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1.
BMC Pregnancy Childbirth ; 21(1): 828, 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1571748

ABSTRACT

BACKGROUND: The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores. METHODS: This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey. RESULTS: Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05). CONCLUSIONS: The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.


Subject(s)
COVID-19 , Child Care , Depression, Postpartum , Physical Distancing , Stress, Psychological , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Child , Child Care/methods , Child Care/psychology , Child Care/statistics & numerical data , Communicable Disease Control/methods , /trends , Cross-Sectional Studies , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Depression, Postpartum/prevention & control , Depression, Postpartum/psychology , Female , Humans , Maternal-Child Health Services/organization & administration , Maternal-Child Health Services/trends , Needs Assessment , Psychiatric Status Rating Scales/statistics & numerical data , Risk Assessment , SARS-CoV-2 , Stress, Psychological/complications , Stress, Psychological/etiology , Stress, Psychological/physiopathology , United States/epidemiology
2.
BMC Pregnancy Childbirth ; 21(1): 826, 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1571747

ABSTRACT

BACKGROUND: Postpartum depression affects a significant proportion of women of childbearing age. The birth of a newborn baby is normally considered a joyful event, inhibiting mothers from expressing their depressive feelings. If the condition is not well understood and managed, mothers with postpartum depression are likely to experience suicidal ideation or even commit suicide. This study explored lived experiences of women who had recovered from a clinical diagnosis of postpartum depression in southwestern Uganda. METHODS: This phenomenological study adopted the explorative approach through in-depth interviews as guided by the biopsychosocial model of depression. It was conducted in Mbarara Regional Referral Hospital, Bwizibwera Health Centre IV and Kinoni Health Centre IV located in Mbarara and Rwampara districts, southwestern Uganda. Data were collected from 30 postpartum mothers who were purposively selected, between 9th December 2019 and 25th September 2020. We analyzed this work using thematic data analysis and this was steered by the Colaizzi's six-step phenomenological approach of inquiry. RESULTS: The findings were summarized into five major themes: 1) somatic experiences including insomnia and headache, breast pain, poor breast milk production, weight loss and lack of energy; 2) difficulties in home and family life including overwhelming domestic chores, lack of social support from other family members, fighting at home and financial constraints due to COVID-19 pandemic; 3) negative emotions including anger, self-blame, despondency and feelings of loneliness and regrets of conceiving or marriage; 4) feelings of suicide, homicide and self-harm including suicidal ideation and attempt, homicidal ideations and attempt and feelings of self-harm and 5) coping with postpartum depression including spirituality, termination of or attempt to leave their marital relationships, acceptance, counselling and seeking medical treatment, perseverance. CONCLUSION AND RECOMMENDATIONS: Suicidal and homicidal thoughts are important parts of the postpartum depression experience, and these may put the lives of the mothers, their spouses and their babies at a great risk. Poor relationship quality, intimate partner violence and lack of financial resources contribute significantly to the negative emotional experiences of mothers with PPD.


Subject(s)
COVID-19 , Depression, Postpartum , Financial Stress , Marriage/psychology , Physical Distancing , Stress, Psychological , Suicidal Ideation , Adaptation, Psychological , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Communicable Disease Control/methods , Depression, Postpartum/diagnosis , Depression, Postpartum/physiopathology , Depression, Postpartum/psychology , Female , Financial Stress/etiology , Financial Stress/psychology , Humans , Models, Biopsychosocial , Qualitative Research , SARS-CoV-2 , Social Support/psychology , Stress, Psychological/complications , Stress, Psychological/etiology , Stress, Psychological/physiopathology , Uganda/epidemiology
3.
J Clin Psychiatry ; 82(4)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1518675

ABSTRACT

Objective: The conditions created by the COVID-19 pandemic could negatively affect maternal mental health and the mother-infant relationship. The aim of this study is to determine the impact of the COVID-19 pandemic on depression, anxiety, and mother-infant bonding among women seeking treatment for postpartum depression (PPD).Methods: Baseline data collected in two separate randomized controlled trials of a psychoeducational intervention for PPD in the same geographic region, one prior to COVID-19 (March 2019-March 2020) and one during the COVID-19 pandemic (April-October 2020), were compared. Eligible participants had an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10, were ≥ 18 years of age, had an infant < 12 months old, and were fluent in English. Outcomes included PPD (EPDS), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and mother-infant relationship (Postpartum Bonding Questionnaire [PBQ]). All were measured continuously and dichotomized at accepted clinical cutoffs.Results: Of the 603 participants (305 pre-COVID-19; 298 during COVID-19), mothers enrolled during the COVID-19 pandemic reported higher levels of symptoms of PPD (B = 1.35; 95% CI, 0.64 to 2.06; Cohen d = 0.31) and anxiety (B = 1.52; 95% CI, 0.72 to 2.32; Cohen d = 0.30). During COVID-19, women had 65% higher odds of clinically significant levels of depression symptoms (OR = 1.65; 95% CI, 1.13 to 2.31) and 46% higher odds of clinically relevant anxiety symptoms (OR = 1.46; 95% CI, 1.05 to 2.05). However, there were no statistically significant differences in mother-infant bonding.Conclusions: The findings of this study suggest that rates and severity of PPD and anxiety symptoms among women seeking treatment for PPD have worsened in Canada during the COVID-19 pandemic. However, treatment-seeking mothers have consistently maintained good relationships with their infants. Considering the difficulties women with PPD face when accessing treatment, it is important that strategies are developed and disseminated to safely identify and manage PPD to mitigate potential long-term adverse consequences for mothers and their families.Trial Registration: ClinicalTrials.gov identifiers: NCT03654261 and NCT04485000.


