Breastfeeding and Postpartum Depression: A Review of Relationships and Potential Mechanisms.

PURPOSE OF REVIEW: Postpartum depression (PPD) and breastfeeding are important, interrelated health factors. It is established that women who breastfeed exclusively have lowered likelihood of developing significant PPD. Yet, many questions remain around what factors are involved. The purpose of this review is to provide updated information about the relationship between PPD and breastfeeding. RECENT FINDINGS: Both psychological and physiological factors have emerged as important moderators and mechanisms of the relationship between postpartum depression and breastfeeding. Breastfeeding self-efficacy, self-compassion, and engagement with the infant during feeding all modify or mediate the relationship, and a complex dynamic relationship among cortisol, oxytocin, progesterone, and estrogen is involved. Importantly, recent intervention studies suggest psychosocial interventions may impact both breastfeeding and mood. Providers and researchers should recognize the interrelationship between the breastfeeding and PPD and apply this understanding to patient care through integrated education and care for both mood and breastfeeding enhancement.

College transition Fall 2020 and 2021: Understanding the relationship of COVID-19 experiences and psychosocial correlates with anxiety and depression.

Rates of mental health symptoms, particularly anxiety and depression, have increased significantly in college students in the past decade along with utilization of mental health resources. The COVID-19 pandemic created an additional source of stressors to an already challenging landscape of college transition. COVID-19 has been associated with an increase of anxiety among college students, particularly first year students, entering college in Fall 2020. The shifts in policy (e.g., federal, state, and college) accruing medical data, and vaccine availability between Fall 2020 and Fall 2021 provide an opportunity to examine the role of COVID-19 experiences in the transition to college for these two first-year student cohorts. This study examined two cohorts of first-year students, Fall 2020 and 2021, to better understand the relationship between COVID-19 experiences, psychosocial correlates, and mental health symptoms. Results suggest that for students in our Fall 2020 cohort COVID-19 experiences played a distinct role in the prediction of mental health symptoms while in Fall 2021 COVID-19 experiences did not uniquely contribute to prediction of mental health symptoms. These findings have implications for mental health interventions for first-year students transitioning to college.

Couples talk about breastfeeding: Interviews with parents about decision-making, challenges, and the role of fathers and professional support.

Despite health benefits, sustained breastfeeding rates remain low in the United States, and the role of partners in breastfeeding is not well understood. Using a grounded theory approach, the current qualitative study explored how couples communicate regarding breastfeeding decisions and challenges. Mother-father dyads (n = 16) completed individual semi-structured interviews 1 year after the birth of their first child. Following iterative qualitative analysis, three phases of breastfeeding communication emerged: Should we try this? ( Mother's opinion counts) How do we make this work? (adjusting and problem-solving) and How do we settle into a routine? (gaining confidence, resolving issues) Findings underscore the complexity of defining the partner role in breastfeeding.

How will this help me? Exploring expectations at the time of intake among first-time users of a college counseling center.

OBJECTIVE: The study explored first-time college counseling center clients' preintake expectations of the counseling process and the extent that these expectations were related to confidence that counseling will be effective and attendance after intake. Participants: Participants were 418 first-time counseling clients with complete intake and termination data from September 2013 to April 2016. Methods: New clients reported open-ended counseling expectations which were coded into three distinct categories: don't know, just talking, or beyond talking. Outcome measures include rated preintake confidence that counseling will be effective and client attendance at scheduled follow up session. Results: Regression analysis results indicate that expectations categorized as don't know were associated with lower pretreatment counseling confidence while beyond talking expectations predicted postintake attendance. Conclusions: Simple expectations about how counseling will work are a relevant therapeutic factor to consider in improving outcomes for counseling center clients.

"Trying to Figure Out If You're Doing Things Right, and Where to Get the Info": Parents Recall Information and Support Needed During the First 6 weeks Postpartum.

