Published 11/14/2024
Keywords
- postpartum depression,
- mental health,
- breastfeeding,
- motherhood
How to Cite
Copyright (c) 2024 Psychological Research (in the Balkans)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Postpartum depression is the most common mental disorder in the postnatal period and affects not only the mental health of the mother but also that of the child. There is no screening in Bulgaria and no data on what percentage of women suffer from postpartum depression. The aim of this study is to report how common it is in breastfeeding women within the first year after giving birth and whether there is a relationship between it and the independent variables of age and sex of the baby, as well age, place of residence, and educational level of the mother. A survey was conducted in Novem- ber 2023, involving women with children up to 12 months of age (n=431), 86.5% of whom were breastfeeding (n=373). The questionnaire included the Edinburgh Postnatal Depression Scale (α=.862) and questions on breastfeeding status and demographics. The analysis showed that 23.5% of women were likely to suffer from postpartum depression of varying severity (score ≥13), with 21.8% of breastfeeding women affected. The first four months are the most vulnerable for depres- sive symptoms, although symptoms are typical throughout the first year postpartum. None of the independent variables of baby‘s sex, as well age, place of residence and mother‘s education predicted the severity of postpartum depression, but the smaller the place where the mother lives, the lower the risk of postpartum depression. Early detection of depression, access to specialist help and the organization of psychological support for women in the postnatal period are important steps in caring for the mental health of mother and child.
References
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/APPI.BOOKS.9780890425596
- Atias, K., & Tagareva, K. (2023). The secure attachment as a prerequisite for flourishing [Атиас, К. & Тагарева, К. (2023). Сигурното привързване като предпоставка за процъфтяване. Годишник за студенти, докторанти и научни ръководители, 545–550. ISSN: 2815–357X]. (In Bulgarian).
- Barandon, S., Castel, L., Galera, C., van der Waerden, J., & Sutter-Dallay, A. L. (2023). Women’s quality of life and mental health in the first year after birth: Associated factors and effects of antenatal preventive measures among mothers in the ELFE cohort. Journal of Affective Disorders, 321, 16–27. https://doi.org/10.1016/J.JAD.2022.10.012
- Bianciardi, E., Ongaretto, F., De Stefano, A., Siracusano, A., & Niolu, C. (2023). The Mother-Baby Bond: Role of Past and Current Relationships. Children (Basel, Switzerland), 10(3). https://doi.org/10.3390/CHILDREN10030421
- Borra, C., Iacovou, M., & Sevilla, A. (2015). New Evidence on Breastfeeding and Postpartum Depression: The Importance of Understanding Women’s Intentions. Maternal and Child Health Journal, 19(4), 897–907. https://doi.org/10.1007/S10995-014-1591-Z
- Bottino, M. N., Nadanovsky, P., Moraes, C. L., Reichenheim, M. E., & Lobato, G. (2012). Reappraising the relationship between maternal age and postpartum depression according to the evolutionary theory: Empirical evidence from a survey in primary health services. Journal of Affective Disorders, 142(1–3), 219–224. https://doi.org/10.1016/J.JAD.2012.04.030
- Cadman, T., Strandberg-Larsen, K., Calas, L., Christiansen, M., Culpin, I., Dadvand, P., de Castro, M., Foraster, M., Fossati, S., Guxens, M., Harris, J. R., Hillegers, M., Jaddoe, V., Lee, Y., Lepeule, J., el Marroun, H., Maule, M., McEachen, R., Moccia, C., … Pedersen, M. (2024). Urban environment in pregnancy and postpartum depression: An individual participant data meta-analysis of 12 European birth cohorts. Environment International, 185, 108453. https://doi.org/10.1016/J.ENVINT.2024.108453
- Chen, Q., Li, W., Xiong, J., & Zheng, X. (2022). Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19(4). https://doi.org/10.3390/IJERPH19042219
- Cowell, W., Colicino, E., Askowitz, T., Nentin, F., & Wright, R. J. (2021). Fetal sex and maternal postpartum depressive symptoms: findings from two prospective pregnancy cohorts. Biology of Sex Differences, 12(1). https://doi.org/10.1186/S13293-020-00348-X
- Dias, C. C., & Figueiredo, B. (2015). Breastfeeding and depression: A systematic review of the literature. Journal of Affective Disorders, 171, 142–154. https://doi.org/10.1016/J.JAD.2014.09.022
- Dimitrova, D., Petrova, D., Boeva, T. (2020). What help does a young mother need after the birth of her first child [Димитрова, Д., Петрова, Д., Боева, Т. (2020). От каква помощ се нуждае младата майка след раждането на първото си дете. Сборник Медико-социални аспекти в здравната грижа. 97-102, ISBN 978-619-7491-23-4]. (In Bulgarian).
