Publication Date




Embargo Period


Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Rosina Cianelli

Second Committee Member

Natalia Villegas

Third Committee Member

Karina Gattamorta

Fourth Committee Member

Giovanna De Oliveira

Fifth Committee Member

Danuta Wojnar


Postpartum depression (PPD) is a significant maternal health problem afflicting nearly 800,000 new mothers in the United States every year. Mothers suffering from PPD endure feelings of sadness, anxiety, extreme fatigue that makes it difficult to care for one’s self or for others, feeling worthless, and even thoughts of harming oneself or child. Mothers who are not treated for PPD may have negative health outcomes, including difficulty bonding with and caring for their children, chronic anxiety, and are at an increased risk for substance abuse. PPD is considered the single greatest risk factor for maternal suicide and infanticide. The important role that breastfeeding may have with PPD has been a topic of interest amongst the scientific community. Prior research conducted has examined the role PPD has on the initiation and duration of breastfeeding practices. However, a new premise under discussion is the possibility of breastfeeding practices reducing PPD risk. Consequently, the aims of the study were to: (1) explore risk factors for PPD; (2) examine the relationship between breastfeeding practices (currently breastfeeding and breastfeeding length) and PPD risk; (3) determine if breastfeeding intent moderated the relationship between breastfeeding practices and PPD risk; and (4) determine if depression during pregnancy moderated the relationship between breastfeeding practices and PPD risk. A cross-sectional, correlational study design was used to address study aims. Data was taken from a large national dataset from the Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System (PRAMS) to examine the four specific aims. The study used data from mothers that responded to the 2016 PRAMS questionnaire residing in 26 states in the United States. A secondary analysis was conducted using a subsample of mothers (n = 29,682) that met inclusion criteria using descriptive analysis, bivariate analyses, logistic regressions and a multiple logistic regression model. Statistical significance was found for aim one related to PPD maternal risk factors: demographical (race, age, education, household income), behavioral (breastfeeding practices and abuse), pregnancy related (pregnancy intention), health (history of maternal depression) and infant (infant length of hospital stay) related characteristics. Statistical significance was found for aim two, indicating that mothers currently breastfeeding and mothers who breastfed for longer periods of time had a lower risk for PPD. Non significance was determined for aim three, finding that breastfeeding intent did not moderate the relationship between breastfeeding practices (breastfeeding status and length) and PPD risk. Non-significance was determined for aim four, finding that depression during pregnancy did not moderate the relationship between breastfeeding practices and PPD risk. Study results provided significant risk factors for PPD that could be used to develop a tailored risk assessment tool to screen mothers. Additionally, results provided supportive evidence to support breastfeeding practices as a preventive health behavior to decrease PPD risk, even after controlling for significant covariates. Further research is needed to determine the quality, directionality, and mechanism behind the relationship between various breastfeeding practices and PPD risk. It is imperative that nurse scientists bring awareness and address PPD as a major public health concern for all childbearing mothers living in the US within the realms of research, practice, education, and policy.


breastfeeding; postpartum depression; PRAMS; maternal health

Available for download on Thursday, November 25, 2021