母乳喂养自我效能感在围产期抑郁症状与纯母乳喂养关系中的作用：一项纵向中介分析
The role of breastfeeding self-efficacy in the relationship between perinatal depressive symptoms and exclusive breastfeeding: a longitudinal mediation analysis.
作者信息
Liu Li, Feng Shuya, Zhang Yu, Xiao Gui, Zhou Mengjia, Li Xingxing, Li Ying, Qin Chunxiang
机构信息
Health Management Medicine Center and Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.
Xiangya School of Nursing, Central South University, Changsha, 410013, China.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 27;25(1):356. doi: 10.1186/s12884-025-07481-8.
BACKGROUND
Perinatal depressive symptoms are associated with exclusive breastfeeding; however, the longitudinal mediating process of this relationship remains unclear. Breastfeeding self-efficacy may be an important variable in understanding the complex process involved in their co-occurrence. Therefore, we aimed to explore the role of breastfeeding self-efficacy in the relationship between perinatal depressive symptoms and exclusive breastfeeding using both between- and within-person approaches.
METHODS
A prospective longitudinal study was conducted from October 2021 to January 2024 at a tertiary hospital in Hunan, China. Depressive symptoms were measured at 36 gestational weeks and 1 week, 6 weeks, 3 months, and 6 months postpartum. Exclusive breastfeeding and breastfeeding self-efficacy were evaluated at the same postpartum intervals. Cross-lagged panel models, random intercepts cross-lagged panel models, and longitudinal mediation models were used to analyze their relationships.
RESULTS
A total of 334 participants were included. Longitudinal mediation models revealed that breastfeeding self-efficacy mediated the prospective negative effect of perinatal depressive symptoms on exclusive breastfeeding at the between-person level (b = - 0.017, SE = 0.008, 95% CI (- 0.032, - 0.001), P = 0.036), and suppressed the positive effect of exclusive breastfeeding on depressive symptoms at the within-person level (b = - 0.044, SE = 0.022, 95% CI (- 0.087, 0.000), P = 0.047).
CONCLUSIONS
Mothers with perinatal depressive symptoms may face challenges in exclusive breastfeeding due to reduced breastfeeding self-efficacy. While increasing exclusive breastfeeding might help reduce depressive symptoms over time, this positive effect can be hindered if breastfeeding self-efficacy remains low. Our findings highlight breastfeeding self-efficacy as a critical target for future interventions.
背景
围产期抑郁症状与纯母乳喂养相关；然而，这种关系的纵向中介过程仍不清楚。母乳喂养自我效能感可能是理解二者同时出现所涉及复杂过程的一个重要变量。因此，我们旨在采用组间和个体内方法探讨母乳喂养自我效能感在围产期抑郁症状与纯母乳喂养关系中的作用。
方法
2021年10月至2024年1月在中国湖南的一家三级医院进行了一项前瞻性纵向研究。在孕36周、产后1周、6周、3个月和6个月时测量抑郁症状。在相同的产后时间间隔评估纯母乳喂养和母乳喂养自我效能感。采用交叉滞后面板模型、随机截距交叉滞后面板模型和纵向中介模型分析它们之间的关系。
结果
共纳入334名参与者。纵向中介模型显示，母乳喂养自我效能感在组间水平上介导了围产期抑郁症状对纯母乳喂养的前瞻性负面影响（b = -0.017，SE = 0.008，95%CI（-0.032，-0.001），P = 0.036），并在个体内水平上抑制了纯母乳喂养对抑郁症状的正面影响（b = -0.044，SE = 0.022，95%CI（-0.087，0.000），P = 0.047）。
结论
有围产期抑郁症状的母亲可能因母乳喂养自我效能感降低而在纯母乳喂养上面临挑战。虽然随着时间推移增加纯母乳喂养可能有助于减轻抑郁症状，但如果母乳喂养自我效能感仍然较低，这种积极效果可能会受到阻碍。我们的研究结果强调母乳喂养自我效能感是未来干预的关键目标。
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