Rate of postpartum depression nearly tripled at start of pandemic
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At the beginning of the COVID-19 pandemic, one in three new moms had postpartum depression, which was nearly three times higher than the rate before the pandemic, data published in BMC Research Notes showed.
Researchers also found that one in five patients had major depressive symptoms.
“When COVID-19 was declared a pandemic, many hospitals and public health departments issued numerous guidelines to prevent the spread of infection, especially to vulnerable populations like perinatal patients and infants,” Clayton J. Shuman, PhD, MSN, RN, assistant professor at the University of Michigan School of Nursing, told Healio. “We hypothesized that many of these new guidelines and mandates could result in decreased social and emotional support for pregnant and postpartum patients, unanticipated changes to the birthing experience and changes to the delivery of maternal-infant care. In recognition of these changes, our team developed the COVID-19 MAMAS (Maternal Attachment, Mood, Ability and Support) study to better understand the postpartum experience during the pandemic.”
Shuman and colleagues enrolled 670 women (mean age, 31.84 years; 88.8% white; 94.5% married) living in 46 states who gave birth between February and July 2020. These women completed the Edinburgh Postnatal Depression Scale (EPDS) and provided demographic and COVID-19 behavior information through an online survey, which was designed specifically for this study and available between June 4 and July 8, 2020.
EPDS results
EPDS scores showed that 256 (38%) participants screened positive for postpartum depression, which was much higher than the pre-pandemic rate of 6.5% to 12.9%, Shuman and colleagues wrote. Overall, 146 participants (57% of participants with postpartum depression; 21.8% of all participants) screened positive for major depressive symptoms.
Self-harm ideation was reported by 51 participants (7.6%), with 74.5% of those screening positive for major depressive symptoms and 19.6% screening positive for postpartum depression.
“We were surprised by the high rate of suicidality and self-harm in our sample,” Shuman said. “Of those who screened positive for postpartum depression, about one in five reported thoughts of harming themselves.”
Risk factors for postpartum depression, major depressive symptoms
Results from the study showed that formula feeding increased the odds of postpartum depression by 92% (95% CI, 1.23-3) and increased the odds of major depressive symptoms by 73% (95% CI, 1.06-2.79) compared with breastfeeding or bottle-feeding with human milk.
Participants whose infants were admitted to a NICU had 74% greater odds of postpartum depression, and those who worried about themselves or their infants contracting COVID-19 had 71% greater odds. Also, at the time of the survey response, each week that had passed since birth increased the odds of postpartum depression by 4%.
“Clinicians and health care systems must understand that policies and guidelines enacted to reduce infection spread may have adversely affected perinatal mental health,” Shuman said. “Although many of these pandemic-related policies (eg, visitation restrictions and telehealth visits) were important to control the spread of infection, we must consider the unintended consequences they had for mothers and infants and provide additional support to lessen these negative effects. Screening for mental illness is an important first step, but screening must be accompanied by treatment and resources that are tailored to the specific needs of each perinatal patient.”
The researchers cautioned that their findings may be limited due to convenience sampling and sample homogeneity. However, the study was one of the first to establish risk factors for postpartum depression early in the pandemic, which can inform future research, they wrote.
“More research is needed to understand the effect of the pandemic on perinatal patients of color who may be more vulnerable,” Shuman said. “Further, postpartum depression was an important public health problem before the pandemic, affecting about one in eight postpartum patients. Many recent studies highlight that this rate is increasing during the pandemic. Researchers, clinicians, public health departments and perinatal patients must work together to identify and develop more robust and effective screening and treatment protocols, as well as education and resources for affected patients and their families.”
Perspective
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Ryan J. Van Lieshout, MD, PhD, FRCPC
Under normal circumstances, up to one in five mothers will develop postpartum depression, a condition that adversely affects their thoughts, emotions and functioning, as well as the mental health of their partners and offspring. While the COVID-19 pandemic has caused substantial stress for people around the world, mothers of infants have faced a number of unique challenges that have substantially affected their mental health. In addition to worries about the virus itself, many mothers have experienced social isolation, reduced income, disrupted schedules and have taken on more responsibilities than ever before, providing care to their infants and other children while managing households and supporting partners. The pandemic and its accompanying restrictions have also reduced access to social supports and medical care in many settings.
The article by Shuman and colleagues reported that up to one in three mothers have been affected by postpartum depression during the pandemic. They also found that the most commonly observed risk factors for this problem were concerns about contracting COVID-19 (and passing it on to family members) and NICU admission. Moreover, the authors suggested that infants who were formula fed were more likely to have mothers who struggled with postpartum depression. These findings are similar to a range of other studies conducted in developed countries around the world where up to 35% of mothers were reported to have developed these postpartum difficulties. Such work has also suggested that those with less access to health care, fewer familial and other social supports, as well as young mothers and single parents are at particular risk.
While the study of Shuman and colleagues utilized a convenience sample of American mothers over a relatively short period early in the pandemic (June to July 2020), the stress of COVID-19 and the myriad role changes mothers have faced have persisted in many settings and support the contemporary relevance of their findings. They did only assess a limited number of risk factors for postpartum depression and so were not able to comment on as wide a range of exposures as other studies. They also used a questionnaire measure to define postpartum depression rather than structured psychiatric interviews. As a result, they were unable to determine how many mothers were affected by a full-syndrome diagnosis of major depressive disorder.
Despite these limitations, this work highlights the silent pandemic that has affected the mental and physical health of mothers and children in the United States and around the world. The short- and long-term adverse effects of postpartum depression on mothers, their partners and their children are substantial and underscore the importance of raising awareness of the potential devastating and lifelong consequences of untreated mental illness in mothers.
It is vitally important that those who are struggling reach out to trusted friends, family and health care professionals so that they can get the help they need and deserve. Such support and treatment are essential given the powerful positive effects that treating postpartum depression can have on maternal mental health and the health and development of their offspring.
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