Breastfeeding Reduces Postpartum Depression Risk: A Case-Control Study of Modifiable Factors in Ha'il, Saudi Arabia

Postpartum depression (PPD) affects 10-20% of new mothers worldwide, impairing maternal and infant well-being. This case-control study investigates breastfeeding’s protective role and modifiable risk factors for PPD among 517 mothers within 12 months postpartum in Ha'il, Saudi Arabia. Using structured interviews and the PHQ-9 scale, we compared 259 breastfeeding mothers (controls) with 258 non-breastfeeding mothers (cases). Breastfeeding was associated with a significant reduction in PPD risk (mean PHQ-9 score: 4.37 vs. 6.44, p<0.000), particularly after vaginal delivery (p = 0.001). Cesarean delivery (p = 0.001), weak home support (p<0.000) and a personal/family history of depression (p<0.000) increased PPD risk. Logistic regression confirmed breastfeeding’s protective odds (OR = 0.62, 95% CI: 0.45-0.87). These findings underscore the need to promote breastfeeding and enhance social support in maternal care, especially for cesarean mothers. However, the cross-sectional design limits causal inference and hospital-based sampling may reduce generalizability. Future longitudinal research is needed to confirm these associations and inform targeted interventions in Saudi Arabia.