ABSTRACT
Objective: COVID-19 impacted the childbirth experience and increased rates of postpartum depression (PPD). We assessed longitudinal effects of the pandemic on rates of PPD. Study Design: We evaluated PPD causes and symptoms among women who delivered during the first COVID-19 quarantine in Israel. Postpartum women completed online questionnaires 3 (T1) and 6 months (T2) following delivery. COVID-19 related questionnaires included ‘Fear of COVID-19’ and ‘COVID-19 exposure’ questionnaires. PPD symptoms, situational anxiety and social support, were evaluated with the EPDS, STAI, and MSPSS questionnaires. Results: Mean EPDS scores increased between T1 and T2 (6.31±5.6 vs. 6.92±5.9, mean difference -0.64±4.59 (95% CI (-1.21)- (-0.06));t(244)=-2.17, p=0.031) and STAI scores decreased (45.35±16.4 vs. 41.47±14.0, t(234)=4.39, p=0.000). Despite exposure to increased numbers of COVID-19 events (3.63±1.8 vs. (6.34±2.3) the impact of exposure decreased between T1 and T2 (8.91±4.6 vs. 7.47±4.1), p< 0.001). No differences were found between Fear of COVID-19 in T1 (17.25±5.3), and T2 (17.10±5.3);t=0.42, p=0.676, nor in COVID-19 related financial difficulties between T1 (2.80±1.2) and T2 (2.83±1.1);t(266)=-0.581, p=0.561. In the MSPSS, significant differences were noted on the family scale between T1 (.36.10±1) and T2 (5.91±1.4) scores;t(216)=2.68, p=0.0008. Regression analysis showed three statistically significant variables that correlated with increased EPDS scores;MSPSS family subscale [F(1,212.00)= 4.308, p =0.039], STAI scores [F(1,212.00)= 31.988, p =0.000], and the impact of exposure to COVID-19 [F(1,212.00)= 5.038, p =0.026]. Conclusion: Rates of PPD increased for women who delivered during the first COVID 19 lockdown. Further research is warranted to help reduce PPD among these women.
ABSTRACT
This is a multicenter prospective observational study, aimed to evaluate the relations between Fear of COVID-19 and postpartum depression (PPD) symptom, that included a cohort of women who delivered during COVID-19 lockdown between 03 and 05/2020. Participants were approached after delivery and asked to complete an online questionnaire. Data was verified with each center's perinatal database. The validated Fear of COVID-19 Scale was in use. PPD was evaluated using the EPDS questionnaire as a categorical (≥13) and as a continuous scale. Pre-existing maternal disability was defined as any prior physiological/psychological chronic health condition. Continuous medical supervision or stress contributing complications at birth included pregnancy and labor related complications. Regression analysis and ROC statistics were utilized to evaluate associations and control for confounders. Overall, 421 women completed the questionnaires. Of them, 53(12.6%) had a high EPDS score. Fear of COVID-19 was positively correlated with PPD symptoms (r = 0.35,p = 0.000), ROC-AUC 0.73, 95% CI 0.65-0.81, p = 0.000. Following adjustment to confounders (maternal age, nulliparity, ethnicity, marital status, financial difficulties, maternal disability, accessibility to medical services, and continuous medical supervision (, the most important factor that correlated with depression symptoms was maternal disability (aOR 4.61,95% CI 1.96-10.82) followed by Fear of COVID-19 (aOR 1.11,95% CI 1.05-1.17). High accessibility to medical services during pregnancy (aOR 0.62, 95%CI 0.45-0.84) was protective for PPD symptoms. To conclude, during the COVID-19 pandemic, maternal disability and Fear of COVID-19 are positively associated with a high EPDS score. High medical accessibility during pregnancy was found as a protective factor for PPD.