The mediating role of self-compassion in the relationship between postpartum depression and breastfeeding self-efficacy

Abstract

Postpartum depression (PPD) may adversely affect breastfeeding self-efficacy, yet the underlying mechanisms remain unclear. This study explored whether self-compassion mediates the relationship between PPD and breastfeeding self-efficacy among Turkish women. An expert model was developed based on validated scales: the Self-Compassion Scale, the Edinburgh Postpartum Depression Scale, and the Postnatal Breastfeeding Self-Efficacy Scale-Short Form. In this cross-sectional study, 236 women (mean age: 28.71, SD = 6.16) were surveyed. Results showed that depression was negatively associated with self-compassion (β = −0.474, p < 0.001), and self-compassion was positively associated with breastfeeding self-efficacy (β = 0.785, p < 0.001). Mediation analysis indicated that self-compassion partially mediated the link between PPD and breastfeeding self-efficacy, with a significant indirect effect (−0.586, −0.209). Depression also had a direct negative effect on breastfeeding self-efficacy (β = −0.484, p < 0.001). These findings suggest that fostering self-compassion may enhance maternal mental health and breastfeeding outcomes.

Keywords

breastfeeding self-efficacy self-compassion postpartum depression postpartum period nursing care

Introduction

Breastfeeding plays a vital role in promoting the health of both the mother and infant, while also fostering a deep emotional connection between them (Rodríguez Vázquez et al., 2023). Implementing optimal breastfeeding practices is essential for infant survival and early development (UNICEF, 2023). According to the World Health Organization (WHO), infants should be exclusively breastfed for the first 6 months, followed by the gradual introduction of complementary foods while continuing breastfeeding thereafter (Headey et al., 2020). Despite these recommendations, many mothers encounter difficulties in initiating or maintaining optimal breastfeeding practices, and these challenges may stem from various factors (Zimmerman et al., 2022). One of the key factors influencing breastfeeding behavior is low breastfeeding self-efficacy—a mother’s confidence in her ability to breastfeed (Brockway et al., 2017). Although the benefits of breastfeeding are well established, current breastfeeding rates still fall short of global targets.

Breastfeeding self-efficacy is a critical determinant of both the initiation and duration of breastfeeding. The Breastfeeding Self-Efficacy Theory (Dennis and Faux, 1999)—widely applied in breastfeeding research—draws upon Bandura’s self-efficacy and social learning theories (Bandura, 1986, 1997). According to Dennis, a mother’s belief in her breastfeeding ability influences her decision to breastfeed, the effort she puts forth, her persistence in the face of difficulties, and her emotional responses to breastfeeding challenges (Dennis and Faux, 1999). Numerous challenges, such as latching problems, cracked nipples, and low milk supply, may negatively impact mothers’ breastfeeding self-efficacy. Studies report that around one-third of mothers’ experience such problems, often accompanied by considerable emotional distress (Hall et al., 2014). When mothers are unable to breastfeed or fail to meet their breastfeeding goals, they may experience psychological distress, including symptoms of depression (Gregory et al., 2015; Shepherd et al., 2017). Conversely, increasing breastfeeding self-efficacy has been associated with improved breastfeeding outcomes and reduced depressive symptoms. Evidence suggests that longer breastfeeding duration is linked to fewer depressive symptoms among mothers (Alimi et al., 2022; Dias and Figueiredo, 2015).

The postpartum period is a time of significant emotional and lifestyle adjustments, and many women struggle to cope with these changes. This period is considered high risk for mental health issues, especially for those who find it difficult to adapt (O’Hara and Wisner, 2014). Postpartum depression (PPD) is a common and serious psychological disorder that can occur anytime within the first year after childbirth (Alexandrou et al., 2018), and it is widely recognized as a prevalent clinical condition during this time (Howard and Khalifeh, 2020). The prevalence of PPD ranges between 13% and 20% (Fisher et al., 2012; O’Hara and McCabe, 2013). Risk factors for PPD include a prior history of depression, exposure to stressful life events, poor marital relationships, and lack of social support (O’Hara and Wisner, 2014).

