differences in research methodology or study limitations. Some of the limitations include differences in definition and criteria for assessing breastfeeding. Also, one of the methodological differences that makes integration and comparison of studies difficult pertains to various discrepancies in how postpartum depression is operationalized between studies. For instance, some studies used assessment instruments that were not specific to depression e.
Furthermore, some studies used samples with higher than normal rates of women reporting postpartum depression. Also, some studies used women at high risk for postpartum depression. For instance, Kendall-Tackett et al. Furthermore, for many of the studies, the primary focus was not to delineate the relationship between breastfeeding and depression [ 92 ], which likely explains many of the methodological or interpretive shortfalls noted.
Mechanism of Action The mechanisms by which breastfeeding is affected by or affects postpartum depression have been assessed in a number of studies. Breastfeeding self-efficacy and negative breastfeeding perceptions have been implicated as playing a primary role in the relationship. Specifically, during the first week postpartum, depressed mothers have been found to be at increased risk for feeling unsatisfied with breastfeeding and were experiencing significant breastfeeding problems.
They are also at risk for experiencing lower levels of breastfeeding self-efficacy compared to nondepressed mothers [ 36 ]. Furthermore, mothers' postpartum depressive symptoms were found in one study to be inversely related to the belief that breastfeeding is the best option for infant feeding and positively related to the beliefs that breastfeeding is private and breastfeeding is restrictive [ 93 ].
Additionally, in a study that did not find a relationship between breastfeeding and depressive symptoms, women who worried about breastfeeding were significantly more likely to develop depression than women who did not worry [ 32 ]. Similarly, Tamminen [ 94 ] found that women with more depressive symptoms also reported more breastfeeding difficulties, and Dennis [ 95 ] noted that level of depressive symptoms at one, four, and eight weeks postpartum was inversely related to breastfeeding self-efficacy at the corresponding time periods.
This is a similar finding to that recorded by Dai and Dennis [ 96 ]. Collectively, this research suggests that it is not necessarily the postpartum depression per se that leads to reduced breastfeeding; it might be the mothers' negative perceptions of their breastfeeding experiences that are responsible. Alternatively, complications with the mother-infant interaction may also play a role.
One study reported that breastfeeding led to less burping, less intrusive stimulation e. Further, these benefits were found to extend to both the depressed and nondepressed breastfeeding women [ 97 ]. Thus, breastfeeding may enhance the mother-child interaction, which may lead to improved maternal mental health.
Breastfeeding difficulties and lack of breastfeeding confidence are reported as common concerns for mothers with postpartum depressive symptoms [ 98 ]. Dennis and McQueen [ 36 ] suggested that the factors underlying the relationship between breastfeeding duration and postpartum depression are multifactorial.
In other words, it is likely that the interplay between the mothers' negative cognitions and impaired mother-infant interaction, in addition to other factors, such as underlying physiological processes, are responsible for the emergence of postpartum depression. Moreover, depressive symptoms in the early postpartum period resulted in the mother being more vulnerable to feelings of low self-esteem and self-efficacy.
As a consequence, the depressive symptoms and accompanying negative cognitions may reinforce perceived breastfeeding difficulties or may reduce the mothers' ability to accurately interpret infant cues, further perpetuating actual breastfeeding difficulties [ 36 ].
Also, breastfeeding is suggested to attenuate neuroendocrine responses to stress and may act to enhance maternal mood. Specifically, oxytocin and prolactin, hormones responsible for lactation, are suggested to have mood-ameliorating effects. Oxytocin in particular is a hormone that promotes feelings of nurturance and relaxation during nursing [ 99 — ].
Also, lactation is suggested to attenuate cortisol stress responses [ ] by decreasing stress hormone levels especially cortisol and enhancing sleep [ ]. Moreover, it is also possible that only a subset of women who have a hormonal sensitivity are at risk for depressive symptoms in relation to breastfeeding cessation.
Thus, future research aimed at assessing the specific circumstances whereby breastfeeding may offer protective or ameliorating benefits against postpartum depression is warranted and needed in order to make informed recommendations tailored to each new mothers' unique circumstance. Future Research Future researchers examining the relationship between breastfeeding and postpartum depression should consider the following methodological recommendations.
These recommendations are made in an effort to make results of this research more comparable and to allow for an integration of findings to aid in conclusions and clinical recommendations. Future researchers should use standardized assessment protocols and cut-off values established by psychometric evaluations of the measures. Currently the Edinburgh Postnatal Depression Scale EPDS is among the most widely used empirically validated self-report screening measures for postpartum depression.
When possible, diagnostic clarification through the use of established structured clinical interviews is ideal as this process is currently the gold standard for psychiatric diagnosis.
