title: Breastfeeding and Postnatal Depression: A Prospective Cohort Study in Sabah, Malaysia.
abstract: BACKGROUND
  Postnatal depression is a disorder that can lead to serious consequences for both the mother and infant. Despite the extensively documented health benefits of breastfeeding, its association with postnatal depression remains uncertain.
  
  
  OBJECTIVE
  To investigate the relationship between full breastfeeding at 3 months postpartum and postnatal depressive symptoms among mothers in Sabah, Malaysia.
  
  
  METHODS
  A prospective cohort study of 2072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36 to 38 weeks of gestation and followed up at 1 and 3 months postpartum. Depressive symptoms were assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale (EPDS). Repeated-measures analyses of variance was performed to compare the depression scores over time and between subgroups of breastfeeding mothers.
  
  
  RESULTS
  Approximately 46% of women were fully breastfeeding their infants at 3 months postpartum. These mothers had significantly (P < .001) lower mean EPDS scores at both 1 and 3 months postpartum (mean ± SD, 4.14 ± 4.12 and 4.27 ± 4.12, respectively) than others who did not initiate or maintain full breastfeeding for 3 months (4.94 ± 4.34 and 5.25 ± 4.05, respectively). After controlling for the effects of covariates, the differences in EPDS scores remained statistically significant (P = .001) between the 2 breastfeeding groups.
  
  
  CONCLUSIONS
  Full breastfeeding appeared to be negatively associated with postnatal depressive symptoms for mothers residing in Sabah.
authors.affiliation: School of Medicine, University Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
authors.forename: Aza Sherin Mohamad
authors.initials: AS
authors.lastname: Yusuff
authors.affiliation: Department of Management Sciences, City University of Hong Kong, Hong Kong School of Public Health, Curtin University, Perth, WA, Australia.
authors.forename: Li
authors.initials: L
authors.lastname: Tang
authors.affiliation: School of Public Health, Curtin University, Perth, WA, Australia.
authors.forename: Colin W
authors.initials: CW
authors.lastname: Binns
authors.affiliation: School of Public Health, Curtin University, Perth, WA, Australia Andy.Lee@curtin.edu.au.
authors.forename: Andy H
authors.initials: AH
authors.lastname: Lee
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology* / Q000706:statistics & numerical data; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D065840:Protective Factors
keywords: Edinburgh Postnatal Depression Scale; Malaysia; breastfeeding; depression; depressive symptoms; postnatal depression