Association between depressive symptoms in the postpartum period and COVID-19: A meta-analysis

Trajectories of mothers' perinatal depressive symptoms during COVID-19 pandemic lockdowns: The protective role of romantic relationship quality

This study tracked depressive symptoms across the first year of parenthood in two cohorts of mothers recruited during pregnancy: one (n = 99) recruited before spring 2020, and one (n = 615) recruited during the first wave of pandemic lockdowns in spring 2020. We fit a series of multigroup covariance pattern models to our data. Within the pandemic cohort, symptoms were highest during pregnancy and decreased curvilinearly from pregnancy to 6 months postpartum, before leveling off by 12 months postpartum. Nonetheless, depressive symptoms were significantly higher in the pandemic cohort at all time points from pregnancy to 12 months compared to the prepandemic cohort. This effect was weaker among mothers who endorsed greater romantic relationship quality during pregnancy. Namely, pandemic-exposed mothers reporting high relationship quality showed trajectories of depressive symptoms that resembled the prepandemic sample. This evidence of sustained depression risk in pandemic-exposed mothers is of high public health concern given the consequences of perinatal mood disorders. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

COVID-19 and anxiety in pregnancy and postpartum: a longitudinal survey

BACKGROUND

Anxiety is estimated to affect between 15 and 20 per cent of women during pregnancy and postpartum. The COVID-19 pandemic resulted in wide-ranging changes to how people lived, worked and socialised around the world. COVID and pandemic-related restrictions to maternity services may have exacerbated anxiety during pregnancy and the postnatal period. This study aimed to determine: (1) levels of COVID exposure and perceived risk; (2) adherence to Government guidelines and restrictions; and (3) the impact of COVID and COVID-related restrictions on perinatal anxiety and mental health in the UK.

METHODS

A longitudinal survey (n = 2122) of COVID and anxiety in women during early pregnancy, mid-pregnancy, late pregnancy and postpartum.

RESULTS

38.41% of participants had COVID before or during the study. Perinatal anxiety was predicted by participants having poor general health, being of Asian or mixed ethnicity, having previous mental health problems, believing that COVID would make them severely ill, and reporting that COVID had impacted on their mental health. Over time, more women were infected with COVID, and the perceived severity of COVID decreased. Experiencing mild COVID was associated with decreased anxiety at the subsequent time point (mean difference -0.72, 95% CI -1.38 to -0.07, p = 0.030). Very few participants in this sample had severe COVID (2.9%) or reported it having a severe impact on their mental health (5.66%). Most participants (75.3%) said the pandemic had 'no' or a 'slight' impact on their mental health. Pandemic-related restrictions to maternity care affected more women, with around 40% reporting anxiety about being separated from baby, their partner not being with them in labor, or having to leave shortly after the birth. Level of adherence to guidelines was variable, depending on the restriction.

CONCLUSIONS

Findings suggest pandemic-related restrictions caused anxiety for more women than COVID per se. Adherence to guidelines was variable yet the prevalence of COVID infections was low compared to the general population. Findings can be used to inform policy and practice for future pandemics and health-related crises.

Postpartum Depression and Anxiety in COVID-19-Positive and COVID-19-Negative Mothers: Insights From a Dedicated Hospital in Eastern India

