Depression, sleep quality, and maternal well-being in postpartum women with a history of sexual assault: a comparison of breastfeeding, mixed-feeding, and formula-feeding mothers

Breastfeed Med. 2013 Feb;8(1):16-22. doi: 10.1089/bfm.2012.0024. Epub 2012 Dec 18.


Background: Women with a history of sexual assault are at increased risk for sleep difficulties and depression in their first year of motherhood. Breastfeeding improves sleep parameters and lowers risk of depression for women in general. However, it is unknown whether breastfeeding is related to maternal depression, sleep quality, and maternal well-being in sexual assault survivors. We examined the association between sexual assault and several indices of sleep, depression, and maternal well-being in a large sample of sexual assault survivors in the first year postpartum. We also explored whether feeding method was related to our outcome variables for both sexually assaulted and non-assaulted women.

Subjects and methods: A sample of 6,410 mothers of infants 0-12 months old participated in the online Survey of Mothers' Sleep and Fatigue; 994 women had a history of sexual assault.

Results: As predicted, women with a history of sexual assault had a number of sleep difficulties, increased risk of depression, and overall poorer subjective well-being than their non-assaulted counterparts. However, sexual assault survivors who were breastfeeding were at lower risk on all of the sleep and depression parameters than sexual assault survivors who were mixed or formula feeding.

Conclusions: Sexual assault has a pervasive negative effect on new mothers' sleep quality and risk of depression. However, these negative effects were less severe for the breastfeeding mothers than they were for the mixed- or formula-feeding mothers.

MeSH terms

  • Adrenocorticotropic Hormone / metabolism
  • Adult
  • Austria / epidemiology
  • Breast Feeding / psychology*
  • Breast Feeding / statistics & numerical data
  • C-Reactive Protein / metabolism
  • Canada / epidemiology
  • Depression, Postpartum / epidemiology*
  • Female
  • Humans
  • Hydrocortisone / metabolism
  • Infant
  • Infant Formula* / statistics & numerical data
  • Infant, Newborn
  • Male
  • Maternal Age
  • Mother-Child Relations
  • Mothers
  • New Zealand / epidemiology
  • Oxytocin / metabolism
  • Pregnancy
  • Risk Factors
  • Sex Offenses / psychology*
  • Sex Offenses / statistics & numerical data
  • Sleep Wake Disorders / epidemiology*
  • Sleep Wake Disorders / psychology
  • Surveys and Questionnaires
  • United Kingdom / epidemiology
  • United States / epidemiology


  • Oxytocin
  • Adrenocorticotropic Hormone
  • C-Reactive Protein
  • Hydrocortisone