title: Breastfeeding and depression: a systematic review of the literature.
abstract: BACKGROUND
  Research has separately indicated associations between pregnancy depression and breastfeeding, breastfeeding and postpartum depression, and pregnancy and postpartum depression. This paper aimed to provide a systematic literature review on breastfeeding and depression, considering both pregnancy and postpartum depression.
  
  
  METHODS
  An electronic search in three databases was performed using the keywords: "breast feeding", "bottle feeding", "depression", "pregnancy", and "postpartum". Two investigators independently evaluated the titles and abstracts in a first stage and the full-text in a second stage review. Papers not addressing the association among breastfeeding and pregnancy or postpartum depression, non-original research and research focused on the effect of anti-depressants were excluded. 48 studies were selected and included. Data were independently extracted.
  
  
  RESULTS
  Pregnancy depression predicts a shorter breastfeeding duration, but not breastfeeding intention or initiation. Breastfeeding duration is associated with postpartum depression in almost all studies. Postpartum depression predicts and is predicted by breastfeeding cessation in several studies. Pregnancy and postpartum depression are associated with shorter breastfeeding duration. Breastfeeding may mediate the association between pregnancy and postpartum depression. Pregnancy depression predicts shorter breastfeeding duration and that may increase depressive symptoms during postpartum.
  
  
  CONCLUSIONS
  The selected keywords may have led to the exclusion of relevant references.
  
  
  CONCLUSIONS
  Although strong empirical evidence regarding the associations among breastfeeding and pregnancy or postpartum depression was separately provided, further research, such as prospective studies, is needed to clarify the association among these three variables. Help for depressed pregnant women should be delivered to enhance both breastfeeding and postpartum psychological adjustment.
authors.affiliation: School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal. Electronic address: cdias@psi.uminho.pt.
authors.forename: Cláudia Castro
authors.initials: CC
authors.lastname: Dias
authors.affiliation: School of Psychology, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal. Electronic address: bbfi@psi.uminho.pt.
authors.forename: Bárbara
authors.initials: B
authors.lastname: Figueiredo
mesh_terms: D001903:Bottle Feeding / Q000523:psychology / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data*; D019052:Depression, Postpartum / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D033182:Intention; D038622:Internationality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Bottle-feeding; Breastfeeding; Postpartum depression; Pregnancy depression