Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed. The current study aimed to provide quantitative evidence for the relationship between the post-natal social context (i.e., perceived pressure to breastfeed and perceived quality of health care professional support), infant feeding method and post-natal emotional well-being (i.e., guilt, shame, post-natal anxiety and post-natal depression scores). Structural equation modelling revealed that the post-natal social context indeed predicted post-natal anxiety and depression scores: guilt, but not shame, mediated these pathways via infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context and provides recommendations for health care practitioners and the maternal social support network to advocate breastfeeding and emotional well-being outcomes.image Guilt and shame are empirically evidenced as distinct, overlapping concepts: guilt is more behaviour-orientated, while shame is more social context-orientated.Guilt and shame both predict postnatal depression and anxiety, supporting their conceptualisation as transdiagnostic phenomena.While guilt acts indirectly through one's social context and infant feeding method to increase depression and anxiety, shame acts independently of infant feeding method. General definitions of guilt and shame are thus deemed transferable to an infant feeding context.Recommendations are made to address issues regarding perceived insufficient healthcare professional support and pressure to breastfeed, so to improve postnatal wellbeing and extend any breastfeeding continuation.