Sibolboro Mezzacappa E, Endicott J
Behavioral Medicine Program, Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
Arch Womens Ment Health. 2007;10(6):259-66. doi: 10.1007/s00737-007-0207-7. Epub 2007 Nov 26.
Maternal depression is the most common complication of the postpartum, having devastating and long lasting effects on mother and infant. Lactation is associated with attenuated stress responses, especially that of cortisol, and the lactogenic hormones, oxytocin and prolactin, are associated with anti-depressant and anxiolytic effects. These associations suggest that breast-feeding may decrease maternal depressive symptoms, yet empirical results have been conflicting. Recent findings have indicated that parity may mediate the association between breast-feeding and stress response. Because a decreased stress response is associated with a decreased risk for depression, parity may also mediate the association between infant feeding method and depressive symptoms. Specifically, the benefits of breast-feeding may appear in multiparous but not primiparous mothers. In the present study, data drawn from a national sample of primiparous and multiparous mothers were examined for possible associations between infant feeding method and depressive symptoms, as assessed by the Center for Epidemiological Survey-Depression scale (CES-D). After controlling for several possible confounding variables, breast-feeding by multiparas was associated with significantly decreased odds of having depression compared with bottle-feeders (OR = 0.41, CI 0.19-0.87, p = 0.02); however, no risk reduction from breast-feeding was evident among primiparas. The results support a parity-mediated association between lactation and maternal depressive symptoms. The results provide a reason for earlier conflicting findings, present new research avenues, and suggest possible clinical approaches.
产后抑郁是产后最常见的并发症，对母亲和婴儿具有毁灭性且长期的影响。哺乳与应激反应减弱有关，尤其是皮质醇，而生乳激素、催产素和催乳素与抗抑郁和抗焦虑作用有关。这些关联表明母乳喂养可能会减轻母亲的抑郁症状，但实证结果一直存在冲突。最近的研究结果表明，产次可能介导母乳喂养与应激反应之间的关联。由于应激反应降低与抑郁症风险降低相关，产次也可能介导婴儿喂养方式与抑郁症状之间的关联。具体而言，母乳喂养的益处可能出现在经产妇而非初产妇身上。在本研究中，我们检查了从初产妇和经产妇的全国样本中获取的数据，以探讨婴儿喂养方式与抑郁症状之间可能存在的关联，抑郁症状通过流行病学调查中心抑郁量表（CES-D）进行评估。在控制了几个可能的混杂变量后，与人工喂养的经产妇相比，母乳喂养的经产妇患抑郁症的几率显著降低（OR = 0.41，CI 0.19 - 0.87，p = 0.02）；然而，初产妇中母乳喂养并没有明显的降低风险的作用。这些结果支持了产次介导的泌乳与母亲抑郁症状之间的关联。这些结果为早期相互矛盾的研究结果提供了一个解释，提出了新的研究途径，并暗示了可能的临床方法。
