ABSTRACT
Background: Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using comparable data across time. We used data from three national maternity surveys in England to compare prevalence and risk factors for postnatal depression before and during the pandemic. Methods: Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and 2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression. Findings: Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95% CI: 4.0-7.4); RR = 1.55 (95% CI: 1.36-1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9-9.9); RR = 1.49 (95% CI: 1.34-1.66)). Having a long-term mental health problem (aRR range = 1.48-2.02), antenatal anxiety (aRR range = 1.73-2.12) and antenatal depression (aRR range = 1.44-2.24) were associated with increased risk of postnatal depression, whereas satisfaction with birth (aRR range = 0.89-0.92) and social support (aRR range = 0.73-0.78) were associated with decreased risk before and during the pandemic. Interpretation: This analysis indicates that Covid-19 had an important negative impact on postnatal women's mental health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for postnatal depression were consistent before and during the pandemic. Timely identification, intervention and follow-up are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened during times of heightened risk such as the pandemic. Funding: NIHR Policy Research Programme.
ABSTRACT
BACKGROUND: Pregnancy and the postnatal period can be times of psychosocial stress and insecurity, but high quality maternity care and social support can help mothers cope with stress and feel more secure. The COVID-19 pandemic and associated social and economic disruption increased rates of antenatal and postnatal stress, anxiety and depression, and also had profound impacts on the organisation of maternity services in England. METHODS: This was a qualitative descriptive study of the impact of pandemic-related changes to maternity care on mothers' emotional wellbeing, using inductive thematic analysis of open text responses to the National Maternity Survey (NMS) 2020 in England. A random sample of 16,050 mothers who gave birth 11-24th May 2020 were invited to take part in the survey, and 4,611 responded, with 4,384 answering at least one open text question. RESULTS: There were three themes: 'Chaos: impact of uncertainty', 'Abandoned: impact of reduction in care', and 'Alone: impact of loss of social support'. Mothers valued maternity care and many experienced additional stress from chaotic changes and reduction in care during the pandemic; from health professionals' own uncertainty and anxiety; and from restrictions on essential social support during pregnancy, labour and birth. Others felt that health professionals had communicated and cared for them well despite the changes and restrictions, and these mothers felt psychologically safe. CONCLUSIONS: Planning for future crises should include considering how necessary adaptations to care can be implemented and communicated to minimise distress; ensuring that mothers are not deprived of social support at the time when they are at their most vulnerable; and supporting the psychological welfare of staff at a time of enormous pressure. There are also lessons for maternity care in 'normal' times: that care is highly valued, but trust is easily lost; that some mothers come into the maternity system with vulnerabilities that can be ameliorated or intensified by the attitudes of staff; that every effort should be made to welcome a mother's partner or chosen companion into maternity care; and that high quality postnatal care can make a real difference to mothers' wellbeing.
Subject(s)
COVID-19 , Maternal Health Services , Female , Humans , Pregnancy , Mothers/psychology , Pandemics , COVID-19/epidemiology , Parturition , EnglandABSTRACT
Perinatal anxiety affects an estimated 15% of women globally and is associated with poor maternal and infant outcomes. Identifying women with anxiety is essential to prevent these adverse associations, but there are a number of challenges around measurement. We used data from England's 2020 National Maternity Survey to compare the prevalence of anxiety symptoms at six months postpartum using three different measures: the two-item Generalised Anxiety Disorders Scale (GAD-2), the anxiety subscales of the Edinburgh Postnatal Depression Scale (EPDS-3A) and a direct question. The concordance between each pair of measures was calculated using two-by-two tables. Survey weights were applied to increase the representativeness of the sample and reduce the risk of non-response bias. The prevalence of postnatal anxiety among a total of 4611 women was 15.0% on the GAD-2, 28.8% on the EPDS-3A and 17.1% on the direct question. Concordance between measures ranged between 78.6% (95% CI 77.4-79.8; Kappa 0.40) and 85.2% (95% CI 84.1-86.2; Kappa 0.44). Antenatal anxiety was the strongest predictor of postnatal anxiety across all three measures. Women of Black, Asian or other minority ethnicity were less likely to report self-identified anxiety compared with women of White ethnicity (adjusted odds ratio 0.44; 95% CI 0.30-0.64). Despite some overlap, different anxiety measures identify different groups of women. Certain population characteristics such as women's ethnicity may determine which type of measure is most likely to identify women experiencing anxiety.