Breastfeeding and PND Relationship — MRCPsych Paper B MCQ
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Correct answer: D — The association is bidirectional and context-dependent: depression can impair breastfeeding, while a positive supported breastfeeding experience may be associated with lower depression risk, although causality remains uncertain.
Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D
B is correct. The relationship between breastfeeding and postnatal depression is bidirectional and influenced by feeding difficulties, maternal intentions, support and pre-existing depressive symptoms. Depression can reduce breastfeeding exclusivity or duration, while a positive and supported breastfeeding experience may be associated with fewer depressive symptoms. However, current intervention evidence is limited and does not establish that breastfeeding itself reliably prevents postnatal depression. A therefore overstates a causal protective effect. C incorrectly excludes the possible effect of breastfeeding experience on mood, whereas D converts an association into universal direct causation and ignores major confounders. E is inconsistent with the recurring association found across systematic reviews. In UK practice, women should receive practical breastfeeding support while being supported in the feeding choice that best suits them and their family.
Reference: Lenells M et al. Breastfeeding interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews. 2025;2:CD014833. https://pubmed.ncbi.nlm.nih.gov/39963955/