Analysis of the relationships between breastfeeding self-efficacy, postpartum depression, and social support

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Maternal anxiety, stress, and depression can dramatically affect breastfeeding and reduce the mother's motivation and ability to perform this process. This study evaluates the relationships between breastfeeding self-efficacy (BSE), postpartum depression (PPD), and social support in postpartum women. Methods : This descriptive-cross-sectional study was conducted in Hamadan City in 2024. The study population consisted of 240 randomly selected mothers who gave birth in the first 6 months after delivery. Data were collected using standard questionnaires, including a BSE questionnaire, the Edinburgh PPD scale, and a social support questionnaire. Data were analyzed with SPSS software using statistical methods such as mean, standard deviation, and Pearson’s correlation coefficient. Results : The average ages of mothers and spouses were 29.77 ± 5.85 and 34.78 ± 5.42 years, respectively. A normal body mass index was measured in 55.8% of the mothers, and 90.8% were housewives. Examining the relationships between variables revealed a significant relationship between BSE and two types of social support. BSE showed a significant positive relationship with family social support (r = 0.212, p = 0.001) and general social support (r = 0.180, p = 0.005). Moreover, a significant negative relationship was observed between BFSE and PPD (r = -0.507, p < 0.001). However, social support was not related significantly to PPD. Conclusion : This study demonstrates that social support, especially family support, can play an important role in increasing BSE and reducing PPD. Therefore, it is of paramount importance to strengthen support networks in the postpartum period for mothers' psychological well-being. breastfeeding self-efficacy postpartum depression social support mothers mental health Introduction Natural breastfeeding not only meets the infant’s nutritional and safety needs but also has long-term effects on the psychophysical health of the mother and child (1). The World Health Organization (WHO) recommends exclusive breastfeeding for at least the first 6 months of life, continued with complementary foods until 2 years of age (2). Breastfeeding strengthens the infant's immune system, improves emotional bonding with the mother, and promotes maternal mental health (3). However, mothers face challenges such as postpartum depression, lack of social support, and sociocultural pressures (4). Postpartum depression (PPD) is a major challenge affecting 10–20% of women and can reduce their breastfeeding ability and motivation (5). The disorder can reduce the breastfeeding desire and level and influence the quality of the mother-infant emotional bond (6). Evidence suggests that mothers suffering from postpartum depression often experience feelings of frustration, fatigue, and anxiety, which can reduce their breastfeeding ability (7). A wide range of structural barriers undermine the breastfeeding environment globally (e.g., the medicalization of infant care, misinformation about breastfeeding, and gender inequalities, including labor markets that do not adequately accommodate women’s reproductive rights (8). Breastfeeding rates are also associated with psychosocial factors (9), one of the most important of which is breastfeeding self-efficacy (BSE), generally referring to a mother’s perceived ability and confidence to breastfeed her infant (10). The BSE theory suggests that the mother’s BSE power influences breastfeeding cognitions and behaviors, which in turn influence breastfeeding rates (usually measured as breastfeeding initiation, exclusiveness, and duration (11). A mother’s confidence in her breastfeeding ability is of particular importance in the success of this process (12). Govern et al. reported that mothers with higher self-efficacy were more successful at breastfeeding(13). High self-efficacy can reduce depression and increase satisfaction with breastfeeding (14). Social support is known as a key factor in supporting mothers after childbirth (15). Studies show that adequate support from family, friends, and society can reduce symptoms of depression and increase BSE (16). Mercan et al. claimed mothers who received more social support were more successful in breastfeeding and experienced less depression (14). In Iran, cultural pressures and social expectations affect mothers’ self-confidence in breastfeeding (17). These pressures may negatively affect mothers’ psychological conditions and cause anxiety and distress (18). Inadequate social support can exacerbate the negative effects of PPD (19). The relationship between postpartum depression, BSE, and social support can be analyzed to help improve psychosocial care for mothers (20). Targeted health programs to increase social support and enhance mothers' self-esteem can improve mothers' mental health conditions and reduce rates of postpartum disorders (14, 21). Given the importance of these three factors, research on the interrelationship between BSE, PPD, and social support can help better understand the challenges experienced by mothers. Methods In this descriptive-cross-sectional study, the study group consisted of 240 lactating mothers aged 15-49 who were in the first 6 months after delivery and visited health centers for health care in Hamadan City. The mothers were sampled in a multi-stage manner in which the four regions of Hamadan City were determined as strata and comprehensive health centers as clusters. The study participants were of Iranian nationality, with minimum literacy, singleton infants, full-term, and healthy infants who were discharged from hospitals with their mothers, as well as with breasts without abnormalities and ready to breastfeed. If mothers were not willing to participate in the study or their infants were hospitalized in the intensive care unit during the study period, they were excluded from the study. The data were collected using the following three tools: The demographic-midwifery questionnaire consisted of two parts. The demographic section of the questionnaire included questions such as age, education level, occupation, family income status (mother's perception of the family's economic status), place of residence, smoking, drug and alcohol use, parity, desirous current pregnancy, and history of psychiatric disorders. The obstetric section included the pregnancy period, including questions about the start of preconception care, the number of prenatal care visits, and participation in childbirth preparation classes; postpartum, including questions about the type of delivery, infant gender, and skin-to-skin contact; breastfeeding, including questions about previous breastfeeding experience, time of first breastfeeding, time of decision to breastfeed, decision on breastfeeding duration, and decision on the breastfeeding type. BSE questionnaire: The short form of the BSE questionnaire contained 14 items with positive loading. Questions began with the prefix "I can always …" and were scored on a 5-point Likert scale from always or completely confident (score 5) to never or absolutely unconfident (score 1). The minimum and maximum scores were 14 and 70, respectively, with the highest score indicating the highest level of BSE. Edinburgh Postpartum Depression Scale (EPDS): This questionnaire contains 10 items and allows the diagnosis of depression up to 6 weeks after delivery. The Edinburgh scale score ranges from 0 to 30, and a score of 12 or more is considered PPD (22). Data were analyzed using SPSS software version 27. The relationships between variables were examined with Pearson’s correlation test. The Multidimensional Scale of Perceived Social Support (PSS) is a 12-item instrument that measures social support from three sources (family, community, and friends) on a seven-point scale from 1 (strongly disagree) to 7 (strongly agree). The minimum and maximum scores for the entire scale are 12 and 84, respectively, and are respectively calculated at 4 and 28 for each of the subscales of support from the family, community, and friends. A higher score indicates greater PSS (23). Results Table 1. Demographic information of the participants (n = 240) Variable Mean/ Count SD (%) Age (Year) 29.77 5.855 Spouse Age (Year) 34.78 5.427 Pre-pregnancy weight 65.79 9.521 Height 163.65 5.220 Body Mass Index (kg/m^2) 2.52 0.743 30 30 12.5 Mother's Job Employed 22 9.2 Unemployed 218 90.8 Spouse's Job Employed 230 95.8 Unemployed 10 4.2 Mother's Education Less than high school diploma 65 27.1 High School Diploma 102 42.5 Academic 73 30.4 Spouse's Education Less than high school diploma 75 31.3 High School Diploma 87 36.3 Academic 78 32.5 Number of Pregnancy 1.83 0.896 Number of Delivery 1.60 0.801 Breastfeeding history Yes 123 51.3 No 117 48.8 Type of Pregnancy Wanted Pregnancy 204 85.0 Unwanted Pregnancy 36 15.0 Alcohol and Cigarettes Consumption Yes 5 2.1 No 235 97.9 Preconception care Yes 191 79.6 No 49 20.4 Regular Prenatal Care Yes 222 92.5 No 18 7.5 Satisfaction from spousal support during breastfeeding Completely satisfied 53 22.1 Satisfied 156 65.0 Dissatisfied 27 11.3 Completely dissatisfied 4 1.7 Monthly Income Weak 19 7.9 Moderate 150 62.5 Good 71 29.6 Amount of Monthly Income (Tooman) 16.20 6.78 Infant Gender Female 110 45.8 Male 130 54.2 Type of Delivery Normal Vaginal Delivery 154 64.2 Cesarean Section 86 35.8 Gestational Age (Week) 38.32 1.774 Infant's Weight (g) 3093.94 494.304 Table 1 represents the demographic characteristics of the mothers participating in the study. According to the results, the mean ages of the mothers and spouses are 29.77 ± 5.85 and 34.78 ± 5.42 years, respectively. A normal body mass index (BMI) is observed in most mothers (55.8%). The means of pregnancies and deliveries are 1.83 ± 0.89 and 0.80 ± 1.60, respectively. Most mothers and husbands were housewives (90.8%) and employed (95.8%), respectively. In addition, a high school diploma was the education of most mothers (42.5%) and husbands (36.3%). Most pregnancies were voluntary (85.0%), and a history of breastfeeding was seen in 51.3% of the mothers. Besides, 79.6% received prenatal care and 92.5% followed up on regular care during pregnancy. Most participants (62.5%) reported a moderate monthly income, and normal deliveries were reported in 64.2% of the cases, with an average gestation of 38.32 ± 1.77 weeks. Regarding infant characteristics, the gender of 54.2% of infants was male, and the reported average infant weight was 3093.94 ± 494.30 g. Table 2. Mean values of Breastfeeding Self-Efficacy and Postpartum Depression Variable Minimum Maximum Mean / count SD/% Breastfeeding self-efficacy 33.00 131.00 63.86 23.05 Edinburgh Postnatal Depression Scale 2.00 27.00 19.26 5.50 Not Having Postpartum Depression 24 10.0 Having Postpartum Depression 216 90.0 Perceived Social Support subscales Significant Other Support 4.00 28.00 23.04 5.39 Friends Support 4.00 28.00 18.55 7.83 Family Support 4.00 28.00 22.48 6.12 Total Score 12.00 84.00 64.07 17.38 Table 2 presents the descriptive statistics of the variables evaluated in this study. The BSE scale shows that scores ranged from 18 to 57, with a mean score of 37.53 ± 6.07. The scores of EPDS ranged from 2.00 to 27.00, with a mean score of 19.26 (SD = 5.50). According to the cut-off point of this questionnaire, 90% (n = 216) of the participants experienced PPD. PSS is divided into three separate subscales. Support from significant others has scores ranging from 4 to 28 with a mean of 23.04 ± 5.39. Support from friends has scores ranging from 4 to 28 with a mean of 18.55 ± 7.83. Family support has scores in the same range with a mean of 22.48 ± 6.12. Finally, the total score of PSS was determined as a score between 12 and 84 with a mean of 64.07 ± 17.38. Table 3. Correlations of breastfeeding self-efficacy, postpartum depression, and social support Variable Index breastfeeding self-efficacy Edinburgh Postnatal Depression Scale Significant Other Support Friends Support Family Support Perceived Social Support Breastfeeding self-efficacy r P-value breastfeeding self-efficacy r 1 P-value - Edinburgh Postnatal Depression Scale r -0.507 1 P-value <0.001 - Significant Other Support r -0.178 0.123 1 P-value 0.006 0.057 - Friends Support r -0.217 0.206 0.630 1 P-value 0.001 0.001 <0.001 - Family Support r -0.090 0.111 0.823 0.698 1 P-value 0.164 0.086 <0.001 <0.001 - Perceived Social Support r -0.185 0.170 0.883 0.891 0.922 1 P-value 0.004 0.008 <0.001 <0.001 <0.001 Table 3 examines the correlation of the main study variables, showing that BSE has a weak negative correlation with the PPD scale (r = -0.190), suggesting that a lower BSE may lead to a greater PPD; this relationship is significant statistically (P-value = 0.003). The EPDS has a stronger negative correlation with BSE (r = -0.507), indicating that increased PPD may be associated with reduced BSE. This relationship is significant and very strong (P-value < 0.001). PPD is also weakly associated with significant other social support (r = 0.128) and social support from friends (r = 0.206), both of which are significant (P-values 0.048 and 0.001, respectively). Significant other support is weakly associated with BSE and PPD. Its relationship is particularly significant with PPD (P-value = 0.006). Furthermore, this support is very strongly associated with friends (r = 0.630) and family (r = 0.823) social support (P-value < 0.001). Friends support is significantly associated with BSE (r = 0.131), PPD (r = -0.217), and family social support (r = 0.698), all of which are significant (P-values 0.043, 0.001, and < 0.001, respectively). Family support is strongly associated with significant other (r = 0.823) and friends (r = 0.698) social support, and these relationships are significant (P-value < 0.001). There is also a weak positive association between BSE (r = 0.212) and PPD (r = 0.111), which are significant (P-values 0.001 and 0.086, respectively). Overall PSS, which is the sum of all supports, has high correlations with all variables. In particular, it has a strong and significant relationship with significant other (r = 0.883), friends (r = 0.891), and family (r = 0.922) social support (P-value < 0.001 in all cases). Table 4. Comparison of mean BSE and PSS based on PPD Variable EPDS classification N Mean SD P-value BSE No PPD 24 103.96 25.59 <0.001 PPD development 216 59.41 17.92 Important other support No PPD 24 21.58 4.85 0.163 PPD development 216 23.2 5.43 Friend support No PPD 24 17.25 6.97 0.392 PPD development 216 18.69 7.92 Family support No PPD 24 21.13 5.84 0.255 PPD development 216 22.63 6.14 PSS No PPD 24 59.96 15.86 0.223 PPD development 216 64.52 17.51 Table 4 compares mean BSE and PSS scores between individuals with and without PPD. The group without PPD had a slightly higher mean score (38.50) of BSE than those with PPD (37.43), but this difference was not statistically significant (p = 0.414). However, a significant difference was found for the second format of BSE, and a significantly higher mean (103.96) was recorded in those not experiencing PPD than in those with PPD (59.41, p < 0.001). Regarding PSS, no significant differences were found in the subscales of support from significant others (p = 0.163), friends (p = 0.392), family (p = 0.255), or total PSS (p = 0.223), indicating that PSS levels did not differ significantly between those with and without PPD. These findings highlight a significant difference in BSE between groups, but no significant difference in PSS. Table 5. Correlations between study variables and quantitative demographic variables Variable Maternal age (year) Paternal age (year) Pregnancy Parity BMI ( kg/m^2 ( Monthly income Gestational age Infant’s weight P-value BSE -.203** -.182** -0.048 -0.047 0.026 -.131* -0.123 -.141* r 0.002 0.005 0.464 0.465 0.687 0.042 0.057 0.029 P EPDS 0.076 0.107 -0.054 -0.025 -.137* .173** -0.029 -0.013 r 0.242 0.098 0.401 0.696 0.033 0.007 0.66 0.841 P PSS -.187** -.153* -.282** -.177** -.153* .353** 0.017 0.075 r 0.004 0.018 0 0.006 0.017 0 0.796 0.245 P Table 5 presents the relationships between study variables (BSE, PPD, and PSS) and various quantitative demographic variables. Significant correlations are observed in the table, shedding new light on the interaction between these factors. BSE (second format) was significantly negatively correlated with maternal (r = -0.203, p = 0.002) and paternal (r = -0.182, p = 0.005) age, indicating that older parental age is associated with