title: The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review.
abstract: BACKGROUND
  The negative health consequences of postpartum depression are well documented, as are the benefits of breastfeeding. Despite the detailed research related to these maternal and infant health outcomes, the relationship between maternal mood and breastfeeding remains equivocal.
  
  
  OBJECTIVE
  A qualitative systematic review was conducted to examine the relationship between postpartum depressive symptomatology and infant-feeding outcomes.
  
  
  METHODS
  We performed electronic searchers in Medline (1966-2007), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982-2007), and Embase (1980-2007) by using specific key words. A hand search of selected specialist journals and reference lists of articles obtained was then conducted. Seventy-five articles were reviewed, of which 49 specifically provided data to be extracted related to postpartum depressive symptomatology and infant-feeding outcomes. Both authors independently extracted data including study design, participants (number and characteristics), and results.
  
  
  RESULTS
  The results from this review suggest that women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy. There is also beginning evidence to suggest that depressed women may be less likely to initiate breastfeeding and do so exclusively.
  
  
  CONCLUSIONS
  Depressive symptomatology in the postpartum period negatively influences infant-feeding outcomes. These findings have important clinical implications and support the need for early identification and treatment of women with depressive symptomatology. However, strategies to address help-seeking barriers are needed if women are to receive appropriate and timely treatment. Research to determine effective interventions to support depressed breastfeeding women is warranted.
authors.affiliation: University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College St, Toronto, Ontario, Canada M5T 1P8. cindylee.dennis@utoronto.ca
authors.forename: Cindy-Lee
authors.initials: CL
authors.lastname: Dennis
authors.forename: Karen
authors.initials: K
authors.lastname: McQueen