Postpartum Depression And Breastfeeding Share An Important Link | HuffPost Canada
Use of both the EPDS and diagnostic interviews can be valuable as each provides a different approach to examining the relationship between breastfeeding and postpartum depression. That is, information from the EPDS allows researchers to evaluate depressive symptoms on a continuum to examine whether breastfeeding status might be associated with more transient symptoms or subclinical levels of depression.
The addition of a diagnostic interview allows researchers to evaluate whether breastfeeding is involved in clinically confirmed postpartum depression. Future researchers should also specify and clearly define breastfeeding variables as well as the time intervals assessed for postpartum depression. Investigators should also make efforts to determine the time frame for onset of symptoms. Currently there is debate over the time frame at which a woman is considered to have onset of a postpartum depressive episode [ 1 ].
Diagnostic guidelines dictate time frames ranging from anytime during pregnancy to the first six weeks postpartum [ 34 ]. However, many researchers and clinicians consider onset within the first year postpartum to be considered a postpartum depressive episode [ 15 ].
Postpartum Depression And Breastfeeding Share An Important Link
Due to the lack of consensus regarding what constitutes postpartum onset and variation in the postpartum intervals investigated by researchers it is important that investigators are very clear about the interval addressed in their research.
This is especially pertinent as various biological, environmental, and psychosocial factors that may influence the relationship between breastfeeding and postpartum depression can vary depending on the postpartum time period being assessed. Research that is prospective or longitudinal in nature will also be helpful in evaluating the direction of the proposed relationship between breastfeeding and postpartum depression.
This will facilitate inferences regarding the temporal relationship. Such designs should take into consideration other potential factors suggested to influence postpartum depression. Considering the role of other potential postpartum depression risk factors within the breastfeeding and postpartum depression dynamic will better facilitate interpretation of results. Some of the risk factors more commonly identified in research include low socioeconomic status [ 131 ], poor social support [ 46 ], and history of depression [ 31434553 ].
Conclusions The primary purpose of this paper was to provide an overview of the potential relationships between breastfeeding and postpartum depression that have been suggested by research and to provide recommendations to facilitate comparisons between investigations.
Due to numerous methodological discrepancies between studies it is difficult to draw conclusions at this time. Also, interpretations of research are impeded by many of the same conundrums that exist when attempting to empirically understand postpartum depression in general.
For instance, much of the research is naturalistic in nature, restricting the ability to make causal inferences. Also, the physiological changes that occur over the course of pregnancy and the postpartum period are not completely understood and hormonal shifts during the postpartum period may influence women's mental health and well-being in different ways depending on the time period referenced.
Improved standardization between future research investigations will promote comparison between studies. To facilitate comparison and integration of study findings in this area we recommend that future research protocols 1 use standardized assessment protocols; 2 confirm diagnosis through established clinical interview when possible; 3 provide a clear operationalized definition for breastfeeding variables; 4 clearly define the postpartum period interval assessed and time frame for onset of symptoms; 5 be prospective or longitudinal in nature; and 6 take into consideration other potential risk factors identified in the empirical literature.
Pope gratefully acknowledges financial support from the Canadian Institutes of Health Research. Competing Interests The authors declare that there are no competing interests regarding the publication of this paper. Annual Review of Clinical Psychology. A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period.
Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; World Health Organization; The DSM-5 peripartum specifier: Archives of Women's Mental Health. Effects of gonadal steroids in women with a history of postpartum depression. The American Journal of Psychiatry.
Breast-feeding and postpartum depression: is there a relationship?
The structure of women's mood in the early postpartum. Prospective study of postpartum blues: Archives of General Psychiatry.
A longitudinal study of maternal postpartum depression symptoms. Research and Theory for Nursing Practice. The course of postpartum depression: Harvard Review of Psychiatry. The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms.
Risk of obsessive-compulsive disorder in pregnant and postpartum women: Journal of Clinical Psychiatry. Postpartum and nonpostpartum depression: The influence of psychological factors on breastfeeding duration.
Journal of Advanced Nursing. Thoughts of harming infants in depressed and nondepressed mothers.
Journal of Affective Disorders. A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.
Prevalence of suicidality during pregnancy and the postpartum. Recognition, diagnosis and treatment of postpartum bipolar depression.
Expert Review of Neurotherapeutics. Postpartum depression effects on early interactions, parenting, and safety practices: A longitudinal study of maternal prenatal, postnatal and concurrent depressive symptoms and adolescent well-being. Intellectual disability and other neuropsychiatric outcomes in high-risk children of mothers with schizophrenia, bipolar disorder and unipolar major depression.
The British Journal of Psychiatry. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Maternal infanticide associated with mental illness: