Department of Psychological Sciences, University of Liverpool, Liverpool, Merseyside, UK.
Matern Child Nutr. 2024 Jan;20(1):e13558. doi: 10.1111/mcn.13558. Epub 2023 Sep 26.
High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. 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 health care 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 post-natal 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 others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal 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 health care practitioners and the maternal social support network are discussed.
高母乳喂养压力和低医疗保健专业人员支持度感知与早期母乳喂养中断、内疚和羞耻感有关。这是有问题的，因为内疚和羞耻感显著预测产后焦虑和抑郁。以前没有人试图提供产后社会环境、婴儿喂养方式和产后情绪健康之间关系映射的定量证据。本研究旨在通过实证调查上述途径。结构方程模型应用于 876 名母亲在线提供的调查数据。内疚和羞耻都显著预测了焦虑和抑郁。医疗保健专业人员支持不足和母乳喂养压力增加了焦虑和抑郁，这些影响通过内疚和羞耻感的增加而产生间接影响。配方奶喂养专属性与产后焦虑症状呈负相关。这一发现可以用与观察到的婴儿体重增加和能够与他人分担婴儿喂养责任（例如与伴侣分担）相关的解脱感来解释。这种关系被另一条间接途径所平衡，即更大程度的配方奶喂养专属性会积极预测内疚感，从而增加产后焦虑评分。虽然内疚感作为婴儿喂养方式的中介因素增加了产后抑郁和焦虑，但羞耻感独立于婴儿喂养方式。这些已识别的差异为将内疚（即对违反道德规范的行为感到悔恨）和羞耻（即将违反规范的悔恨内化到自我）的一般定义转移到婴儿喂养环境提供了实证支持。讨论了医疗保健从业者和产妇社会支持网络的建议。