lower BSE. Additionally, negative associations were found with monthly income (r = -0.131, p = 0.042) and infant weight (r = -0.141, p = 0.029), indicating that BSE decreases with rising these factors. PPD symptoms, measured by the EPDS, showed a weak negative correlation with the BMI (r = -0.137, p = 0.033), suggesting that a higher BMI is associated with fewer depressive symptoms. Conversely, a positive association was observed between monthly income and depressive symptoms (r = 0.173, p = 0.007), signifying that higher income levels may be linked to more depressive symptoms. PSS showed several significant correlations. It was negatively correlated with maternal age (r = -0.187, p = 0.004), paternal age (r = -0.153, p = 0.018), parity (r = -0.282, p < 0.001), the number of deliveries (r = -0.177, p = 0.006), and BMI (r = -0.153, p = 0.017). These findings indicate that older age, a higher BMI, and higher parity are associated with lower levels of PSS. However, PSS showed a strong positive correlation with monthly income (r = 0.353, p < 0.001), demonstrating that higher income is associated with increased levels of PSS. Discussion This study evaluated BSE, PPD, and social support among 240 postpartum mothers. The obtained data indicated a moderate level of breastfeeding self-confidence among the participants. A significant negative association was observed between BSE and PPD, which indicates the relationship between breastfeeding self-confidence and depression, such that depression increased with decreased self-confidence. About 90% of the participants reported PPD symptoms with a mean score of 19.26, indicating a high prevalence of this phenomenon in the study population. A mean score of 64.07 for PSS indicates a good level of social support in most of the mothers. This support acts as a protective factor against depression and decreased self-efficacy. The age of the mothers averaged 29.77 years and many of them were housewives, which could have effects on family dynamics and social support. Income and education showed statistically significant associations with self-efficacy levels. Social support plays a major role as a key factor in mothers’ breastfeeding success and improving their mental health, particularly in the postpartum period. Our findings show that mothers who receive emotional, informational, and practical support from their family, friends, and spouses feel more satisfied with breastfeeding than those who lack this support. This indicates a direct effect of emotional and practical support on their self-confidence and success. These results are also confirmed by other studies. For example, Bolin et al. (2018) found that mothers in countries with stronger social support structures, such as Scandinavian countries, were more successful in breastfeeding (24). Social support not only improves breastfeeding success but also reduces PPD symptoms. Scientific evidence shows that mothers who receive adequate social support act better and experience PPD less frequently (25). Stewart et al. (2017) reported better stress and depression reduction in mothers who received emotional support from their families and spouses (26). BSE refers to mothers’ belief in their own abilities in this process. Social support can reinforce this belief and help mothers overcome breastfeeding challenges (27). Dennis et al. (2015) documented that mothers with strong social support were more confident in breastfeeding and could better cope with challenges (28). The findings of this study correspond to other studies on the importance of social support in improving breastfeeding and maternal mental health. In particular, Brockington et al. (2013) accentuated the importance of social support in preventing PPD and increasing breastfeeding success (29). Shefaly et al. (2018) reported that high rates of PPD could negatively affect BSE (30). This negative association is confirmed by the results of the present study. Similarly, Elaina Ross et al. (2021) confirmed the fortifying role of social support on self-efficacy (31), which agrees with our findings. The positive association with PSS (r = 0.122) indicates the importance of this variable in improving self-efficacy. No relationship between depression and self-efficacy was reported in studies conducted by Murray et al.(32) and Cooper et al. (1997) (33) while our study revealed a significant and negative association. This discrepancy could be related to differences in methodological and sampling design or cultural factors. According to Chan et al. (2016), increasing maternal age may decrease breastfeeding confidence (34), which is similar to the findings in our study. Conclusion Overall, this study confirms the prevalence of PPD that can reduce BSE. Meanwhile, social support positively influences the increase of mothers’ self-confidence. Designing and implementing support and educational programs for mothers can help improve their mental health. Future research should investigate the effects of cultural, economic, and other social factors on the association between these variables. Limitations The cross-sectional design of the study could be a limitation of this study. Besides, the reliance on self-reported information may be biased because participants might be unable or reluctant to provide accurate information. Declarations Ethics approval and consent to participate The Ethics Committee of Hamadan University of Medical Sciences reviewed and approved the study (Ethics Code: IR.UMSHA.REC.1403.392). This research was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all study participants prior to data collection. Clinical Trial Not applicable. Consent for publication All participants consented to the publication of aggregated data. Availability of data and material The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding This study was supported by the Student Research Committee of Hamadan University of Medical Sciences. The funding body had no role in the design of the study, data collection, analysis, interpretation, or in the writing of the manuscript. Authors’ contributions RAN, EF, SZM, MR, AS, FEA, OH, and AT contributed to the study as follows: RAN: Conceptualization, Methodology, Data Collection, Writing - Original Draft. EF: Investigation, Data Collection, Project Administration. SZM: Data Analysis, Validation, Writing - Review & Editing. MR: Statistical Analysis, Formal Analysis, Visualization. AS: Resources, Supervision, Review & Editing. FEA: Conceptualization, Investigation, Writing - Review & Editing. OH: Advanced Statistical Analysis, Interpretation of Results, Writing - Review & Editing. AT: Supervision, Project Administration, Funding Acquisition, Writing - Review & Editing. Acknowledgements The authors would like to express their sincere gratitude to the Student Research Committee of Hamadan University of Medical Sciences for supporting this research project. We also extend our appreciation to the Modeling of Noncommunicable Diseases Research Center at Avicenna Institute for their invaluable consultation. Special thanks are owed to the mothers who participated in this study and shared their experiences with us. Finally, we thank the staff at Hamadan City health centers who helped facilitate the data collection process. References Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6413761","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":466038109,"identity":"76d4517d-9689-4ba8-adf0-de7eed193145","order_by":0,"name":"Roya Ahmadi Niyatabesh","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Roya","middleName":"Ahmadi","lastName":"Niyatabesh","suffix":""},{"id":466038112,"identity":"b579eba8-34c5-44e0-9fdb-bea9de581a69","order_by":1,"name":"Elham Fatholahi","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Elham","middleName":"","lastName":"Fatholahi","suffix":""},{"id":466038115,"identity":"ec630d18-221d-4719-a835-17b31a5a9e55","order_by":2,"name":"Zahra Masoumi","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Masoumi","suffix":""},{"id":466038116,"identity":"080e7f3c-73e8-4d81-b24d-32928c5016e6","order_by":3,"name":"Mansoureh Refaei","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mansoureh","middleName":"","lastName":"Refaei","suffix":""},{"id":466038119,"identity":"1a342a03-c622-4fb9-b1b5-ca6b25d1814d","order_by":4,"name":"Arezoo