breastfeeding empowerment program, preventative care for post-partum depression

1. Michelle Irvin-Grajeda
Dissertation Defesnse
January 11, 2012
Breastfee
ding
Empowerm
ent

2. Postpartum Depression
•PPD affects 13-19.2% of women who deliver babies
(O’Hara & Swain, 1996; Gavin, et al., 2005)
•Following first PPD episode risk increases to 30-50%
(American Psychiatric Association, 2000)
•PPD is not always diagnosed

3. Parenting Efficacy
•Parent feels competent
•Increases well being
•Minimizes stress
•parent-child relationships
•child development outcomes
(de Montigny & Lacharite, 2005;Hudson et al.,2001; Gilmore & Cuskelly, 2008; Jones & Prinz, 2005)

4. Breastfeeding
Benefits
• motor development
• infant disease
• Infant’s immune system
• cognitive abilities
(Evidence, 2005)

5. PPD and Breastfeeding
• Desire to BF decreases
• Mother-child relationship
(Hoddinott et al., 2009)

6. Empowerment
• Focuses on health
• Builds on strengths
• Builds confidence

7. Social Support for New Mothers
•Many sources of social support
•More important for 1st time
mothers
•Linked to successful
breastfeeding
(Hoddinnott & Phil, 1999; Bosnjak, et al, 2009)

8. Breastfeeding Support Groups
•United States has low breastfeeding
prevalence
•Recommended to new mothers
•Research is limited
(Ekstrom, et al., 2006; Bosnjak, 2009; Hoddinnott, et al., 2006; Kang, et al., 2007)

9. Current Study
•Examined whether and how attending BF support groups impacts new
mothers
•Whether programs that promote the initiation and maintenance of BF
prevent symptoms of:
•PPD
•enhance self-efficacy

10. Limited research
Diverse Sample
Larger sample size
Examined the association of attendance &
DVs

11. Mothers who attend BF groups longer
◦ higher levels of wellbeing, PSOC, SS and BF
empowerment
◦ decrease in depressive sxs
Determine whether empowerment and social
support mediate the effect of attendance on
DV

12. Participants:
◦ 90 participants
◦ Breastfeeding support groups
◦ Community resource center
Breastfeeding support group:
◦ Facilitated by professional
◦ Process group
◦ Additional services available
◦ Open membership

13. Sample
◦ Ages, 16-37, 20% were 29
◦ Education, 32.2% BA, Some 27.8%, MA 20%
◦ Income, 35.6% 50-59k, 15.6% 70-79k, 13.3% 40-
49k
◦ Marital status, 36.7% single/never married, married
62.2%
◦ Ethnicity, 52.2% white, 27.8% Hispanic

14. Measures:
◦ The Edinburgh Postnatal Depression Scale
Cronbachs alpha 0.856
◦ Parenting Sense of Competency
0.965
◦ Psychological General Well Being Index
0.915

15. Hypothesized Mediators
◦ Breastfeeding Empowerment
0.971
◦ Breastfeeding Will
0.885
◦ Scales of Perceived Social Support
0.963

16. Attendance
Identify number of sessions attended
birth date and date first attended

17. Series of correlation between attendance
◦ PPD
◦ Self-efficacy
◦ Well being
◦ Empowerment
◦ Social Support (not correlated)
Mediation
◦ Baron & Kenny, 1986
◦ Control for the effect of attendance

18. Possible confounds tested
Attendance and Experience as a mother
◦ In order to rule out, regression equations were
conducted
◦ Age of child in months and attendance as
predictors for each DV

19. Attendance Attendance controlling
for age of child1
PPD -.299** -.302**
BF Empowerment .638** .717**
PSOC .751** .753**
Wellbeing .465** .463**
1Note. Regression analysis was run entering both days old and
attendance
** p < .01
•Attendance was statistically significant predictor of each even
when controlling for experience as mothers

20. Additional confounds tested:
◦ Individual characteristics commonly associated with
better functioning.
Education
Income
Marriage
Ethnicity
◦ Findings suggest attendance not greater for white,
married, more wealthy, and more educated mothers

21. Mediator
YX
a b
c’

22. A series of steps with 3 regressions were
carried out for each mediator and DV pair
Regression analysis was conducted to
determine whether attendance had stat sig
effect on DV.
◦ Tests total effect (c) of X on Y
YX

23. 2nd step, R.A. conducted
◦ To determine whether the intervention has
statistically sig effect on hypothesized mediator,
path a.
3rd, R.A. to determine whether hypothesized
mediator was statistically sig predictor of
DV’s
◦ while controlling for the effect of the attendance,
path b.

24. Mediator
YX
a b
c’

25. 4th, if mediator completely mediates the
effect of X on Y
◦ the effect controlling for the mediator (path c’)
should become zero
When a partial mediation may exist
If conditions were met:
◦ at least for partial mediation…
◦ sobel test is conducted using an interactive
calculation tool developed by Preacher and
Leonardelli

26. Breastfeeding
Empowerment
PSOCAttendence
.638**
.751** (.629**)
..191*
•BF Empowerment was a significant predictor
of PSOC while controlling for attendance

27. Breastfeeding
Will
PPDAttendence
.682**
.299** (-.205)
.402*
•BF Will was a significant predictor of
PPD while controlling for attendance

28. Breastfeeding
Will
PSOCAttendence
.682**
.751** (.507**)
.358**
•BF Will was a significant predictor of
PPD while controlling for attendance

29. Breastfeeding
Will
WellbeingAttendence
.682**
.465** (.238)
.333**
•BF Will was a significant predictor of
Wellbeing while controlling for attendance

30. Attendance associated with positive outcomes
◦ Greater attendance in BSG associated with increase in
parental self-efficacy
Social support
◦ Attendance appeared to have no effect on social support
in the current study
BF empowerment mediated the effect of
attendance on:
◦ parental self efficacy
◦ PPD symptoms
◦ parental self-efficacy
◦ well-being

31. ◦ Past research only focused on
providing information to mothers
little on the interaction of mothers.
interactions continue to build on strengths
encouraging self help
Teach new skills
education about infants and their needs

32. Limits in the ability to draw causal inferences
Examine the predictors of BF Will

33. Thanks
for
listenin
g!