Subject(s)
Anxiety/etiology , COVID-19/psychology , Depression, Postpartum/etiology , Mother-Child Relations/psychology , Mothers/psychology , Object Attachment , Pandemics , Adolescent , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/psychology , COVID-19/epidemiology , Depression, Postpartum/epidemiology , Depression, Postpartum/psychology , Female , Humans , Infant , Infant, Newborn , Ontario/epidemiology , Risk Factors , Self Report , Severity of Illness Index , Young Adult
4.
Midwifery ; 102: 103072, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1284384

ABSTRACT

OBJECTIVE: The 2019 coronavirus disease pandemic (COVID-19) required strict confinement measures that differentially impacted the individual's daily life. Thus, this work aimed to study postpartum women's mental health in Argentina during mandatory social isolation. DESIGN: A cross-sectional survey was conducted from May to July 2020, which included five validated questionnaires to assess postpartum depression (Postpartum Depression Screening Scale-Short Form), insomnia (Insomnia Severity Index), memory complaints (Memory Complaint Scale), metacognition (Brief Metamemory and Metaconcentration Scale), and breastfeeding self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form). Sociodemographic variables, social isolation characteristics, and breastfeeding practices were also collected. This study was conducted in accordance with the Declaration of Helsinki. Statistical analysis included zero-order correlations, multiple logistic regressions, and a set of structural equation models (SEM) to test direct and indirect effects. Goodness-of-fit indices were calculated for SEM. SETTING: Postpartum women were recruited from public hospitals, private health clinics, and online community recruitment in the Cordoba province (Argentina). PARTICIPANTS: 305 postpartum women from Argentina. MEASUREMENTS AND FINDINGS: 37% of women reported postpartum depression, 46% insomnia, 42% memory impairment, 60% low metaconcentration, 50% low metamemory, and 23% low breastfeeding efficacy. Also, significant associations were found demonstrating that social isolation promoted postpartum depression and insomnia were reciprocally related, which compromised female cognition and efficacy. This situation was aggravated in women during late postpartum, with previous children, and by low social support (e.g., family, health professionals), with non-exclusive breastfeeding being increased. KEY CONCLUSIONS: This is the first study addressing postpartum women's mental status during social isolation in Argentina, which was a promoting factor for postpartum depression and insomnia that were reciprocally related. This situation was also aggravated by reproductive factors, such as late postpartum, multiparity, breastfeeding frequency, and non-exclusive breastfeeding. Additionally, breastfeeding self-efficacy depended on mental health status, and euthymia therefore favoured the practice of exclusive breastfeeding.


Subject(s)
COVID-19/psychology , Cognitive Dysfunction/epidemiology , Depression, Postpartum/epidemiology , Sleep Initiation and Maintenance Disorders/epidemiology , Social Isolation/psychology , Breast Feeding , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cross-Sectional Studies , Depression , Depression, Postpartum/psychology , Female , Humans , Pandemics , Postpartum Period , SARS-CoV-2 , Self Efficacy
5.
Eur Psychiatry ; 64(1): e34, 2021 05 04.
Article in English | MEDLINE | ID: covidwho-1270941

ABSTRACT

BACKGROUND: New recommendations regarding the use of personal protective equipment (PPE) during delivery have changed the maternal birth experience. In this study, we investigated the mental perceived impact of PPE use during delivery on the development of maternal postpartum depression (PPD) and post-traumatic stress symptoms (PTSS). METHODS: This was a multicenter, retrospective cohort study concerning women who delivered during the COVID-19 pandemic first lockdown period in Israel. Postpartum women were approached and asked to complete a comprehensive online questionnaire. Impact of PPE was graded on a scale of 1-5, and Impact of PPE ≥4 was considered high. PPD and PTSS were assessed using the EPDS and City BiTS questionnaires. RESULTS: Of 421 parturients, 36 (9%) reported high Impact of PPE. Parturients with high Impact of PPE had significantly higher PPD and PTSS scores)EPDS 8.4 ± 5.8 vs. 5.7 ± 5.3; City BiTS 9.2 ± 10.3 vs. 5.8 ± 7.8, p < 0.05 for both). Following adjustment for socio-demographic and delivery confounders and fear of COVID-19 (using Fear of COVID19 scale), Impact of PPE remained positively correlated with PPD symptoms (ß = 0.103, 95% confidence intervals [CI] 0.029-1.006, p = 0.038). CONCLUSION: When examining the risk factors for developing postpartum PTSS-experiences during labor and PPE were found to be significant variables. As the use of PPE is crucial in this era of COVID-19 pandemic in order to protect both parturients and caregivers, creative measures should be taken in order to overcome the communication gap it poses.