Acceptance-oriented strategies such as self-compassion can be mediating in preventing psychological problems (Rosenbaum et al., 2020). Self-compassion is defined as being kind to oneself, as opposed to judgmental, being aware of our common humanity, as opposed to isolation and being mindful, as opposed to over-identifying. Self-compassion refers not only to an individual’s tendency to accept their inner experiences but also to be kind and compassionate toward oneself when faced with difficulties, as opposed to being self-judgmental, feeling isolated, and over-identifying with personal difficulties (Neff, 2003). Various inner experiences, including negative thoughts and feelings, determine the adjustment to motherhood. Self-compassion plays a vital role in the adjustment to change for mothers and could help to smooth transition periods (Rosenbaum et al., 2020). Some studies found a positive relationship between higher levels of self-compassion and lower levels of depressive symptoms among women in the perinatal period (Felder et al., 2016; Monteiro et al., 2019). Self-compassion may be associated with positive psychological outcomes and is a potentially crucial mediating factor for mental health (Carona et al., 2022).

Self-compassion could also help mothers when facing a loss of self-efficacy in the transition to motherhood, which could trigger self-doubt and self-criticism, disrupting the adjustment (Mihelic et al., 2018). Therefore, self-compassion can also be helpful in situations that affect the health of the mother and baby after birth, such as breastfeeding self-efficacy (Mitchell et al., 2018). Self-compassion can allow them to accept failures more than to personalize the outcome. Additionally, self-compassionate individuals seek medical support more when needed than their peers (Terry and Leary, 2011). This suggests that women can not only accept the difficulties experienced but also look for ways to solve the problem while experiencing postpartum problems. Although there are increasing studies on self-compassion in the literature, studies investigating its effects on PPD and breastfeeding self-efficacy are limited from the other countries (Lennard et al., 2021; Mahurin-Smith and Beck, 2022; Rosenbaum et al., 2020). While these studies explored aspects of self-compassion, postpartum depression, and breastfeeding, none specifically examined the mediating role of self-compassion between PPD and breastfeeding self-efficacy. Our study uniquely focuses on this relationship using a mediation model and data from a Turkish sample, offering both a theoretical contribution and cultural perspective. Supporting this, a relevant Turkish study by Benli et al. (2025) examined the impact of self-compassion levels on breastfeeding self-efficacy perceptions among postpartum mothers. Their findings demonstrated a positive association between higher self-compassion and greater confidence in breastfeeding abilities, aligning with the results of the current study (Benli et al., 2025). This culturally specific evidence reinforces the importance of self-compassion as a protective and empowering factor for maternal breastfeeding outcomes in Türkiye and highlights how psychological factors influence breastfeeding self-efficacy within this cultural context. Protecting maternal mental health and improving breastfeeding self-efficacy are essential for the well-being of both mothers and infants. In Türkiye’s collectivist culture, strong family ties and traditional caregiving expectations can place significant pressure on mothers, increasing stress and potentially affecting postpartum mental health and breastfeeding practices. Recent studies emphasize the influence of family dynamics and cultural expectations on maternal mental health and breastfeeding behaviors among Turkish women (Benli et al., 2025; Gökçe İsbir et al., 2024). Given the cultural context where maternal identity and family cohesion are highly valued, psychological resources such as self-compassion may be critical for Turkish mothers to manage postpartum challenges, maintain mental well-being, and sustain breastfeeding efforts. Therefore, it is vital to reveal the evidence regarding the effect of the concept of self-compassion on PPD and breastfeeding self-efficacy. This study aims to assess if self-compassion acts as a mediator in the connection between postpartum depression and breastfeeding self-efficacy in the postpartum period.

Methods

Participants

A cross-sectional, self-administered study was conducted among Turkish women from September to December 2022. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Sample size and sampling method

About 236 mothers were recruited from the Antenatal Outpatient Clinic at the Training and Research Hospital, where the researchers conducted face-to-face surveys. A priori power analysis was conducted for the mediation model using G*Power software. Assuming one independent variable and one mediator, with an expected medium effect size (f² = 0.15), the analysis indicated that the statistical power for detecting mediation effects exceeded 99.9% (α = 0.05, two-tailed). This study included women aged between 18 and 35 years who had an infant between 2 and 6 months old and were currently breastfeeding. Participants were required to meet all inclusion criteria to be eligible for the study. Mothers who had discontinued breastfeeding for any reason or had a previously diagnosed psychiatric disorder were excluded.

Measures

Self-compassion levels were assessed with Self-Compassion Scale; It was developed by Neff (2003), and it was developed by measuring the six main components of self-compassion (self-compassion vs self-judgment, sharing awareness vs isolation, mindfulness vs hyper-identification) with separate subscales to create a total score representing the level of self-compassion. It is a scale that aims to obtain a total score from subscales. The scale is a 5-point Likert-type scale and is scored between 1 = almost never and 5 = almost always. The internal consistency of the scale was reported as 0.92, and the internal consistency coefficients of the subscales ranged from 0.78 to 0.81. The validity and reliability study of the scale in Türkiye was conducted by Yıldırım and Sarı (2018). High scores on the scale indicate a high level of self-compassion (Yıldırım and Sarı, 2018). As a result of the studies, it was seen that the Self-Compassion Scale is a valid and reliable scale that can be used to evaluate the self-compassion levels of individuals.

PPD levels was assessed with Edinburgh Postpartum Depression Scale (EDPS). Edinburgh postpartum depression scale was developed by Cox et al. (1987) to determine the risk of depression in postpartum women. EPDS is a 10-item self-report scale in the form of a four-point Likert scale. The answers consisting of four options are scored between 0 and 3, the lowest score that can be obtained from the scale is 0 and the highest score is 30. 1, 2, and 4th items are scored as 0,1,2,3, while items 3,5,6,7,8,9, and 10 are scored in reverse as 3,2,1,0. The internal consistency of the scale developed by Cox et al. (1987) was 0.87, and the cut-off point was 12. The Turkish adaptation of EDPS was carried out by Engindeniz et al. (1996). In the validity and reliability study conducted by Engindeniz et al. (1996), the internal consistency coefficient of this scale was 0.79. The Edinburgh Postnatal Depression Scale, 12, was set as the cut-off score for possible depression as it is an internationally accepted indicator and has been widely tested (Lau et al., 2010; Wu et al., 2022).

Breastfeeding self-efficacy levels was assessed with Postnatal breastfeeding self-efficacy scale-short form. Breastfeeding self-efficacy scale is a 33-item scale developed by Dennis and Faux (1999). The Cronbach’s alpha value was found to be 0.96, Dennis developed the Short Form of the Breastfeeding Self-Efficacy Scale (BSE) by reducing the scale to a 14-item scale. The short form of the scale provides ease of application and accurately evaluates self-efficacy (Dennis, 2003). The Turkish adaptation of scale was carried out by Aluş Tokat et al. (2010). The Turkish validity of the scale was performed by Aluş Tokat et al. (2010), and Cronbach’s alpha value was found to be 0.86, and it was determined to be a valid and reliable scale.

Data analysis procedure

Statistical analyses were conducted using IBM SPSS (Statistical Package for the Social Sciences) 26 for Windows. The normality assumption was assessed by examining skewness and kurtosis values, which fell within the range of −1.5 to +1.5. Descriptive statistics, including mean and standard deviation, were reported for numerical variables with a normal distribution, while qualitative variables were presented as frequencies and percentages. For the mediation analysis, Jamovi v.2.3.26 was employed. Following Hayes (2017), a bootstrap procedure with 5000 resamples was used to test the indirect effects of self-compassion (Hayes, 2017). The bias-corrected bootstrapped confidence interval (95%) was examined to assess the significance of the mediator. A confidence interval excluding zero indicated a significant mediation role for self-compassion. Statistical significance was determined at p < 0.05.

Ethical consideration

The study protocol was approved by the Human Research Ethics Committee of Atılım University (Approval No: E-59394181-604.01.02-33843). Institutional permission to conduct the research was obtained from Ankara Training and Research Hospital (Ankara Eğitim ve Araştırma Hastanesi), and written informed consent was obtained from all participants.

Results

Characteristics of the participants

The mean age of the women was 28.71 years (SD = 6.16). 34.3% of participants had a primary/elementary school or high school education, while 31.4% had a graduate/postgraduate education. More than half of the participants (59.7%) were not working, and most (65.3%) lived in the city center. The income-expenditure status of the participants was also examined, and it was found that 61.0% of the participants had an income equal to their expenses (Table 1).

Table 1.

Characteristics of women (n = 236).

Characteristics	n (%)	M (SD)
Age (years)		28.71 (6.16)
Partner’s age (years)		31.28 (5.64)
Education
Primary/elementary school	81 (34.3)
High school	81 (34.3)
Graduate/postgraduate	74 (31.4)
Partner’s Education
Primary/elementary school	59 (25.0)
High school	165 (69.9)
Graduate/postgraduate	12 (5.1)
Working status
Yes	94 (39.8)
No	141 (59.7)
Living Location
City center	154 (65.3)
County	82 (34.7)
Insurance
Yes	213 (90.3)
No	22 (9.3)
Perceived economic situation
Income more than expense	19 (8.1)
Income equals expense.	144 (61.0)
Income less than expense	73 (30.9)
Self-compassion		2.87 (0.51)
Breastfeeding self-efficacy		51.63 (9.87)
Depression (cut-off:12)	(46) 19.5	9.39 (4.43)

Note. M: mean; SD: standard deviation.

Assessment of the mediation model

A mediation model was tested to examine whether self-compassion mediated the relationship between postpartum depression (PPD) and breastfeeding self-efficacy (BSE). As shown in Figure 1 and Table 2, higher PPD scores were significantly associated with lower levels of self-compassion (B = –0.47, p < 0.001). Self-compassion was positively associated with BSE (B = 0.79, p < 0.001). The indirect effect of PPD on BSE through self-compassion was statistically significant (B = –0.37, 95% BC CI [–0.59, –0.21]), indicating a partial mediation. Although the direct effect of PPD on BSE was not significant (B = –0.11, p = 0.44), the total effect of PPD on BSE remained significant (B = –0.48, p < 0.001).

Table 2.

The results of the mediation analysis (n = 236).

Effect type	Relationships	B	SE	z	p	95% CI (BC)
Effect type	Relationships	B	SE	z	p	Lower	Upper
Effect of X on M	PPD ⇒ SC	−0.474	0.091	−5.201	<0.001	−0.654	−0.294
Effect of M on Y	SC ⇒ BSE	0.785	0.105	7.460	<0.001	0.589	0.992
Indirect	PPD ⇒ SC ⇒ BSE	−0.372	0.098	−3.809	<0.001	−0.586	−0.209
Direct	PPD ⇒ BSE	−0.112	0.145	−0.772	0.440	−0.395	0.185
Total	PPD ⇒ BSE	−0.484	0.146	−3.322	<0.001	−0.734	−0.177

Note. Confidence intervals computed with bias corrected bootstrap.

B: regression coefficient; SE: standard error; CI: confidence interval; BC: bias-corrected; X: PPD; M: SF; Y: BSE.

These results demonstrate that self-compassion statistically mediates the relationship between postpartum depression and breastfeeding self-efficacy. The overall model supports a partial mediation pattern, in which postpartum depression influences breastfeeding self-efficacy both directly and indirectly through self-compassion (Table 3).

Table 3.

Hierarchical linear regression models of the predictors of the self-compassion.

