Parental postpartum depression directly and indirectly affects exclusive breastfeeding: a cross-sectional study

Exclusive breastfeeding (EBF) is essential for infant health. Parental postpartum depression (PPD) may play a crucial role in shaping maternal intention and behavior to breastfeeding. This study, grounded in the ABC model of behavior theory, aimed to examine the direct and indirect pathways linking maternal and paternal PPD with EBF intention and practice.

A total of 273 couples attending postpartum health check-ups were invited to complete structured questionnaires with assistance from trained interviewers. Symptoms of PPD in both mothers and fathers were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analyses were conducted to examine the associations between parental PPD and intention and practice related to EBF. Path analysis was further employed to identify potential pathways linking parental PPD, maternal intention to EBF, and EBF practice. Direct and indirect effects were estimated within the path model using the weighted least squares mean and variance adjusted (WLSMV) estimator. Standardized path coefficients (β) were reported for all effects.

Among 273 couples, 41.0% of mothers and 28.5% of fathers screened positive for PPD. Although most mothers (93.4%) showed a positive intention to EBF, only 52.4% practiced it. Maternal depression was associated with a less positive intention to EBF (adjusted OR = 0.20, 95% CI: 0.06-0.64). Path analysis further revealed that paternal PPD indirectly influenced maternal intention through maternal PPD (β _indirect = -0.177, p = 0.001), while maternal PPD exerted an indirect effect on EBF practice through intention (β _indirect = -0.189, p = 0.038). These findings highlight a family-level psychological pathway linking parental mental health to breastfeeding behaviors.

A substantial gap was found between willingness and actual practice of EBF. Both maternal and paternal postpartum depression were directly and indirectly associated with breastfeeding intention and practice. Early identification and intervention for parental depression are essential to promote exclusive breastfeeding.