- Eastwood, J. G., Phung, H., & Barnett, B. (2011). Postnatal Depression and Socio-Demographic Risk: Factors Associated with Edinburgh Depression Scale Scores in a Metropolitan Area of New South Wales, Australia. Http://Dx.Doi.Org/10.3109/00048674.2011.619160, 45(12), 1040–1046. https://doi.org/10.3109/00048674.2011.619160
- Eslahi, Z., Bahrami, N., Allen, K. A., & Alimoradi, Z. (2021). Spouse’s social support in the postpartum period, predictors and its relationship with postpartum depression in a sample of Iranian primiparous women. International Journal of Gynecology & Obstetrics, 154(1), 24–30. https://doi.org/10.1002/IJGO.13488
- Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology, 106(5), 1071–1083. https://doi.org/10.1097/01.AOG.0000183597.31630.DB
- Gilden, J., Molenaar, N. M., Smit, A. K., Hoogendijk, W. J. G., Rommel, A. S., Kamperman, A. M., & Bergink, V. (2020). Mother-to-Infant Bonding in Women with Postpartum Psychosis and Severe Postpartum Depression: A Clinical Cohort Study. Journal of Clinical Medicine, 9(7), 1–10. https://doi.org/10.3390/JCM9072291
- Hahn-Holbrook, J., Cornwell-Hinrichs, T., & Anaya, I. (2018). Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Frontiers in Psychiatry, 8. https://doi.org/10.3389/FPSYT.2017.00248
- He, Q., Cheng, G., He, S., Tian, G., Xie, X., Jiang, N., Min, X., Li, C., Li, R., Shi, Y., Zhou, T., & Yan, Y. (2023). Association between maternal postpartum depression and children’s physical growth in early childhood: a birth cohort study. Frontiers in Pediatrics, 11, 1135876. https://doi.org/10.3389/FPED.2023.1135876/BIBTEX
- Jackson, L., Fallon, V., Harrold, J. A., & De Pascalis, L. (2023). Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context. Maternal & Child Nutrition, e13558. https://doi.org/10.1111/MCN.13558
- Kim, S., Park, M., & Ahn, S. (2021). The Impact of Antepartum Depression and Postpartum Depression on Exclusive Breastfeeding: A Systematic Review and Meta-Analysis. Https://Doi.Org/10.1177/10547738211053507, 31(5), 866–880. https://doi.org/10.1177/10547738211053507
- Koutra, K., Vassilaki, M., Georgiou, V., Koutis, A., Bitsios, P., Kogevinas, M., & Chatzi, L. (2018). Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother–child cohort in Crete, Greece. Epidemiology and Psychiatric Sciences, 27(3), 244–255. https://doi.org/10.1017/S2045796016001062
- Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ, 371. https://doi.org/10.1136/BMJ.M4022
- Liu, L., Zhou, M., Xiao, G., Zhang, T., Li, X., Owusua, T., He, W., & Qin, C. (2023). The impact of antenatal depressive symptoms on exclusive breastfeeding intention: A moderating effect analysis. Midwifery, 116, 103551. https://doi.org/10.1016/J.MIDW.2022.103551
- Matsumura, K., Hamazaki, K., Tsuchida, A., Kasamatsu, H., Inadera, H., Kamijima, M., Yamazaki, S., Ohya, Y., Kishi, R., Yaegashi, N., Hashimoto, K., Mori, C., Ito, S., Yamagata, Z., Nakayama, T., Iso, H., Shima, M., Kurozawa, Y., Suganuma, N., … Katoh, T. (2019). Education level and risk of postpartum depression: Results from the Japan Environment and Children’s Study (JECS). BMC Psychiatry, 19(1), 1–11. https://doi.org/10.1186/S12888-019-2401-3/TABLES/3
- Mawson, A. R., & Wang, X. (2013). Breastfeeding, retinoids, and postpartum depression: A new theory. Journal of Affective Disorders, 150(3), 1129–1135. https://doi.org/10.1016/J.JAD.2013.05.038