Shayan","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arezoo","middleName":"","lastName":"Shayan","suffix":""},{"id":466038121,"identity":"54f61d24-e2dc-4bc1-8d43-af8e8da614e9","order_by":5,"name":"Fahimeh Ezzati Arasteh","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fahimeh","middleName":"Ezzati","lastName":"Arasteh","suffix":""},{"id":466038122,"identity":"9aff6a46-1205-461d-96be-49bbb1912361","order_by":6,"name":"Azita Tiznobik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYFACxgYQyQNiPQAx+IjQ0gjUYwDSwmwA0sJGpDUgxQxsEmCSkHr+/sPtD34w/JGRn918rPJrjp0MGwPzw0c38GiROHCwsbEH6DDGOcfSbstuSwY6jM3YOAefNUAdDTxALcwSOWa3JbcxA7XwsEnj0yJ/mLGx8Q9QCxtQS7HktnrCWgyOMTY2g2zhAWph/LjtMGEthmcYG2fLGBjzSEikJUszbjvOw8ZMwC9y548/+PimQs5efkbywY8/t1Xb87M3P3yM1/sQ50EoZh4wSVA5EmD8QYrqUTAKRsEoGDEAAAu8PmaqTPgRAAAAAElFTkSuQmCC","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Azita","middleName":"","lastName":"Tiznobik","suffix":""},{"id":466038123,"identity":"05d6948f-f0b8-4ed5-9e00-dee46b818656","order_by":7,"name":"Omid Hamidi","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Omid","middleName":"","lastName":"Hamidi","suffix":""}],"badges":[],"createdAt":"2025-04-09 16:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6413761/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6413761/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83883605,"identity":"bc956d1e-6369-4a6a-8f4f-d856e7df4356","added_by":"auto","created_at":"2025-06-04 06:13:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":724768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6413761/v1/9ae1d8ee-443d-4a69-ac92-dd3833cf28d8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of the relationships between breastfeeding self-efficacy, postpartum depression, and social support","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNatural breastfeeding not only meets the infant\u0026rsquo;s nutritional and safety needs but also has long-term effects on the psychophysical health of the mother and child (1). The World Health Organization (WHO) recommends exclusive breastfeeding for at least the first 6 months of life, continued with complementary foods until 2 years of age (2). Breastfeeding strengthens the infant\u0026apos;s immune system, improves emotional bonding with the mother, and promotes maternal mental health (3). However, mothers face challenges such as postpartum depression, lack of social support, and sociocultural pressures (4).\u003c/p\u003e\n\u003cp\u003ePostpartum depression (PPD) is a major challenge affecting 10\u0026ndash;20% of women and can reduce their breastfeeding ability and motivation (5). The disorder can reduce the breastfeeding desire and level and influence the quality of the mother-infant emotional bond (6). Evidence suggests that mothers suffering from postpartum depression often experience feelings of frustration, fatigue, and anxiety, which can reduce their breastfeeding ability (7).\u003c/p\u003e\n\u003cp\u003eA wide range of structural barriers undermine the breastfeeding environment globally (e.g., the medicalization of infant care, misinformation about breastfeeding, and gender inequalities, including labor markets that do not adequately accommodate women\u0026rsquo;s reproductive rights (8). Breastfeeding rates are also associated with psychosocial factors (9), one of the most important of which is breastfeeding self-efficacy (BSE), generally referring to a mother\u0026rsquo;s perceived ability and confidence to breastfeed her infant (10). The BSE theory suggests that the mother\u0026rsquo;s BSE power influences breastfeeding\u0026nbsp;cognitions and behaviors, which in turn influence breastfeeding rates (usually measured as breastfeeding initiation, exclusiveness, and duration (11).\u003c/p\u003e\n\u003cp\u003eA mother\u0026rsquo;s confidence in her breastfeeding ability is of particular importance in the success of this process (12). Govern et al. reported that mothers with higher self-efficacy were more successful at breastfeeding(13). High self-efficacy can reduce depression and increase satisfaction with breastfeeding (14).\u003c/p\u003e\n\u003cp\u003eSocial support is known as a key factor in supporting mothers after childbirth (15). Studies show that adequate support from family, friends, and society can reduce symptoms of depression and increase BSE (16). Mercan et al. claimed mothers who received more social support were more successful in breastfeeding and experienced less depression (14).\u003c/p\u003e\n\u003cp\u003eIn Iran, cultural pressures and social expectations affect mothers\u0026rsquo; self-confidence in breastfeeding (17). These pressures may negatively affect mothers\u0026rsquo; psychological conditions and cause anxiety and distress (18). Inadequate social support can exacerbate the negative effects of PPD (19).\u003c/p\u003e\n\u003cp\u003eThe relationship between postpartum depression, BSE, and social support can be analyzed to help improve psychosocial care for mothers (20). Targeted health programs to increase social support and enhance mothers\u0026apos; self-esteem can improve mothers\u0026apos; mental health conditions and reduce rates of postpartum disorders (14, 21). Given the importance of these three factors, research on the interrelationship between BSE, PPD, and social support can help better understand the challenges experienced by mothers.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn this descriptive-cross-sectional study, the study group consisted of 240 lactating mothers aged 15-49 who were in the first 6 months after delivery and visited health centers for health care in Hamadan City. The mothers were sampled in a multi-stage manner in which the four regions of Hamadan City were determined as strata and comprehensive health centers as clusters. The study participants were of Iranian nationality, with minimum literacy, singleton infants, full-term, and healthy infants who were discharged from hospitals with their mothers, as well as with breasts without abnormalities and ready to breastfeed. If mothers were not willing to participate in the study or their infants were hospitalized in the intensive care unit during the study period, they were excluded from the study. The data were collected using the following three tools:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe demographic-midwifery questionnaire consisted of two parts. The demographic section of the questionnaire included questions such as age, education level, occupation, family income status (mother\u0026apos;s perception of the family\u0026apos;s economic status), place of residence, smoking, drug and alcohol use, parity, desirous current pregnancy, and history of psychiatric disorders. The obstetric section included the pregnancy period, including questions about the start of preconception care, the number of prenatal care visits, and participation in childbirth preparation classes; postpartum, including questions about the type of delivery, infant gender, and skin-to-skin contact; breastfeeding, including questions about previous breastfeeding experience, time of first breastfeeding, time of decision to breastfeed, decision on breastfeeding duration, and decision on the breastfeeding type.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBSE questionnaire: The short form of the BSE questionnaire contained 14 items with positive loading. Questions began with the prefix \u0026quot;I can always \u0026hellip;\u0026quot; and were scored on a 5-point Likert scale from always or completely confident (score 5) to never or absolutely unconfident (score 1). The minimum and maximum scores were 14 and 70, respectively, with the highest score indicating the highest level of BSE.\u003c/p\u003e\n\u003cp\u003eEdinburgh Postpartum Depression Scale (EPDS): This questionnaire contains 10 items and allows the diagnosis of depression up to 6 weeks after delivery. The Edinburgh scale score ranges from 0 to 30, and a score of 12 or more is considered PPD (22). Data were analyzed using SPSS software version 27. The relationships between variables were examined with Pearson\u0026rsquo;s correlation test.