# Social Support and Breastfeeding Attitudes Among Polish Mothers of Infants and Young Children: The Mediating Role of Anxiety and Depressive Symptoms

## TL;DR

Polish mothers with more social support have better mental health, which in turn influences their breastfeeding attitudes.

## Contribution

This study identifies mental health as a mediator between social support and breastfeeding attitudes in Polish mothers.

## Key findings

- Social support is negatively correlated with anxiety–depressive symptoms.
- Anxiety–depressive symptoms show a weak positive correlation with breastfeeding attitudes.
- Mental health mediates the relationship between social support and breastfeeding attitudes.

## Abstract

Background: Breastfeeding is essential for infant development and maternal health. Although initiation rates in Poland are high (97–99.4%), continuation of exclusive breastfeeding declines sharply to 4–22.4% at six months postpartum. In this study, the relationship between social support and attitudes toward breastfeeding was examined, focusing on the mediating role of anxiety and depressive symptoms, based on Conservation of Resources Theory. Methods: This cross-sectional online survey was conducted between April and October 2025. A total of 769 women aged ≥18 years with infants and children up to 24 months of age participated. Standardized tools were used: Multidimensional Scale of Perceived Social Support (MSPSS), the Iowa Infant Feeding Attitude Scale (IIFAS), and the Patient Health Questionnaire-4 (PHQ-4). Mediation analysis (PROCESS Model 4) was employed to assess indirect effects, controlling for demographic and perinatal factors. Bootstrapping (5000 samples) was implemented to determine statistical significance. Results: Social support was negatively correlated with anxiety–depressive symptoms (r = −0.368, p < 0.001) and weakly negatively correlated with breastfeeding attitudes (r = −0.075, p = 0.036). Anxiety–depressive symptoms showed a weak but statistically significant positive correlation with breastfeeding attitudes (r = 0.120, p < 0.001), which contrasts with most previous findings. Mediation analysis confirmed a significant indirect effect of social support on breastfeeding attitudes via mental health (indirect effect = −0.013, 95% CI [−0.023, −0.004]). The direct effect was non-significant (β = −0.010, p = 0.435). The model explained 14% of variance in anxiety–depressive symptoms and 2% in breastfeeding attitudes. Conclusions: Maternal mental health mediates the relationship between social support and breastfeeding attitudes. Effective lactation support should combine social support with psychoeducational interventions to reduce anxiety and depression. Integrated mental health programs in perinatal care are essential in promoting sustained breastfeeding.