- Miyake, Y., Tanaka, K., Sasaki, S., & Hirota, Y. (2011). Employment, income, and education and risk of postpartum depression: The Osaka Maternal and Child Health Study. Journal of Affective Disorders, 130(1–2), 133–137. https://doi.org/10.1016/J.JAD.2010.10.024
- Munk-Olsen, T., Laursen, T. M., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2006). New Parents and Mental Disorders: A Population-Based Register Study. JAMA, 296(21), 2582–2589. https://doi.org/10.1001/JAMA.296.21.2582
- Nagel, E. M., Howland, M. A., Pando, C., Stang, J., Mason, S. M., Fields, D. A., & Demerath, E. W. (2022). Maternal Psychological Distress and Lactation and Breastfeeding Outcomes: a Narrative Review. Clinical Therapeutics, 44(2), 215–227. https://doi.org/10.1016/J.CLINTHERA.2021.11.007
- Nam, J. Y., Choi, Y., Kim, J., Cho, K. H., & Park, E. C. (2017). The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea. Journal of Affective Disorders, 218, 53–58. https://doi.org/10.1016/J.JAD.2017.04.048
- Norhayati, M. N., Nik Hazlina, N. H., Asrenee, A. R., & Wan Emilin, W. M. A. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175, 34–52. https://doi.org/10.1016/J.JAD.2014.12.041
- O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry, 8(1), 37–54. https://doi.org/10.3109/09540269609037816
- Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum depression. American Journal of Obstetrics and Gynecology, 200(4), 357–364. https://doi.org/10.1016/j.ajog.2008.11.033
- Putnick, D. L., Bell, E. M., Ghassabian, A., Mendola, P., Sundaram, R., & Yeung, E. H. (2023). Maternal antenatal depression’s effects on child developmental delays: Gestational age, postnatal depressive symptoms, and breastfeeding as mediators. Journal of Affective Disorders, 324, 424–432. https://doi.org/10.1016/J.JAD.2022.12.059
- Riem, M. M. E., Bakermans-Kranenburg, M. J., Cima, M., & van IJzendoorn, M. H. (2023). Grandparental Support and Maternal Postpartum Mental Health: A Review and Meta-Analysis. Human Nature, 34(1), 25–45. https://doi.org/10.1007/S12110-023-09440-8/FIGURES/3
- Shiga, T. (2023). Examination of risk factors for high Edinburgh Postnatal Depression Scale scores: a retrospective study at a single university hospital in Japan. https://doi.org/10.21203/RS.3.RS-3204237/V1
- Silverman, M. E., Reichenberg, A., Savitz, D. A., Cnattingius, S., Lichtenstein, P., Hultman, C. M., Larsson, H., & Sandin, S. (2017). The Risk Factors for Postpartum Depression: A Population Based Study. Depression and Anxiety, 34(2), 178. https://doi.org/10.1002/DA.22597
- Śliwerski, A., Kossakowska, K., Jarecka, K., Świtalska, J., & Bielawska-Batorowicz, E. (2020). The Effect of Maternal Depression on Infant Attachment: A Systematic Review. International Journal of Environmental Research and Public Health, 17(8). https://doi.org/10.3390/IJERPH17082675
- Slomian, J., Honvo, G., Emonts, P., … J. R.-W., & 2019, undefined. (2019). Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Journals.Sagepub.ComJ Slomian, G Honvo, P Emonts, JY Reginster, O BruyèreWomen’s Health, 2019•journals.Sagepub.Com, 15. https://doi.org/10.1177/1745506519844044
- Stark, E. L., Shim, J., Ross, C. M., & Miller, E. S. (2021). The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation. American Journal of Perinatology, 38(2), 171–175. https://doi.org/10.1055/S-0039-1695775/ID/JR190127-19/BIB
