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Table 2 Exposure to breastfeeding compared to absence of breastfeeding in protection of children mental health. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment

From: Association of breastfeeding with mental disorders in mother and child: a systematic review and meta-analysis

Certainty assessment

Summary of findings

Participants (studies)

Follow-up

Risk of bias

Inconsistency

Indirectness

Imprecision

Publication bias

Overall certainty of evidence

Study event rates (%)

Relative effect (95% CI)

Anticipated absolute effects

With absence of breastfeeding

With exposure to breastfeeding

Risk with absence of breastfeeding

Risk difference with exposure to breastfeeding

Schizophrenia

 3 observational studiesa

Serious

Not serious

Not serious

Serious

Unclear

⨁○○○

Very low

261 cases 363 controls

OR 0.98 (0.57 to 1.71)

Satisfactory

156 per 1,000

3 fewer per 1000 (from 61 fewer to 84 more)

Depressive disorders

 5 observational studiesb

Seriousc

Seriousd

Seriouse

Not serious

Unclear

⨁○○○

Very low

There is conflicting evidence regarding associations between breastfeeding and depressive disorders development with some studies showing small protective effect and others reporting no effect

Anxiety disorders

 3 observational studies

Seriousf

Seriousg

Not serious

Not serious

Unclear

⨁○○○

Very low

There is conflicting evidence regarding associations between breastfeeding and anxiety disorders development with one cohort study (n = 3657) reporting no effect while one cross-sectional study (n = 98,702) and one case–control study (n = 450) demonstrating protective effect

  1. CI confidence interval, OR odds ratio
  2. aMcCreadi et al. 1997 study used siblings as a control group. Outcomes of the sensitivity analysis, which included this study did not differ (OR 0.89 (95% CI 0.58–1.38)) from the primary analysis. Two cohort studies provided conflicting evidence with Sorensen et al. 2005 demonstrating reduced risk and Leask et al. 2000 no effect
  3. bDe Mola et al. 2016 study compared different durations of breastfeeding but did not provide “ever” vs. “never” comparison
  4. cThree studies were ranked as “satisfactory” using NOS score, while one was rated as “good”
  5. dThe direction and magnitude of effect varied across the studies. Overall, the results showed either small protective effect or no association between breastfeeding and depressive disorders
  6. eWe judged the evidence to have potential serious indirectness due to substantial variability in the outcome measure used
  7. fOne of two studies was rated as “unsatisfactory” as per NOS
  8. gThe direction and magnitude of effect varied across the studies
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BMC Medicine

ISSN: 1741-7015

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