Association of early initiation of breastfeeding on postpartum depression—multi-centric longitudinal cohort study in Nepal

Background Evidence of the relationship between breastfeeding and maternal mental health is mixed and complex, with some studies suggesting breastfeeding may lower the risk for postpartum depressive symptoms, while others report no clear or consistent effects. Given these inconsistencies, we aim to assess the association between the timing of initiation of breastfeeding and postpartum depressive symptoms 90 days after birth in Nepal. Methodology This longitudinal multi-centric cohort study included 898 mother-infant pairs in 9 district hospitals of Nepal. Data was collected on timing of initiation of breastfeeding, sociodemographic variables and depressive symptoms assessed through the Edinburg Postnatal Depression Scale. A Directed Acyclic Graph was constructed and multiple logistic regression, generalized mixed linear regression model and Generalized Estimating Equations (GEE) were used to assess the association of timing of breastfeeding with postpartum depressive symptoms. Principal results At the 90th day postpartum, 31.4% of women reported depressive symptoms. Compared to women who had immediate breastfeeding, those who had no immediate breastfeeding had 3.47 higher odds of depressive symptoms (cOR: 3.47; 95% CI; 2.40, 5.01). After adjusting for confounding and mediating factors, the odds of depressive symptoms were 2.81 times higher among women who did not immediately breastfeed (aOR, 2.81; 95% CI; 1.76, 4.50). Using GEE modeling, there was a positive association between delayed breastfeeding and postpartum depression at 7 days (β coefficient, 0.583, p = 0.001) and at 45 days (β coefficient, 0.551, p = 0.003). Using the generalized linear mixed model, the prediction to postpartum depression score increased with delay in breastfeeding. Conclusions This study highlights that the delayed initiation of breastfeeding is associated with higher odds of symptoms for postpartum depression among various groups of women, especially among women from disadvantageous groups and women with no education in Nepal. Improving support to women for early initiation of breastfeeding could help reduce postpartum depression.