- Sun, Y., Molitor, J., Benmarhnia, T., Avila, C., Chiu, V., Slezak, J., Sacks, D. A., Chen, J. C., Getahun, D., & Wu, J. (2023). Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California. The Lancet Regional Health - Americas, 21, 100462. https://doi.org/10.1016/j.lana.2023.100462
- Syamantha Putri, A., Wurisastuti, T., Yunita Suryaputri, I., & Mubasyiroh, R. (2023). Postpartum Depression in Young Mothers in Urban and Rural Indonesia. Journal of Preventive Medicine and Public Health, 56(3), 272. https://doi.org/10.3961/JPMPH.22.534
- Thul, T. A., Corwin, E. J., Carlson, N. S., Brennan, P. A., & Young, L. J. (2020). Oxytocin and postpartum depression: A systematic review. Psychoneuroendocrinology, 120. https://doi.org/10.1016/J.PSYNEUEN.2020.104793
- Toledo, C., Cianelli, R., Villegas Rodriguez, N., De Oliveira, G., Gattamorta, K., Wojnar, D., & Ojukwu, E. (2022). The significance of breastfeeding practices on postpartum depression risk. Public Health Nursing, 39(1), 15–23. https://doi.org/10.1111/PHN.12969
- Uvnas-Moberg, K., Ekstrom-Bergstrom, A., Buckley, S., Massarotti, C., Pajalic, Z., Luegmair, K., Kotlowska, A., Lengler, L., Olza, I., Grylka-Baeschlin, S., Leahy-Warren, P., Hadjigeorgiu, E., Villarmea, S., & Dencker, A. (2020). Maternal plasma levels of oxytocin during breastfeeding—A systematic review. PLoS ONE, 15(8). https://doi.org/10.1371/JOURNAL.PONE.0235806
- Vigod, S. N., Tarasoff, L. A., Bryja, B., Dennis, C. L., Yudin, M. H., & Ross, L. E. (2013). Relation between place of residence and postpartum depression. CMAJ : Canadian Medical Association Journal, 185(13), 1129. https://doi.org/10.1503/CMAJ.122028
- Wang, D., Li, Y. L., Qiu, D., & Xiao, S. Y. (2021). Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis. Journal of Affective Disorders, 293, 51–63. https://doi.org/10.1016/J.JAD.2021.05.088
- Whitley, J., Wouk, K., Bauer, A. E., Grewen, K., Gottfredson, N. C., Meltzer-Brody, S., Propper, C., Mills-Koonce, R., Pearson, B., & Stuebe, A. (2020). Oxytocin during breastfeeding and maternal mood symptoms. Psychoneuroendocrinology, 113, 104581. https://doi.org/10.1016/J.PSYNEUEN.2019.104581
- Wu, D., Jiang, L., & Zhao, G. (2022). Additional evidence on prevalence and predictors of postpartum depression in China: A study of 300,000 puerperal women covered by a community-based routine screening programme. Journal of Affective Disorders, 307, 264–270. https://doi.org/10.1016/J.JAD.2022.04.011
- Xia, M., Luo, J., Wang, J., & Liang, Y. (2022). Association between breastfeeding and postpartum depression: A meta-analysis. Journal of Affective Disorders, 308, 512–519. https://doi.org/10.1016/J.JAD.2022.04.091
- Ye, Z., Wang, L., Yang, T., Chen, L. Z., Wang, T., Chen, L., Zhao, L., Zhang, S., Luo, L., & Qin, J. (2022). Gender of infant and risk of postpartum depression: a meta-analysis based on cohort and case-control studies. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 35(13), 1–10. https://doi.org/10.1080/14767058.2020.1786809
- Ystrom, E. (2012). Breastfeeding cessation and symptoms of anxiety and depression: A longitudinal cohort study. BMC Pregnancy and Childbirth, 12(1), 1–6. https://doi.org/10.1186/1471-2393-12-36/TABLES/2
- Zhao, X. hu, & Zhang, Z. hua. (2020). Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian Journal of Psychiatry, 53, 102353. https://doi.org/10.1016/J.AJP.2020.102353