\u003c/p\u003e\n\u003cp\u003eThe Multidimensional Scale of Perceived Social Support (PSS) is a 12-item instrument that measures social support from three sources (family, community, and friends) on a seven-point scale from 1 (strongly disagree) to 7 (strongly agree). The minimum and maximum scores for the entire scale are 12 and 84, respectively, and are respectively calculated at 4 and 28 for each of the subscales of support from the family, community, and friends. A higher score indicates greater PSS (23).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1. Demographic information of the participants (n = 240)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMean/ Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSD (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAge (Year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.855\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpouse Age (Year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePre-pregnancy weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHeight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e163.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBody Mass Index (kg/m^2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.743\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.5 - 24.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e55.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25 - 29.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMother\u0026apos;s Job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e90.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpouse\u0026apos;s Job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e95.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMother\u0026apos;s Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than high school diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSpouse\u0026apos;s Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLess than high school diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e32.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.896\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber of Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBreastfeeding history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWanted Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e85.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUnwanted Pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAlcohol and Cigarettes Consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePreconception care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e79.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRegular Prenatal Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e92.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSatisfaction from spousal support during breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCompletely satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCompletely dissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMonthly Income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAmount of Monthly Income (Tooman)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInfant Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNormal Vaginal Delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCesarean Section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGestational Age (Week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e38.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.774\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInfant\u0026apos;s Weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3093.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e494.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 represents the demographic characteristics of the mothers participating in the study. According to the results, the mean ages of the mothers and spouses are 29.77 \u0026plusmn; 5.85 and 34.78 \u0026plusmn; 5.42 years, respectively. A normal body mass index (BMI) is observed in most mothers (55.8%). The means of pregnancies and deliveries are 1.83 \u0026plusmn; 0.89 and 0.80 \u0026plusmn; 1.60, respectively. Most mothers and husbands were housewives (90.8%) and employed (95.8%), respectively. In addition, a high school diploma was the education of most mothers (42.5%) and husbands (36.3%). Most pregnancies were voluntary (85.0%), and a history of breastfeeding was seen in 51.3% of the mothers. Besides, 79.6% received prenatal care and 92.5% followed up on regular care during pregnancy.\u003c/p\u003e\n\u003cp\u003eMost participants (62.5%) reported a moderate monthly income, and normal deliveries were reported in 64.2% of the cases, with an average gestation of 38.32 \u0026plusmn; 1.77 weeks. Regarding infant characteristics, the gender of 54.2% of infants was male, and the reported average infant weight was 3093.94 \u0026plusmn; 494.30 g.\u003c/p\u003e\n\u003cp\u003eTable 2. Mean values of Breastfeeding Self-Efficacy and Postpartum Depression\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMinimum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMaximum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eMean\u003cspan dir=\"RTL\"\u003e/\u003c/span\u003ecount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003eSD/%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eBreastfeeding self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e33.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e131.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e63.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e23.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e27.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e19.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e5.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNot Having Postpartum Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eHaving Postpartum Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e90.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003ePerceived Social Support subscales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eSignificant Other Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e23.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e5.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eFriends Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e18.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e7.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eFamily Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e4.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e22.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eTotal Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e12.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e84.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e64.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e17.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 presents the descriptive statistics of the variables evaluated in this study. The BSE scale shows that scores ranged from 18 to 57, with a mean score of 37.53 \u0026plusmn; 6.07.\u003c/p\u003e\n\u003cp\u003eThe scores of EPDS ranged from 2.00 to 27.00, with a mean score of 19.26 (SD = 5.50). According to the cut-off point of this questionnaire, 90% (n = 216) of the participants experienced PPD.\u003c/p\u003e\n\u003cp\u003ePSS is divided into three separate subscales. Support from significant others has scores ranging from 4 to 28 with a mean of 23.04 \u0026plusmn; 5.39. Support from friends has scores ranging from 4 to 28 with a mean of 18.55 \u0026plusmn; 7.83. Family support has scores in the same range with a mean of 22.48 \u0026plusmn; 6.12. Finally, the total score of PSS was determined as a score between 12 and 84 with a mean of 64.07 \u0026plusmn; 17.38.