Objectives The first 6 weeks postpartum represent a time of significant adjustment and learning for parents. Healthcare providers accurately understanding parents' needs and preferences regarding support, education, and services during this critical time is essential for optimizing maternal and infant health. The first objective of this study was to explore parents' experiences adjusting to the parenting role during the first 6 weeks postpartum. The second objective was to elicit from parents where and how they sought support and information during the early postpartum period, and what hindered this process. Methods Five focus groups were conducted with 33 mothers and fathers of young children, stratified by ethnicity, education, and income. An interdisciplinary team thematically coded verbatim transcripts and identified emergent themes. Results Main themes included low confidence in parenting and sifting through parenting information. Additional themes included communicating with partner about changing roles, breastfeeding, maternal mental health, and maternal postpartum recovery. Low parenting confidence was closely linked with information seeking, yet participants expressed being overwhelmed by the task of managing conflicting parenting information. Women reported that providers focused on infant needs, leaving them feeling unprepared for their own mental and physical health needs. Conclusions for Practice Parents report extensive needs for education and support in the early postpartum period, yet also report feeling overwhelmed by the quantity of parenting information available. These findings suggest parents need and desire reliable healthcare education after discharge that includes parent health and adjustment.

First-time parents' shared representation of postpartum depressive symptoms: A qualitative analysis.

RATIONALE: Maternal postpartum depression (PD) is a common, debilitating mental health problem. Yet despite effective treatments and widespread screening, treatment rates remain low. Previous studies suggest fathers are frequently consulted about maternal PD symptoms, but little is known about the process, content, or outcomes of these consultations. OBJECTIVE: The aim of this work was to explore how couples communicate about PD symptoms. METHODS: A single purposive sample of first-time parents stratified by maternal depression screening scores (Edinburgh Postnatal Depression Scale; EPDS) and partner status was drawn from a prospective survey of 300 parents in the U.S. Midwest. Partnered mothers with an elevated (EPDS≥10) depression screening score at one of four time points in the postpartum year comprised the majority of the sample. Smaller samples of participants with low EPDS scores and single participants were included to provide contrast in the consultation and decision making process. A total of 39 participants (22 married/EPDS-high, 10 married/EPDS-low, 5 single/ EPDS-high, 2 single/EPDS-low) were interviewed at one year postpartum. Mothers and fathers were interviewed separately to promote candid responses and allow comparison of illness conceptualizations. Interviews were transcribed, analyzed, and coded through an iterative process. RESULTS: Couples' conversations about mood changes centered on two overarching questions: How bad is it? and What should we do about it? Answering How bad is it? involved parents comparing maternal mood changes to uncertain depression criteria, and mothers asking partners and female relatives whether changes were normal. Answering What should we do about it? had three themes: Fathers feeling unprepared to respond to depression, mothers and fathers expressing reluctance to seek treatment, and couples working collaboratively to accommodate treatment or self-care. CONCLUSION: Themes suggest partners significantly contribute to women's conceptualization of mood changes and should be actively engaged in education, screening, and referral practices.

Breastfeeding Self-Efficacy, Mood, and Breastfeeding Outcomes among Primiparous Women.

BACKGROUND: A link between postpartum mood and breastfeeding has been established in the literature, but little is known about the relationship of breastfeeding self-efficacy (BSE) to breastfeeding and mood outcomes, particularly in primiparous women. OBJECTIVES: The purpose of this study was to prospectively evaluate the relationship among BSE, mood, and breastfeeding outcomes in primiparous women. A secondary purpose was to explore self-reported reasons for difficult emotional adjustment during the transition to motherhood. METHODS: Primiparous women who initiated breastfeeding were surveyed at 2 days, 6 weeks, and 6 months postpartum. Breastfeeding self-efficacy, depressive symptoms, work status, breastfeeding difficulties, partner support, and use of lactation services were included in a hierarchical multiple regression analysis. Women who identified as emotionally distressed provided open-ended responses identifying the main cause of their stress. RESULTS: High BSE at 2 days postpartum predicted positive emotional adjustment and fewer depressive symptoms at 6 weeks postpartum, as well as more exclusive breastfeeding at 6 months postpartum. Among distressed mothers, breastfeeding concerns were among the most commonly named reasons for stress, along with lack of sleep, lack of social support, and overwhelming learning demands involved with being a new parent. CONCLUSION: Breastfeeding perceptions are associated with emotional health and breastfeeding outcomes. Bolstering women's early BSE may be an important goal for multiple dimensions of postpartum health.

