{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:54:05Z","timestamp":1777456445298,"version":"3.51.4"},"reference-count":15,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T00:00:00Z","timestamp":1717200000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dysphoric milk ejection reflex (D-MER) is a phenomenon that occurs before milk letdown and is described as a wave of negative or devastating emotions, ranging from mild to severe and lasting for seconds to minutes. To date, there has been little research regarding this phenomenon. This study aims to determine the prevalence of D-MER in our population as well as its association with postnatal depression scores and breastfeeding self-efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Lactating persons between 4 and 12 weeks postpartum at our institution were invited to complete an anonymous 59-question survey via an online platform. Questions asked included patient demographics, presence of symptoms of dysphoria (including timing, duration, and frequency), the Edinburgh Postnatal Depression Scale (EPDS), and the Breastfeeding Self-Efficacy Scale Short Form (BSES-sf).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">:<\/jats:italic>\n                      In total, 201 women completed the survey. Twelve women were classified as likely having D-MER (6%). Symptom resolution primarily occurred within a minute to 5 minutes (58%). Mean EPDS scores differed significantly between those with likely D-MER and those without (12.2 vs. 5.4,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.002). BSES-sf scores differed significantly between the two groups (43.1 vs. 52.5,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.009). Preexisting depression or anxiety was not associated with D-MER (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.133), other reported mood disorders differed significantly between those with D-MER and those without (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.004). Demographic characteristics of women with and without D-MER were similar.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">:<\/jats:italic>\n                      D-MER prevalence may be lower than previously reported. Patients with likely D-MER appear to have lower breastfeeding self-efficacy and higher depression scores. Those with preexisting mood disorders may be at higher risk of experiencing D-MER.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/bfm.2023.0241","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T07:42:40Z","timestamp":1712562160000},"page":"467-475","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Dysphoric Milk Ejection Reflex: Characteristics, Risk Factors, and Its Association with Depression Scores and Breastfeeding Self-Efficacy"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4529-6899","authenticated-orcid":false,"given":"Lina","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Stokes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kendall","family":"Alsup","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Zahler-Miller","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,6,13]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2019.0091"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1891\/2158-0782.9.1.23"},{"key":"e_1_3_5_4_2","unstructured":"D-MER.org. Understanding D-MER. 2023. Available from: https:\/\/d-mer.org\/understanding-d-mer [Last accessed: 9August 2023]."},{"key":"e_1_3_5_5_2","unstructured":"La Leche League International. What is D-MER? 2018. Available from: https:\/\/llli.org\/what-is-d-mer\/ [Last accessed: 9August 2023]."},{"key":"e_1_3_5_6_2","unstructured":"Levine H Wu J. What to expect. Breastfeeding with dysphoric milk ejection reflex (D-MER). 2022. Available from: https:\/\/www.whattoexpect.com\/first-year\/breastfeeding\/dysphoric-milk-ejection-reflex\/ [Last accessed: 9August 2023]."},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/1746-4358-6-6"},{"issue":"1","key":"e_1_3_5_8_2","first-page":"16","article-title":"A case of dysphoric milk ejection reflex (D-MER)","volume":"18","author":"Cox S","year":"2010","unstructured":"Cox S. A case of dysphoric milk ejection reflex (D-MER). Breastfeeding Rev, 2010; 18(1):16\u201318.","journal-title":"Breastfeeding Rev"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2017.0086"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2016.02.019"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1210\/en.2011-1091"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.150.6.782"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0884217503258459"},{"key":"e_1_3_5_14_2","unstructured":"American College of Obstetricians and Gynecologists. Breastfeeding benefits. 2020. Available from: https:\/\/www.acog.org\/womens-health\/infographics\/breastfeeding-benefits [Last accessed: 9August 2023]."},{"key":"e_1_3_5_15_2","unstructured":"Kellams A. UpToDate. Breastfeeding: Parental education and support. 2023. Available from: https:\/\/www.uptodate.com\/contents\/breastfeeding-parental-education-and-support?search=breastfeeding&source=search_result&selectedTitle=2\u223c150&usage_type=default&display_rank=2#H1 [Last accessed: 9August 2023]."},{"issue":"8","key":"e_1_3_5_16_2","first-page":"552","article-title":"Overcoming challenges faced by breastfeeding mothers","volume":"45","author":"Amir LH","year":"2016","unstructured":"Amir LH, , Bearzatto A. Overcoming challenges faced by breastfeeding mothers. Aust Fam Physician, 2016; 45(8):552\u2013556.","journal-title":"Aust Fam Physician"}],"container-title":["Breastfeeding Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/bfm.2023.0241","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/bfm.2023.0241","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/bfm.2023.0241","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:01:55Z","timestamp":1777381315000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/bfm.2023.0241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,1]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6,1]]}},"alternative-id":["10.1089\/bfm.2023.0241"],"URL":"https:\/\/doi.org\/10.1089\/bfm.2023.0241","relation":{},"ISSN":["1556-8253","1556-8342"],"issn-type":[{"value":"1556-8253","type":"print"},{"value":"1556-8342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,1]]}}}