\u003c/p\u003e\n\u003cp\u003eTable 3. Correlations of breastfeeding self-efficacy, postpartum depression, and social support\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ebreastfeeding self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eSignificant Other Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eFriends Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003eFamily Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003ePerceived Social Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eBreastfeeding self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ebreastfeeding self-efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eEdinburgh Postnatal Depression Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSignificant Other Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eFriends Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eFamily Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003ePerceived Social Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 examines the correlation of the main study variables, showing that BSE has a weak negative correlation with the PPD scale (r = -0.190), suggesting that a lower BSE may lead to a greater PPD; this relationship is significant statistically (P-value = 0.003).\u003c/p\u003e\n\u003cp\u003eThe EPDS has a stronger negative correlation with BSE (r = -0.507), indicating that increased PPD may be associated with reduced BSE. This relationship is significant and very strong (P-value \u0026lt; 0.001). PPD is also weakly associated with significant other social support (r = 0.128) and social support from friends (r = 0.206), both of which are significant (P-values 0.048 and 0.001, respectively). Significant other support is weakly associated with BSE and PPD. Its relationship is particularly significant with PPD (P-value = 0.006). Furthermore, this support is very strongly associated with friends (r = 0.630) and family (r = 0.823) social support (P-value \u0026lt; 0.001). Friends support is significantly associated with BSE (r = 0.131), PPD (r = -0.217), and family social support (r = 0.698), all of which are significant (P-values 0.043, 0.001, and \u0026lt; 0.001, respectively). Family support is strongly associated with significant other (r = 0.823) and friends (r = 0.698) social support, and these relationships are significant (P-value \u0026lt; 0.001). There is also a weak positive association between BSE (r = 0.212) and PPD (r = 0.111), which are significant (P-values 0.001 and 0.086, respectively).\u003c/p\u003e\n\u003cp\u003eOverall PSS, which is the sum of all supports, has high correlations with all variables. In particular, it has a strong and significant relationship with significant other (r = 0.883), friends (r = 0.891), and family (r = 0.922) social support (P-value \u0026lt; 0.001 in all cases).\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of mean BSE and PSS based on PPD\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eEPDS classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eBSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e103.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e25.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ePPD development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e59.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e17.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eImportant other support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e21.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e4.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ePPD development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFriend support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e17.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e6.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ePPD development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e18.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e7.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e21.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e5.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ePPD development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e22.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e6.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003ePSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003eNo PPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e59.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e15.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 145px;\"\u003e\n \u003cp\u003ePPD development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e64.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e17.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 compares mean BSE and PSS scores between individuals with and without PPD. The group without PPD had a slightly higher mean score (38.50) of BSE than those with PPD (37.43), but this difference was not statistically significant (p = 0.414). However, a significant difference was found for the second format of BSE, and a significantly higher mean (103.96) was recorded in those not experiencing PPD than in those with PPD (59.41, p \u0026lt; 0.001). Regarding PSS, no significant differences were found in the subscales of support from significant others (p = 0.163), friends (p = 0.392), family (p = 0.255), or total PSS (p = 0.223), indicating that PSS levels did not differ significantly between those with and without PPD. These findings highlight a significant difference in BSE between groups, but no significant difference in PSS.\u003c/p\u003e\n\u003cp\u003eTable 5. Correlations between study variables and quantitative demographic variables\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"658\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePaternal age (year)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003e\u003cstrong\u003ekg/m^2\u003cspan dir=\"RTL\"\u003e(\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInfant\u0026rsquo;s weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e-.203**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e-.182**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-.131*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-.141*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEPDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-.137*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e.173**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e-.187**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e-.153*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-.282**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e-.177**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e-.153*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e.353**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 97px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 presents the relationships between study variables (BSE, PPD, and PSS) and various quantitative demographic variables. Significant correlations are observed in the table, shedding new light on the interaction between these factors.\u003c/p\u003e\n\u003cp\u003eBSE (second format) was significantly negatively correlated with maternal (r = -0.203, p = 0.002) and paternal (r = -0.182, p = 0.005) age, indicating that older parental age is associated with lower BSE. Additionally, negative associations were found with monthly income (r = -0.131, p = 0.042) and infant weight (r = -0.141, p = 0.029), indicating that BSE decreases with rising these factors.\u003c/p\u003e\n\u003cp\u003ePPD symptoms, measured by the EPDS, showed a weak negative correlation with the BMI (r = -0.137, p = 0.033), suggesting that a higher BMI is associated with fewer depressive symptoms. Conversely, a positive association was observed between monthly income and depressive symptoms (r = 0.173, p = 0.007), signifying that higher income levels may be linked to more depressive symptoms.\u003c/p\u003e\n\u003cp\u003ePSS showed several significant correlations. It was negatively correlated with maternal age (r = -0.187, p = 0.004), paternal age (r = -0.153, p = 0.018), parity (r = -0.282, p \u0026lt; 0.001), the number of deliveries (r = -0.177, p = 0.006), and BMI (r = -0.153, p = 0.017). These findings indicate that older age, a higher BMI, and higher parity are associated with lower levels of PSS. However, PSS showed a strong positive correlation with monthly income (r = 0.353, p \u0026lt; 0.001), demonstrating that higher income is associated with increased levels of PSS.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated BSE, PPD, and social support among 240 postpartum mothers. The obtained data indicated a moderate level of breastfeeding self-confidence among the participants. A significant negative association was observed between BSE and PPD, which indicates the relationship between breastfeeding self-confidence and depression, such that depression increased with decreased self-confidence. About 90% of the participants reported PPD symptoms with a mean score of 19.26, indicating a high prevalence of this phenomenon in the study population.