Cumulative effects of pre-pandemic vulnerabilities and pandemic-related hardship on psychological distress among pregnant individuals

Psychological Distress in Childbearing Persons During the COVID-19 Pandemic: A Multi-Trajectory Study of Anger, Anxiety, and Depression

Psychological distress can manifest as depression, anxiety, and anger in the perinatal period. These conditions are often comorbid yet studied in isolation. A full understanding of perinatal psychopathology requires the spectrum of common psychological distress to be studied concurrently to better understand interconnected symptoms. A transdiagnostic approach provides valuable insights into how symptoms interact and cumulatively affect mental health, which can inform more effective screening and treatment strategies. This, in turn, can improve outcomes for birthing parents experiencing psychological distress. We undertook group-based multi-trajectory modeling (GBMTM) to uncover the patterns of affective disorders (anger, anxiety, and depression) over three-time points (pregnancy, 3-, and 12-months postpartum (mPP)) in a large longitudinal cohort of persons who gave birth during the COVID-19 pandemic (n = 2145). We identified five trajectory groups: high-stable (11.3%), postpartum-increase (16.0%), postpartum-decrease (21.5%), low-stable (37.9%), and minimal stable (13.2%) symptoms of anger, anxiety, and depression. Multinomial regression revealed that lower levels of sleep disturbance, less financial hardship, and lower intolerance of uncertainty predicted postpartum decreases in psychological distress compared with the high stable group. Higher levels of sleep disturbance, greater financial hardship, lower level of social support, and greater intolerance of uncertainty predicted postpartum increases in psychological distress compared with the low-stable and minimal-stable groups. Screening for psychological distress symptoms (i.e., anger, anxiety, and depression), paired with access to evidence-based management for those who screen positive, is warranted during the first postpartum year to reduce the harmful effects of unmanaged distress on families.

The impact of the early COVID-19 pandemic on maternal mental health during pregnancy and postpartum

PURPOSE

The aim of this study was to investigate the effects of the COVID-19 pandemic on maternal mental health during pregnancy and the postpartum period.

METHODS

The impact of the COVID-19 pandemic situation during and post pregnancy was addressed on three main factors; maternal mental health, mother-child bonding, and maternal self-confidence. To do this, two different patient cohorts were compared; data from one cohort was collected pre-pandemic, and data was collected from the other cohort at the beginning of the pandemic. Questionnaires were used to collect data regarding depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS]), anxiety (State Trait Anxiety Inventory [STAI]), maternal self-confidence (Lips Maternal Self-Confidence Scale [LMSCS]) and mother-child bonding (Postpartum Bonding Questionnaire [PBQ]).

RESULTS

There were no significant differences in depressive symptoms (EPDS with an average median of 4.00-5.00) or anxiety (STAI with an average median of 29.00-33.00) between the cohorts. However, the quality of postpartum maternal bonding was higher at 3-6 months in the pandemic cohort, which was also influenced by education and the mode and number of births. The maternal self-confidence was lower in the pandemic sample, also depending on the mode of birth delivery.

CONCLUSIONS

In this study, a differential effect of the COVID-19 pandemic on mother-child bonding and maternal self-confidence was observed. The results thereby identified possible protective factors of the pandemic, which could potentially be implemented to improve maternal mental health and bonding to the child under normal circumstances.

Language learning in the context of a global pandemic: proximal and distal factors matter

BACKGROUND

Public health measures implemented during the COVID-19 pandemic fundamentally altered the socioecological context in which children were developing.

METHODS

Using Bronfenbrenner's socioecological theory, we investigate language acquisition among 2-year-old children (n = 4037) born during the pandemic. We focus on "late talkers", defined as children below the 10th percentile on the MacArthur-Bates Communicative Development Inventories-III.

RESULTS

Overall, the proportion of late talkers declined as a function of pandemic wave, with 13.0% of those born during the first wave classified as late talkers compared to 10.4% born in wave two, and 8.0% born during wave three. In sex-based analysis, we observed a 15.9% prevalence of late talking among female toddlers, which was significantly different from the norming sample. In contrast, the prevalence of late talking among male toddlers was 9.1%. Using hierarchical logistic regression to identify both proximal and distal factors associated with being a late talker, we found that male sex, lower socioeconomic status, greater screen time, receiving childcare at home, disruptions to childcare, and experiencing greater exposure to public health restrictions were associated with increased odds for being a late talker.

CONCLUSION

We interpret the findings in relation to the need to consider the special needs of young children in disaster preparation and response.

IMPACT

Two-year-old children acquiring language in the context of the COVID-19 pandemic have vocabulary size similar to historical norms. A higher-than-expected prevalence of late talkers (below the 10th percentile) was observed among females and children born during the first wave of the pandemic. Motivated by Bronfenbrenner's socioecological theory, we show that both proximal and distal environmental factors are associated with vocabulary size. Infants exposed to stricter public measures had reduced vocabulary size. The findings suggest a need to recognize the developmental needs of children as part of the public health response to emergencies.

Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic

OBJECTIVES

This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors.

DESIGN

The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic.

SETTING

Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021.

PARTICIPANTS

The study included 336 self-identifying Indigenous pregnant persons in Canada.

RESULTS

Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic.

CONCLUSIONS

Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.