Subject(s)
COVID-19/psychology , Depression, Postpartum/etiology , Personal Protective Equipment/adverse effects , Postpartum Period/psychology , Stress Disorders, Post-Traumatic/etiology , Adult , COVID-19/epidemiology , Communicable Disease Control , Depression, Postpartum/diagnosis , Depression, Postpartum/psychology , Fear , Female , Humans , Israel , Pregnancy , Retrospective Studies , Risk Factors , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires
6.
Matern Child Health J ; 25(3): 353-359, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1064559

ABSTRACT

OBJECTIVES: To examine the mental health of women in the perinatal period prior to and during the COVID-19 pandemic. METHODS: We use provisional vital statistics data for births occurring in the central region of New Jersey. The Edinburgh Postnatal Depression Scale is employed to assess depressive symptoms. Our focal analysis uses linear regression models to test whether giving birth during the pandemic is associated with elevated depressive symptoms. All analyses are performed using time-matched (September 2019-April 2020; n = 18,531) and month-matched (January 2019-April 2019 and January 2020- April 2020; n = 18,346) samples. RESULTS: Women who gave birth in March and not in April reported higher levels of depressive symptoms than those who gave birth prior to the pandemic in our time-matched (b = 0.09) and month-matched (b = 0.09) samples. The magnitude of this association is approximately one-third the magnitude of the association between preterm birth and depressive symptoms. CONCLUSION: These findings suggest that researchers and practitioners should pay special attention to signs of postpartum depression and women's adaptive coping responses in the early stages of pandemics.


Subject(s)
COVID-19/epidemiology , Depression, Postpartum/psychology , Mothers/psychology , Adaptation, Psychological , Adult , Depression, Postpartum/epidemiology , Female , Humans , New Jersey/epidemiology , Pandemics , Premature Birth/epidemiology , Psychiatric Status Rating Scales , SARS-CoV-2
7.
Epidemiol Prev ; 44(5-6 Suppl 2): 369-373, 2020.
Article in English | MEDLINE | ID: covidwho-1068159

ABSTRACT

During a pandemic, pregnancy and the postnatal period are complicated by multiple factors. On the one hand, worries about one's own health and the health of loved ones, in particular of the newborn child, can increase the risk of some mental disorders, such as depression and anxiety in the pregnant woman. On the other hand, as happened for the COVID-19 epidemic in Italy, given the need for physical distancing, the maintenance of the social and family network, so important for new parents in the perinatal period, is lacking. In addition, health services are forced to reorganize their offerings to ensure maximum safety for their operators and patients. This work proposes a model of screening and treatment aimed at identifying women at risk and providing them with effective and safe treatment.


Subject(s)
Anxiety/diagnosis , COVID-19/epidemiology , Depression/diagnosis , Mass Screening/organization & administration , Pandemics , Perinatal Care/organization & administration , Pregnancy Complications/diagnosis , Pregnant Women/psychology , Puerperal Disorders/diagnosis , SARS-CoV-2 , Adult , Anxiety/epidemiology , COVID-19/psychology , Depression/etiology , Depression/therapy , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Depression, Postpartum/psychology , Depression, Postpartum/therapy , Diagnostic Self Evaluation , Empowerment , Evidence-Based Medicine , Female , Follow-Up Studies , Humans , Italy/epidemiology , Perinatal Care/methods , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/psychology , Pregnancy Complications/therapy , Program Evaluation , Puerperal Disorders/epidemiology , Puerperal Disorders/psychology , Puerperal Disorders/therapy , Risk Factors , Stress, Psychological/epidemiology , Stress, Psychological/etiology , Stress, Psychological/psychology , Telemedicine
8.
Hong Kong Med J ; 27(2): 113-117, 2021 04.
Article in English | MEDLINE | ID: covidwho-914806

