Psychosocial predictors of postnatal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, healthcare professional support, postnatal guilt and shame, and postnatal anxiety and depression within an infant feeding context

In high income settings, high perceived pressure to breastfeed and poor perceived quality of healthcare professional support have been associated with early breastfeeding cessation, guilt, and shame. This is important because guilt and shame significantly predict postnatal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the postnatal social context, infant feeding method, and emotional wellbeing outcomes. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor healthcare professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with postnatal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities with others e.g., one’s partner. This relationship, however, was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which in turn increased postnatal anxiety score. While guilt acted as mediator of infant feeding method to increase postnatal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for healthcare practitioners and the maternal social support network are discussed.