Maternal expectations and postpartum emotional adjustment in first-time mothers: results of a questionnaire survey.

OBJECTIVE: Several predictors of postpartum mood have been identified in the literature, but the role of maternal expectations in postpartum mental health remains unclear. The aim of this study was to identify whether maternal expectations during the postpartum hospital stay predict adjustment and depressive symptoms at 6 weeks postpartum. METHODS: The sample included 233 first-time mothers recruited from the postpartum unit of a Midwestern hospital. Participants completed measures of maternal expectations and depressive symptoms (EPDS) at Time 1 (2 d postpartum) and completed EPDS and an Emotional Adjustment Scale (BaM-13) at Time 2 (6 weeks postpartum). RESULTS: A conditional relationship between the expectation that an infant's behavior will reflect maternal skill and Time 2 outcomes (BaM-13 and EPDS) was found, such that endorsing this belief predicted increased depression and poorer adjustment in those with higher (but not lower) Time 1 EPDS scores. Time 2 BaM-13 scores were also negatively predicted by expectations of self-sacrifice and positively predicted by expectations that parenthood would be naturally fulfilling. CONCLUSIONS: The expectations that new mothers hold about parenting soon after delivery are predictive of emotional adjustment in the early postpartum period, suggesting a role for discussion of expectations in future preventive strategies.

Too sick, not sick enough? Effects of treatment type and timing on depression stigma.

A case vignette survey design was used to explore effects of treatment timing (early, delayed, or untreated) and depression treatment type (pharmacological or psychological) on components of depression stigma. The survey was distributed to two samples, 116 undergraduates (UGs) and 301 participants from the online service Amazon Mechanical Turk. As expected, extended untreated depression was associated with greater social distance and negative character evaluation than treated depression, and early treatment was associated with higher illness invalidity stigma (both samples) and illness responsibility stigma (UG sample only). Interaction effects suggested that pharmacotherapy, in comparison with psychotherapy, was more sensitive to the effects of treatment timing on stigma. Taken together, the pattern of results suggests that separate facets of stigma are associated with early depression treatment and prolonged untreated depression. Evidence for separate stigmatization of early treatment and extended illness holds important implications for antistigma campaigns.

Faith-based sex education programs: what they look like and who uses them.

The purpose of this study was to explore the kinds of sex education programs for youth available in mainline churches. This research project sought to identify the kinds of programs developed, the ages of the youth involved, the reasons for implementing the programs, the goals of the programs, the topics covered, and the perceived youth response to these programs as identified by youth ministers and leaders. The sample included 92 churches/synagogues with memberships over 300 that were within a 25-mile radius of our small, urban area in southeast Michigan. Findings from this study lay the groundwork for exploring whether these programs have an impact on adolescents' sexual behaviors.

Patient preferences for clinician interactional style in treatment of perinatal depression.

Most women with depression around the time of childbearing are not treated adequately, or at all. Clinical practice guidelines focus primarily on provision of information rather than on interaction factors. In this study, we explored clinician interactional style characteristics contributing to patient response to perinatal depression referral and treatment. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences with and preferences for clinician interactional style characteristics in the context of obstetrics-setting referral and delivery of depression treatment. Thematic analysis revealed a central theme related to interactional cues that influence women's reactions to clinical encounters, summarized by the question, "Can this person help me?" Women evaluated this question in four domains: feeling heard, developing trust in the clinician, perceiving technical competence in the clinician, and feeling that the intervention focus is effectively chosen and communicated. Our results imply that, in addition to informational factors, the way in which clinicians interact with patients about depression might strongly influence patient responses.