ABSTRACT

INTRODUCTION: Owing to the coronavirus disease 2019 outbreak Hong Kong hospitals have suspended visiting periods and made mask wearing mandatory. In obstetrics, companionship during childbirth has been suspended and prenatal exercises, antenatal talks, hospital tours, and postnatal classes have been cancelled. The aim of the present study was to investigate the effects of these restrictive measures on delivery plans and risks of postpartum depression. METHODS: We compared pregnancy data and the Edinburgh Postpartum Depression Scale (EPDS) scores of women who delivered between the pre-alert period (1 Jan 2019 to 4 Jan 2020) and post-alert period (5 Jan 2020 to 30 Apr 2020) in a tertiary university public hospital in Hong Kong. Screening for postpartum depression was performed routinely using the EPDS questionnaire 1 day and within 1 week after delivery. RESULTS: There was a 13.1% reduction in the number of deliveries between 1 January and 30 April from 1144 in 2019 to 994 in 2020. The EPDS scores were available for 4357 out of 4531 deliveries (96.2%). A significantly higher proportion of women had EPDS scores of ≥10 1 day after delivery in the post-alert group than the pre-alert group (14.4% vs 11.9%; P<0.05). More women used pethidine (6.2% vs 4.6%) and fewer used a birthing ball (8.5% vs 12.4%) for pain relief during labour in the post-alert group. CONCLUSIONS: Pregnant women reported more depressive symptoms in the postpartum period following the alert announcement regarding coronavirus infection in Hong Kong. This was coupled with a drop in the delivery rate at our public hospital. Suspension of childbirth companionship might have altered the methods of intrapartum pain relief and the overall pregnancy experience.


Subject(s)
COVID-19 , Delivery Rooms/organization & administration , Depression, Postpartum , Friends/psychology , Infection Control , Patient Care Planning/organization & administration , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Depression, Postpartum/prevention & control , Depression, Postpartum/psychology , Female , Hong Kong/epidemiology , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/organization & administration , Mass Screening/methods , Mass Screening/statistics & numerical data , Organizational Innovation , Pregnancy , Prenatal Care/organization & administration , Prenatal Care/psychology , Prenatal Education/organization & administration , Prevalence , SARS-CoV-2
9.
Arch Womens Ment Health ; 23(6): 767-773, 2020 12.
Article in English | MEDLINE | ID: covidwho-848347

ABSTRACT

The aim of the current study was to assess the risk for post-partum depression among women delivering during the COVID-19 pandemic as compared to the risk among women delivering before the COVID-19 pandemic. A cohort study was performed among women delivering singletons at term which were recruited in the maternity wards of the Soroka University Medical Center. Recruitment was done during the COVID-19 strict isolation period (March 18 and April 29, 2020). Women delivering during the COVID-19 pandemic completed the Edinburgh Postnatal Depression Scale (EPDS), and the results were compared to women delivering at the same medical center before the COVID-19 pandemic. Multivariable logistic regression models were constructed to control for potential confounders. A total of 223 women who delivered during the COVID-19 strict isolation period were recruited. Women delivering during the COVID-19 pandemic had lower risk of having a high (> 10) or very high (≥ 13) EPDS score as compared with women delivering before the COVID-19 pandemic (16.7% vs 31.3%, p = 0.002, and 6.8% vs 15.2%, p = 0.014, for EPDS ≥ 10 and EPDS ≥ 13, respectively). These results remained similar in the multivariable logistic regression models, for both EPDS score ≥ 10 and EPDS score ≥ 13, while controlling for maternal age, ethnicity, marital status, and adverse pregnancy outcomes (adjusted OR 0.4, 95% CI 0.23-0.70, p = 0.001 and adjusted OR 0.3, 95% CI 0.15-0.74, p = 0.007 for EPDS score > 10 and > 13, respectively). In our population, delivering during the COVID-19 pandemic was independently associated with lower risk of post-partum depression.


Subject(s)
COVID-19/psychology , Depression, Postpartum/epidemiology , Pandemics/prevention & control , Quarantine/psychology , Adult , COVID-19/epidemiology , Cohort Studies , Depression, Postpartum/psychology , Female , Humans , Israel/epidemiology , Postpartum Period , Pregnancy , Psychiatric Status Rating Scales , Risk Factors , SARS-CoV-2 , Young Adult
10.
J Affect Disord ; 277: 5-13, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-705984

ABSTRACT

BACKGROUND: Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. METHODS: We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. RESULTS: We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. CONCLUSION: This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections , Depression/epidemiology , Pandemics , Pneumonia, Viral , Pregnant Women/psychology , Stress, Psychological/epidemiology , Adolescent , Adult , Anxiety/psychology , Betacoronavirus , COVID-19 , Canada/epidemiology , Depression/psychology , Depression, Postpartum/epidemiology , Depression, Postpartum/psychology , Female , Health Services Accessibility , Humans , Middle Aged , Pregnancy , Prenatal Care , Risk Factors , SARS-CoV-2 , Social Isolation , Social Support , Stress, Psychological/psychology , Surveys and Questionnaires , Young Adult
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