The relationship between earthquake-induced PTSD and breastfeeding attitudes and behaviors BMC Psychiatry

Postpartum depression and postpartum PTSD can have harmful effects on the mental and physical health of mothers and their infants. In the two-year postpartum breastfeeding period, including the postpartum period, the earthquake, which can cause PTSD alone, makes the situation mentally more difficult for both mother and child. For this reason, breastfeeding attitudes and behaviours, which are closely linked not only to physical health but also to maternal mental health, should be better understood in times of disaster. Because breastfeeding is critical to the mental health of the mother as well as the physical development of the child, PTSD and breastfeeding, which are expected to be closely related to each other, were examined in this study conducted after a major earthquake.

The recommendation to breastfeed without interruption for up to 2 years after birth is well established [13]. However, in Turkey, the breastfeeding rate after 12 months is only 28%, with an average breastfeeding duration of 16.7 months. [14]. In the current study, only 13.3% of mothers who survived the earthquake breastfed their infants for 13 to 24 months. This finding is consistent with research suggesting that breastfeeding tends to stop prematurely after earthquakes [8, 9]. During disasters such as earthquakes, many mobile health teams provide on-site health care to people staying in tents, containers or homes. These teams must explain to breastfeeding mothers the importance of breastfeeding for their health and the health of their children, educate them about not stopping breastfeeding, and encourage them to breastfeed.

The present study identified a significantly higher total PTSD score (p = 0.009, p = 0.006) among mothers with low education and unemployed. Other studies have also reported higher rates of PTSD among individuals with low education and unemployment; There are conflicting results, suggesting that there is no consistent association between education level, functional status, and PTSD [15]. Low education and unemployment can be due to many reasons. Therefore, studies that include participants from different geographic regions and different social and cultural structures may yield different results. In addition, results may vary depending on the cause of PTSD.

Furthermore, the current study found that the PTSD score (P < 0.001) and PTSD prevalence (P = 0.003) were significantly lower among married individuals compared to widows. This trend is consistent with the findings of Guo et al. [16] And Kuhn et al. [17], who observed a higher incidence of post-earthquake PTSD among single or divorced individuals. All of these findings suggest that husbands play a crucial role in protecting mothers' mental health. For this reason, we also recommend the involvement of married stepfathers in PTSD treatment and follow-up.

We observed a significant positive association between staying in tents and higher PTSD scores (P < 0.001). This finding is consistent with research by Anwar et al., which highlighted a more than three-fold increase in the risk of PTSD among women staying in tents after the earthquake. [18]. However, contradictory results have also been reported; For example, Naeem et al. They found no association between living in a tent and PTSD, although they did identify a link with general psychiatric illness. [19]. The length of time living in a tent after an earthquake, and having access to basic needs such as food, water and toilets, may alter the incidence of PTSD and other psychiatric illnesses. For this reason, studies may have produced different results from each other.

The positive effect of breast milk on maternal mental health is well documented [7]. The present study revealed that both the PTSD score (P < 0.001) and the prevalence of PTSD (P < 0.001) were lower among mothers who continued breastfeeding. Furthermore, both the PTSD score (P < 0.001) and the presence of PTSD (P < 0.001) were higher in mothers who breastfed for 0–6 months compared to those who breastfed for 7–24 months. These findings suggest that breastfeeding may provide protection to mothers from post-earthquake PTSD beyond its established benefits for infant health. Likewise, Garthus-Nagle et al. found a significant increase in PTSD among women who stopped breastfeeding within the first 12 months [20]. It is worth noting that mothers with PTSD may avoid close contact with their infants or resist breastfeeding. High cortisol caused by stress can also impede the release of oxytocin, reducing breast milk production [21]. In essence, PTSD may contribute to the cessation of breastfeeding.

The study revealed that 78.6% of women suffered from a decrease in breast milk due to the earthquake. This finding is consistent with the observations of Nouri et al. about decreased breast milk production after earthquakes [22]. Furthermore, both the PTSD score (P < 0.001) and the presence of PTSD (P < 0.001) were significantly higher among those with low milk supply. This finding raises the possibility that PTSD leads to the perception of insufficient milk supply or, conversely, that low milk supply exacerbates PTSD. This interaction may contribute to a self-perpetuating cycle.

Our findings underscored the importance of breastfeeding education. Those who received breastfeeding training showed higher BAES total scores (P < 0.001). In particular, individuals who received education about breastfeeding had significantly lower PTSD scores (P < 0.001) and lower prevalence of PTSD (P < 0.001) compared to those who did not receive such training. In addition, a significant negative relationship was observed between PTSD score and BAES. In line with our study, Esper et al. reported that prenatal education was associated with a lower incidence of postpartum PTSD [23]. These findings underscore the importance of prenatal education about breastfeeding for all pregnant women. Therefore, all pregnant women should be educated about breastfeeding on a regular basis during pregnancy follow-up. Health professionals must also show sensitivity in this regard.

The present study identified a positive relationship between age and PTSD, confirming the findings of Kuhn et al that older age is a risk factor for PTSD after an earthquake. [17]. However, del Oso et al. A higher rate of PTSD was reported among young women compared to older women, with no age-related difference in men [24]. However, since maternal age at marriage, number of children, and some other variables may influence PTSD, studies may have yielded different results.

In line with all these findings, politicians should organize emergency laws to be implemented after disasters such as earthquakes in a way that gives priority to mothers during the breastfeeding period in terms of nutrition, shelter and access to health services. In addition, municipalities and the Presidency of Disaster and Emergency Management must take all necessary precautions regarding this situation, which is of vital importance for the health of mothers and children.

The current study has some limitations. First, we could not distinguish whether the observed cases of PTSD were clearly related to the postpartum period, caused by the earthquake, or resulted from a complex interaction between birth and earthquake-related experiences. Furthermore, the absence of a comparison group of individuals not affected by the earthquake could affect the overall understanding of our findings. The difference in place of residence after the earthquake is another limitation of the study, because it may change the mental structure, behavior and attitudes of the participants in each subject. Finally, the timing of our study, which was conducted in the fifth and sixth months after the earthquake, may limit the applicability of our findings to early or later stages in the earthquake's aftermath. It would be more appropriate to plan future studies for three short-, medium- and long-term periods after earthquakes or similar disasters, in a way to distinguish whether PTSD is birth-related or earthquake-related while taking into account participants' place of residence.

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