\u003c/p\u003e\n\u003cp\u003eA mean score of 64.07 for PSS indicates a good level of social support in most of the mothers. This support acts as a protective factor against depression and decreased self-efficacy. The age of the mothers averaged 29.77 years and many of them were housewives, which could have effects on family dynamics and social support. Income and education showed statistically significant associations with self-efficacy levels.\u003c/p\u003e\n\u003cp\u003eSocial support plays a major role as a key factor in mothers\u0026rsquo; breastfeeding success and improving their mental health, particularly in the postpartum period. Our findings show that mothers who receive emotional, informational, and practical support from their family, friends, and spouses feel more satisfied with breastfeeding than those who lack this support. This indicates a direct effect of emotional and practical support on their self-confidence and success. These results are also confirmed by other studies. For example, Bolin et al. (2018) found that mothers in countries with stronger social support structures, such as Scandinavian countries, were more successful in breastfeeding (24).\u003c/p\u003e\n\u003cp\u003eSocial support not only improves breastfeeding success but also reduces PPD symptoms. Scientific evidence shows that mothers who receive adequate social support act better and experience PPD less frequently (25). Stewart et al. (2017) reported better stress and depression reduction in mothers who received emotional support from their families and spouses (26).\u003c/p\u003e\n\u003cp\u003eBSE refers to mothers\u0026rsquo; belief in their own abilities in this process. Social support can reinforce this belief and help mothers overcome breastfeeding challenges (27). Dennis et al. (2015) documented that mothers with strong social support were more confident in breastfeeding and could better cope with challenges (28).\u003c/p\u003e\n\u003cp\u003eThe findings of this study correspond to other studies on the importance of social support in improving breastfeeding and maternal mental health. In particular, Brockington et al. (2013) accentuated the importance of social support in preventing PPD and increasing breastfeeding success (29).\u003c/p\u003e\n\u003cp\u003eShefaly et al. (2018) reported that high rates of PPD could negatively affect BSE (30). This negative association is confirmed by the results of the present study. Similarly, Elaina Ross et al. (2021) confirmed the fortifying role of social support on self-efficacy (31), which agrees with our findings. The positive association with PSS (r = 0.122) indicates the importance of this variable in improving self-efficacy. No relationship between depression and self-efficacy was reported in studies conducted by Murray et al.(32) and Cooper et al. (1997) (33) while our study revealed a significant and negative association. This discrepancy could be related to differences in methodological and sampling design or cultural factors. According to Chan et al. (2016), increasing maternal age may decrease breastfeeding confidence (34), which is similar to the findings in our study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, this study confirms the prevalence of PPD that can reduce BSE. Meanwhile, social support positively influences the increase of mothers\u0026rsquo; self-confidence. Designing and implementing support and educational programs for mothers can help improve their mental health. Future research should investigate the effects of cultural, economic, and other social factors on the association between these variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe cross-sectional design of the study could be a limitation of this study. Besides, the reliance on self-reported information may be biased because participants might be unable or reluctant to provide accurate information.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Hamadan University of Medical Sciences reviewed and approved the study (Ethics Code: IR.UMSHA.REC.1403.392). This research was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all study participants prior to data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants consented to the publication of aggregated data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Student Research Committee of Hamadan University of Medical Sciences. The funding body had no role in the design of the study, data collection, analysis, interpretation, or in the writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRAN, EF, SZM, MR, AS, FEA, OH, and AT contributed to the study as follows:\u003c/p\u003e\n\u003cp\u003eRAN: Conceptualization, Methodology, Data Collection, Writing - Original Draft.\u003c/p\u003e\n\u003cp\u003eEF: Investigation, Data Collection, Project Administration.\u003c/p\u003e\n\u003cp\u003eSZM: Data Analysis, Validation, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eMR: Statistical Analysis, Formal Analysis, Visualization.\u003c/p\u003e\n\u003cp\u003eAS: Resources, Supervision, Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eFEA: Conceptualization, Investigation, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eOH: Advanced Statistical Analysis, Interpretation of Results, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eAT: Supervision, Project Administration, Funding Acquisition, Writing - Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the Student Research Committee of Hamadan University of Medical Sciences for supporting this research project. We also extend our appreciation to the Modeling of Noncommunicable Diseases Research Center at Avicenna Institute for their invaluable consultation. Special thanks are owed to the mothers who participated in this study and shared their experiences with us. Finally, we thank the staff at Hamadan City health centers who helped facilitate the data collection process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVictora CG, Bahl R, Barros AJ, Fran\u0026ccedil;a GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The lancet. 2016;387(10017):475-90\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eOrganization WH. The role of midwives and nurses in protecting, promoting and supporting breastfeeding: advocacy brief. 2021\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eKohan S, Heydari Z. The Effect of Family-Oriented Educational-Supportive Programs on Adequacy of Exclusive Breastfeeding from the Perspective of Mothers. Journal of Babol University of Medical Sciences. 2017;19(3):53-8\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eLaili U, Amalia R. The Relationship Between Postpartum Depression and Breastfeeding. Jurnal Midpro. 2020;12(2):275-9\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eWhite LK, Kornfield SL, Himes MM, Forkpa M, Waller R, Njoroge WF, et al. The impact of postpartum\u003cspan dir=\"RTL\"\u003e \u003c/span\u003esocial support on postpartum mental health outcomes during the COVID-19 pandemic. Archives of Women\u0026apos;s Mental Health. 2023;26(4):531-41\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eYuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, et al. The effects of breastfeeding on maternal mental health: a systematic review. Journal of women\u0026apos;s health. 2022;31(6):787-807\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eZhao X-H, Zhang Z-H. Risk factors for postpartum depression: An evidence-based systematic review of systematic reviews and meta-analyses. Asian journal of psychiatry. 2020;53:1023\u003cspan dir=\"RTL\"\u003e53.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez-Escamilla R, Tomori C, Hern\u0026aacute;ndez-Cordero S, Baker P, Barros AJD, B\u0026eacute;gin F, et al. Breastfeeding: crucially important, but increasingly challenged in a market-driven world. Lancet. 2023;401(10375):472-85\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBrockway M, Benzies K, Hayden KA. Interventions to Improve Breastfeeding Self-Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis. J Hum Lact. 2017;33(3):486-99\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDennis CL, Brown HK, Brennenstuhl S. The Postpartum Partner Support Scale: Development, psychometric assessment, and predictive validity in a Canadian prospective cohort. Midwifery. 