Are Maternal Depression or Symptom Severity Associated With Breastfeeding Intention or Outcomes?

Objective: Breastfeeding confers many health benefits to mothers and infants, while depression negatively affects mothers and infants. The aims of this study were to determine relationships between (1) major depressive disorder (MDD) and depressive symptom severity during pregnancy and breastfeeding intention; (2) MDD and depressive symptom severity during pregnancy and breastfeeding initiation and status at 2 and 12 weeks; and (3) serotonin reuptake inhibitor (SRI) use and breastfeeding intention, initiation, and status at 2 and 12 weeks.

Method: Women were followed prospectively from pregnancy through 12 weeks postpartum for infant feeding intention (breast, breast and formula, formula, and uncertain), feeding practices and MDD (Structured Clinical Interview for DSM-IV Disorders), and depressive symptom severity (Hamilton Depression Rating Scale). Bivariate analyses and multivariable regression modeling were conducted. The study was conducted from July 2004 to September 2007.

Results: Study participants (intention n = 168, initiation n = 151, 2 weeks n = 137, 12 weeks n = 103) were well educated (63% college degrees), older (49% ≥ 31 years), and predominantly white (77%). At enrollment, 23% had MDD, 21% had significant depressive symptoms, and 16% were taking an SRI. Neither MDD nor depressive symptom severity in pregnancy was related to breastfeeding intention, initiation or duration at 2 and 12 weeks. Intention to exclusively breastfeed was the most significant predictor of breastfeeding initiation and duration. SRI use in pregnancy was negatively associated with breastfeeding intention. SRI use at 2 weeks was negatively associated with 12-week breastfeeding status.

Conclusion: Pregnancy is the optimal time to intervene to increase breastfeeding rates. Future research should identify strategies to overcome breastfeeding barriers posed by SRI use.

J Clin Psychiatry 2010;71(8):1069-1078

Submitted: May 14, 2009; accepted October 29, 2009.

Online ahead of print: June 15, 2010 (doi:10.4088/JCP.09m05383blu).

Corresponding author: Debra L. Bogen, MD, FAAP, FABM, Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, 3414 Fifth Ave, CHOB 3rd floor, Pittsburgh, PA 15213 (bogendl@upmc.edu).