Variables^a	Model 1				Model 2				Model 3
Variables^a	B	SE	β	t (p)	B	SE	β	t (p)	B	SE	β	t (p)
Age	0.321	0.133	0.328	2.421 (0.017)	0.389	0.126	0.398	3.082 (0.002)	0.279	0.114	0.286	2.453 (0.015)
Educational status	0.059	0.372	0.015	0.159 (0.874)	0.183	0.352	0.048	0.520 (0.604)	0.045	0.315	0.012	0.143 (0.886)
Occupation	0.327	0.208	0.124	1.576 (0.117)	0.402	0.197	0.153	2.040 (0.403)	0.299	0.176	0.114	1.694 (0.092)
Partner’s age	−0.327	0.130	−0.340	−2.523 (0.013)	−0.383	0.123	−0.398	−3.106 (0.002)	−0.228	0.112	−0.236	−2.025 (0.044)
Partner’s education	−0.422	0.506	−0.081	−0.834 (0.406)	−0.519	0.479	−0.100	−1.084 (0.280)	0.085	0.436	0.016	0.196 (0.845)
Partner’s occupation	0.201	3.648	0.004	0.055 (0.956)	1.621	3.463	0.033	0.468 (0.640)	1.448	3.089	0.029	0.469 (0.064)
Income	−2.074	0.805	−0.201	−2.576 (0.011)	−2.855	0.780	−0.277	−3.662 (0.001)	−2.234	0.702	−0.217	−3.184 (0.002)
PPD					−0.410	0.089	−0.330	−4.614 (0.001)	−0.264	0.082	−0.213	−3.207 (0.002)
BSE									0.253	0.038	0.448	6.683 (0.001)
F (p)	2.612 (0.014)				5.217 (0.001)				10.792 (0.001)
R ²	0.097				0.197				0.365
adjR²	0.060				0.159				0.331
R²-change	0.097				0.197				0.365
Durbin Watson	1.184				1.093				1.188

Predictor(s) had a statistically significant association with the outcome variable in bivariate analysis (p < 0.05).

Discussion and conclusion

In our study, we found significant relationships between breastfeeding self-efficacy, depression, and self-compassion. Specifically, we observed a substantial negative relationship between depression and self-compassion, suggesting that higher levels of self-compassion were associated with lower levels of depression. Additionally, we found a significant positive relationship between self-compassion and breastfeeding self-efficacy, indicating that higher levels of self-compassion were linked to greater breastfeeding self-efficacy.

This study showed a level of breastfeeding self-efficacy among women, with a value of 51.63 (9.87), which is lower than what was reported in the original BSES-SF and studies conducted in Brazil (Zubaran and Foresti, 2013), Sweden (Gerhardsson et al., 2014), Poland (Wutke and Dennis, 2007) but higher than what was reported in China (Ip et al., 2016) and Japan (Nanishi et al., 2015). The importance of these differences lies in highlighting how contextual factors shape BSE and in showing that interventions to support breastfeeding should be culturally and structurally tailored. Our findings contribute to this body of evidence by providing data from Türkiye, where BSE levels appear to fall in the middle range internationally. Determining the factors that influence breastfeeding can be an effective way to increase breastfeeding self-efficacy. One of these factors is postpartum depression. The current study revealed a prevalence of 19.5% for PPD in the studied population. Molgora et al. (2022) investigated the predictors of postnatal depression in Italy 17% of women reported clinically significant depressive symptoms (Molgora et al., 2022). A cross-sectional study conducted by Peng et al. (2021) examining postnatal depression in puerperal women reported prevalence rates of 11.5% (Peng et al., 2021). Consequent to the comprehensive meta-analysis encompassing data from 52 studies, the prevalence of PPD was determined to be 23.8% (95% CI, 21.6%–26.1%) (Li et al., 2020). The observed prevalence rates across the included studies exhibited considerable variation, ranging from 5% to 61.8% (Özcan et al., 2017). The wide variation in reported PPD prevalence rates (ranging from 5% to 61.8%) can be attributed to several factors. These include methodological differences such as the type of screening tools used, cut-off scores for depression, and the timing of assessments postpartum. Additionally, cultural perceptions and stigma related to mental health may influence how symptoms are reported or recognized, particularly in different sociocultural contexts. Sociodemographic characteristics such as income level, education, parity, and social support also vary across studies and may contribute to differing prevalence rates. In our study, the use of a validated screening tool at a specific postpartum time frame (2–6 months) and the homogeneous Turkish sample may partly explain the 19.5% prevalence rate we observed. As crucial as the significance of breast milk and breastfeeding is, the mental health of the mother after childbirth is equally paramount. For the mother to effectively care for her baby and sustain breastfeeding over an extended period, her physical and mental well-being must be optimal. The poor mental health of the mother can lead to malnutrition and a decline in the baby’s physical health. In the literature, it is observed that depressed mothers often encounter challenges with breastfeeding (Henshaw, 2023; Zubaran and Foresti, 2013). Similarly, in our study, we identified both indirect and direct relationships between breastfeeding self-efficacy and depression. Postpartum is one of the challenging transition periods for mothers. It requires particular attention since it is a period that may lead mothers to be more vulnerable to developing psychopathological symptoms (Harville et al., 2010; Nayak et al., 2021). Implementing necessary precautions and programs to prevent postpartum depression can have a positive impact on breastfeeding self-efficacy. The incorporation of protection mechanisms assumes significance in getting through this period with heightened attention to health and well-being.

