Breastfeeding Practices, Insomnia Symptoms, Anxiety, and Depression Among Lebanese Mothers: A Cross-Sectional Study

The postpartum period is marked by significant physiological and psychological changes, placing mothers at heightened risk for mental health disturbances such as anxiety, depression, and insomnia. While breastfeeding is widely recognized for its physical and emotional benefits, its association with maternal mental health outcomes in low- and middle-income countries, particularly Lebanon, remains underexplored. This study aimed to assess the relationship between breastfeeding practices (exclusive breastfeeding at 6 months and breastfeeding continuation at 12 and 24 months) and insomnia, anxiety, and depression among Lebanese mothers, adjusting for sociodemographic, pregnancy and delivery, dietary, and lifestyle variables. A cross-sectional online survey was administered in 2023-2024 to Lebanese mothers who had given birth between 2018 and 2023. Participants (n = 305) completed validated tools including the Patient Health Questionnaire (PHQ-4) for anxiety and depression, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and questionnaires on breastfeeding practices, sociodemographic status, dietary habits, and household food security. Statistical analyses examined associations between breastfeeding behaviors and mental health outcomes. Exclusive breastfeeding at 6 months was not associated with maternal insomnia, anxiety, or depression. In contrast, breastfeeding continuation at 12-24 months was positively associated with insomnia (aOR = 2.15). Beyond breastfeeding indicators, insomnia was also associated with anxiety (aOR = 2.42) and with lifestyle-related factors, including lower adherence to the Mediterranean diet (aOR = 0.80). Anxiety was associated with perinatal factors (shorter pregnancy duration: aOR = 0.89; absence of immediate skin-to-skin contact: aOR = 0.49), family characteristics (higher parity: aOR = 1.70), lifestyle factors (tobacco use: aOR = 2.69), and co-occurring mental health symptoms (depression: aOR = 19.79; insomnia: aOR = 2.36). Depression was primarily associated with food insecurity (aOR = 1.15) and anxiety (aOR = 20.00), and was inversely associated with alcohol consumption (aOR = 0.37). Overall, anxiety and depression were more consistently related to social, behavioral, and socioeconomic determinants than to breastfeeding practices. These results underscore the importance of routine perinatal mental health screening, in line with current recommendations, and of interventions targeting modifiable factors such as tobacco use and food insecurity, rather than framing breastfeeding itself as a risk factor for maternal mental health difficulties.