2017;54:18-24\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDennis CL. The breastfeeding self-efficacy scale: psychometric assessment of the short form. J Obstet Gynecol Neonatal Nurs. 2003;32(6):734-44\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMcGovern LM, O\u0026apos;Toole L, Laws RA, Skinner TC, McAuliffe FM, O\u0026apos;Reilly SL. An exploration of prenatal breastfeeding self-efficacy: a scoping review. Int J Behav Nutr Phys Act. 2024;21(1):95\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMcGovern LM, O\u0026rsquo;Toole L, Laws RA, Skinner TC, McAuliffe FM, O\u0026rsquo;Reilly SL. An exploration of prenatal breastfeeding self-efficacy: a scoping review. International Journal of Behavioral Nutrition and Physical Activity. 2024;21(1):95\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMercan Y, Tari Selcuk K. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PloS one. 2021;16(4):e0249538\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBarrero-Castillero A, Morton SU, Nelson III CA, Smith VC. Psychosocial stress and adversity: effects from the perinatal period to adulthood. Neoreviews. 2019;20(12):e686-e96\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003ePhelan A, DiBenedetto M, Paul I, Zhu J, Kjerulff K. Psychosocial stress during first pregnancy predicts infant health outcomes in the first postnatal year. 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British Medical Journal. 1989;298(666\u003cspan dir=\"RTL\"\u003e8):223-6.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBesharat MA. Multidimensional scale of perceived social support: Questionnaire, instruction and scoring. 2019\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBolin A, Whelehan P, Vernon M, Antoine K. Pregnancy and Childbirth. Human Sexuality: Routledge; 2021. p. 188-200\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eVaezi A\u003cspan dir=\"RTL\"\u003e, \u003c/span\u003eSoojoodi F, Banihashemi AT, Nojomi M. The association between social support and postpartum depression in women: A cross sectional study. Women and Birth. 2019;32(2):e238-e42\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eArchibald M, Stewart J, Vo L, Diallo DD, Shabazz W, Owens LE, et al. Chapter 7 the role of social support for women living in poverty. Poverty in the United States: Women\u0026rsquo;s Voices. 2017:113-32\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMoafi F, H. Hajnasiri H, Hosseini T, Alimoradi Z, Bajalan Z. Breastfeeding Self-Efficacy and Its Associated Factors in Women who Gave Birth in Kosar Hospital of Qazvin in 2016-2017: A Descriptive Study. Journal of Rafsanjan University of Medical Sciences. 2019;17(11):1003-16\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eDennis C-L, Hodnett E, Gallop R, Chalmers B. The effect of peer support on breast-feeding duration among\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eprimiparous women: a randomized controlled trial. Cmaj. 2002;166(1):21-8\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eBrockington I. Diagnosis and management of post-partum disorders: a review. World Psychiatry. 2004;3(2):89\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eShorey S, Chee CYI, Ng ED, Chan YH, San Tam WW, Chong YS. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of psychiatric research. 2018;104:235-48\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eRoss E, Woszidlo A. Breastfeeding in the workplace: attitudes toward multiple roles, perceptions of support, and workplace outcomes. Breastfeeding Medicine. 2022;17(1):38-45\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMurray L, Cooper PJ. The impact of postpartum depression on child development. International review of psychiatry. 1996;8(1):55-63\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eMurray L, Cooper PJ. Effects of postnatal depression on infant development. Archives of disease in childhood. 1997;77(2):99-101\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003cli\u003eChan MY, Ip WY, Choi KC. The effect of a self-efficacy-based educational programme on maternal breast feeding self-efficacy, breast feeding duration and exclusive breast feeding rates: A longitudinal study. Midwifery. 2016;36:92-8\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"breastfeeding self-efficacy, postpartum depression, social support, mothers, mental health","lastPublishedDoi":"10.21203/rs.3.rs-6413761/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6413761/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSuccessful breastfeeding depends on both physiological and psychological factors. Maternal anxiety, stress, and depression can dramatically affect breastfeeding and reduce the mother's motivation and ability to perform this process. This study evaluates the relationships between breastfeeding self-efficacy\u003cem\u003e \u003c/em\u003e(BSE), postpartum depression (PPD), and social support in postpartum women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This descriptive-cross-sectional study was conducted in Hamadan City in 2024. The study population consisted of 240 randomly selected mothers who gave birth in the first 6 months after delivery. Data were collected using standard questionnaires, including a BSE questionnaire, the Edinburgh PPD scale, and a social support questionnaire. Data were analyzed with SPSS software using statistical methods such as mean, standard deviation, and Pearson’s correlation coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The average ages of mothers and spouses were 29.77 ± 5.85 and 34.78 ± 5.42 years, respectively. A normal body mass index was measured in 55.8% of the mothers, and 90.8% were housewives. Examining the relationships between variables revealed a significant relationship between BSE and two types of social support. BSE showed a significant positive relationship with family social support (r = 0.212, p = 0.001) and general social support (r = 0.180, p = 0.005). Moreover, a significant negative relationship was observed between BFSE and PPD (r = -0.507, p \u0026lt; 0.001). However, social support was not related significantly to PPD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: This study demonstrates that social support, especially family support, can play an important role in increasing BSE and reducing PPD. Therefore, it is of paramount importance to strengthen support networks in the postpartum period for mothers' psychological well-being.\u003c/p\u003e","manuscriptTitle":"Analysis of the relationships between breastfeeding self-efficacy, postpartum depression, and social support","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-04 06:04:58","doi":"10.21203/rs.3.rs-6413761/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-04T21:01:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-08T07:01:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5521204036859127009361661807519131187","date":"2025-06-08T05:56:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-07T08:17:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-06T16:06:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231983457620147883455808698335273093660","date":"2025-06-03T18:58:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177335498652722095492521443346614622770","date":"2025-06-02T05:28:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T05:17:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-06T09:29:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-23T00:11:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-23T00:10:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-04-09T16:30:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7eb31a6-e9f3-4441-aa8f-75d3e930fc23","owner":[],"postedDate":"June 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-31T17:55:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-04 06:04:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6413761","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6413761","identity":"rs-6413761","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}