Self-compassion, another factor influencing breastfeeding self-efficacy, is a crucial mediating measure linked to positive psychological outcomes, including increased life satisfaction and enhanced social connections (Inwood and Ferrari, 2018; Neff, 2003). The current study revealed that women’s self-compassion levels are moderate, with a value of 2.87 (0.51) compared to the mean score of the self-compassion scale of 2.5. The self-compassion levels among women were consistent with the literature when comparing our study’s findings to them (Papini et al., 2022; Turk and Waller, 2020). In Türkiye, where collectivist values are strong, women often face significant expectations and pressure to fulfill family and household responsibilities. This can make it difficult for women to prioritize their own needs and emotions, potentially hindering their ability to practice self-compassion. However, self-compassion is an important protective factor for maternal mental health. Therefore, understanding women’s self-compassion levels within Turkish cultural and social context and developing interventions accordingly is crucial. This approach can better support women’s mental health during the postpartum period. Recognizing self-compassion’s significance in promoting well-being, interventions to assess and boost self-compassion levels can aid postpartum women’s adaptation and enhance resilience during this crucial period. This study revealed a positive association between breastfeeding self-efficacy and women’s self-compassion levels. In line with our findings, Rosenbaum et al. (2020) found an indirect effect between breastfeeding and self-compassion. This suggests that high self-compassion could be mediating in distress for women attempting breastfeeding (Rosenbaum et al., 2020). Mitchell et al. (2018) conducted a study to evaluate the online program developed for self-compassion, and it was found to increase self-compassion and satisfaction with breastfeeding (Mitchell et al., 2018). The mean levels of self-compassion observed in our study suggest that postpartum women may not be fully attentive to their own emotional needs or consistently practice self-kindness. As a result, identifying the psychosocial support requirements of women during the postpartum period and addressing their emotional well-being could be an effective strategy for enhancing women’s breastfeeding self-efficacy.

In this study, a significant negative relationship was found between self-compassion and depression. These results are in line with the few recent studies that examine the relationship between self-compassion and depression levels of postpartum women (Fonseca and Canavarro, 2018; Podina et al., 2015). Carona et al. (2022) investigated the relationship between depression and self-compassion in postpartum women and found that there was a significant negative relationship between them. The finding is consistent with the hypothesis that self-compassion may have a mediating effect against the development of perinatal depressive symptoms (Carona et al., 2022). Monteiro et al. (2019) examine the self-compassion among at-risk postpartum women presenting and not presenting clinically relevant depressive symptoms. They also found a significant negative association between self-compassion and depressive symptoms (Monteiro et al., 2019). In Türkiye, cultural values often emphasize family interconnectedness, collectivism, and traditional gender roles, which can shape women’s experiences during the postpartum period. Women may prioritize family needs and caregiving responsibilities over their own well-being, sometimes making it challenging to practice self-compassion. This cultural expectation can lead to internalized pressure to be a “perfect mother,” potentially increasing stress and vulnerability to postpartum depression. In our study, higher self-compassion levels mediate the relationship between women’s breastfeeding self-efficacy and postpartum depressive levels.

Our study had two limitations. First, it was a cross-sectional study. Since self-compassion is a multidimensional aspect, qualitative or mixed research can be conducted in the future to collect more in-depth data. Secondly, our study data were limited to women in the postpartum period who applied to a public hospital. Strengths of this study lie in its important focus on examining the impact of self-compassion on PPD and breastfeeding self-efficacy. By exploring this relationship, the study contributes to a deeper understanding of the potential role of self-compassion in maternal well-being during the postpartum period. The results obtained made it possible to determine further recommendations, both in terms of study and practice. Rosenbaum et al. (2020) discovered that early, involuntary cessation of breastfeeding was linked to depressive symptoms, with self-compassion acting as a mediate effect in this relationship. Increased depression levels of mothers may have a negative effect on breastfeeding self-efficacy. However, it was observed that this negative effect decreased, and breastfeeding self-efficacy was preserved when self-compassion levels were high. These results emphasize that protecting mothers’ mental health and improving their self-compassion in the postnatal period may be an essential strategy to increase breastfeeding self-efficacy.

These findings offer several culturally relevant implications for clinical practice in supporting maternal mental health and breastfeeding self-efficacy among Turkish mothers during the postpartum period. Integrating mental health screening into routine postpartum care at family health centers is essential and should be conducted using non-stigmatizing, culturally sensitive approaches to encourage disclosure. Given the strong role of extended family in Türkiye, especially mothers-in-law and grandmothers, family-centered education programs that involve key family members may strengthen support for both maternal mental well-being and breastfeeding. Self-compassion interventions should be framed within familiar cultural values—such as patience, modesty, and spiritual endurance—to increase acceptance and effectiveness. Community-based healthcare providers, including midwives and nurses, should receive training in recognizing postpartum psychological distress and delivering psychoeducation on emotional well-being and breastfeeding confidence. Furthermore, public health messaging should address unrealistic social expectations and normalize the challenges of breastfeeding to reduce maternal guilt and self-blame. Faith-based and communal coping strategies, which are meaningful for many Turkish women, may also be integrated into supportive care. Finally, peer support groups led by trained professionals may serve as an effective platform for emotional expression, shared experiences, and empowerment, fostering resilience and confidence during the postpartum transition.

In conclusion, our study explored the relationship between postpartum depression, self-compassion, and breastfeeding self-efficacy using a mediation model. We found significant relationships: depression correlated negatively with self-compassion, while self-compassion correlated positively with breastfeeding self-efficacy. Self-compassion partially mediated the link between depression and breastfeeding self-efficacy, highlighting its role in alleviating depression’s impact. Maternal mental health, particularly self-compassion, plays a crucial role in breastfeeding self-efficacy postpartum.

Footnotes

Acknowledgements

We would like to thank all the women for their cooperation and contribution to this study.

ORCID iDs

Cansu Akdag Topal

Merve Mert Karadaş

Ethical considerations

Ethical approval for this study was obtained from the Human Research Ethics Committee of Atılım University (Approval No: E-59394181-604.01.02-33843). Institutional permission to conduct the research was obtained from Ankara Training and Research Hospital (Ankara Eğitim ve Araştırma Hastanesi).

Consent to participate

All participants provided informed consent prior to their inclusion in the study.

Consent for publication

Participants consented to the publication of anonymized data.

Author contributions

CAT, MMK, IK, and HB designed the study. CAT and IK collected the data. CAT and MMK analyzed the data. CAT, MMK, IK, and HB prepared the manuscript. All authors approved the final version for submission.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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