Objective Women experienced mental health issues during pregnancy and postpartum, with the prevalence of depression and anxiety varying across different regions during the pandemic. A study was conducted to evaluate the symptoms of postpartum depression (PPD) and anxiety in women who tested positive and negative for COVID-19 and delivered in a tertiary-level hospital in Eastern India during the COVID-19 pandemic from 2020 to 2021. The objective was to explore the clinical and socio-demographic risk factors associated with PPD. Methodology A questionnaire-based cross-sectional study was conducted among women who were either positive or negative for COVID-19 in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences (AIIMS), Patna. A semi-structured questionnaire (the Edinburgh Postnatal Depression Scale (EPDS) questionnaire validated in Hindi) was used to collect socio-demographic and clinical details. The questionnaire included sections on socio-demographic characteristics, knowledge, attitudes, and behaviors related to COVID-19. For the study, the EPDS score was calculated to assess feelings of the last seven days. A score below 8 was indicative of depression not likely, while scores of 9-11 indicated a possibility of depression, and scores of 12-13 suggested a high likelihood of depression. The cut-off score of 12 or higher was used to compare group differences in depression. The anxiety dimension was measured as the cumulative score from items 3, 4, and 5 in the EPDS (EPDS-3A). The sample size was determined to be 51 in each group, assuming a threefold increase in PPD among COVID-19-positive women who delivered at AIIMS Patna, with a study power of 80% and a significance level of 5%. Results A total of 327 candidates were invited to participate, of which 290 completed questionnaires were analyzed, comprising 237 COVID-19-negative and 53 COVID-19-positive mothers. The mean ages, age group distribution, family structure, and residence type were similar in both COVID-19-positive and COVID-19-negative mothers. The prevalence of depression among COVID-19-negative mothers was 13.5% (32/237) with a mean EPDS score of 5.4 ± 3.8 as compared to 39.6% (21/53) with a mean EPDS score of 11.7 ± 3.3 among COVID-19-positive mothers. A statistically significant association of PPD was noted with financial crisis (59.4%) in COVID-19-negative mothers. Poor family support was associated with both COVID-19-negative (81.2%) and COVID-19-positive (66.7%) mothers. Poor availability of medical services (66.7%), societal discrimination (76.2%), and loss of/minimal leisure activities (81%) were significantly associated with COVID-19-positive mothers. Financial crisis (adjusted odds ratio (AOR): 4.3; 95% CI: 1.76-10.38; p = 0.001) and poor family support (AOR: 4.1; 95% CI: 1.33-12.29; p = 0.01) emerged as independent predictors of depression among COVID-19-negative mothers. Among COVID-19 positives, illiteracy (AOR: 2.3; 95% CI: 1.5-9.2; p = 0.01) and social discrimination (AOR: 16.5; 95% CI: 1.9-144.2; p = 0.01) were the independent predictors for PPD. Conclusions The prevalence of PPD and anxiety was found to be three times higher in COVID-19-positive mothers. Significant contributing factors included poor family support, lack of access to antenatal services, societal discrimination, and limited leisure activities during the pandemic. Low literacy and societal discrimination emerged as key predictors of PPD.

Increases in benzodiazepine prescribing for postpartum anxiety during COVID-19

PURPOSE

Postpartum mood disorders affect many women following childbirth. Prescribing medication for depression and anxiety is one strategy for the effective treatment of postpartum mood disorders. Left untreated, mothers experiencing these disorders and their infants face increased risks of adverse health outcomes. Little is known about how diagnosis and treatment of postpartum mood disorders changed during COVID-19.

METHODS

We used a retrospective pooled cross-sectional design in a sample of privately-insured postpartum women in U.S. claims data from January 1, 2016 to December 31, 2020. We measured changes in diagnoses of anxiety and depression and changes in prescription fills and days supplied of classes of medications used to treat these conditions (antidepressants, benzodiazepines, and z-drugs). We used ordinary least squares (OLS) regression for each outcome variable during the pre-pandemic period and forecast expected outcomes the observation period. Forecasted and actual values of the outcomes were then compared.

RESULTS

Following the onset of the COVID-19 pandemic in March 2020, diagnoses of depression and anxiety were not significantly higher among privately insured postpartum women in the United States. The proportion of privately-insured postpartum women filling a benzodiazepine prescription increased by 15.2%.

CONCLUSIONS

We find diagnosis of postpartum mood disorders did not increase after the onset of the COVID-19 pandemic, however, fills of benzodiazepines increased among privately-insured postpartum women. Given prior evidence of increased depressive and anxiety symptoms among postpartum women during COVID-19, this suggests increased barriers to appropriate diagnoses and treatment for depression during this period.

Postpartum depression during the COVID-19 pandemic: an umbrella review and meta-analyses

Introduction

The COVID-19 pandemic has significantly increased anxiety, stress, and depression, which could have harmful consequences for pregnant women. Therefore, this study aimed to investigate the prevalence of postpartum depression during COVID-19 using an umbrella review and meta-analysis.

Methods

The current study followed the PRISMA guideline and utilized data from various sources such as PubMed, Scopus, Web of Science, and Google Scholar. The searches were conducted without a time limit until the end of May 2023. Meta-analysis was performed using the random effects model, heterogeneity was assessed using the I2 index, and publication bias was evaluated using Begg's test. Data analysis was carried out using STATA software (version 15).

Results

In this study, 243 articles were initially identified. Only meta-analysis studies that reported PPD during COVID-19 were included. After quality assessment, nine papers were selected for the meta-analysis stage. The study found that the prevalence postpartum depression (PPD) was 25.27% (95% CI = 23.66-27.86, I2 = 0.0%, p = 0.549).

Conclusion

The findings of this study revealed that the incidence of PPD during the COVID-19 pandemic was relatively high. To decrease mental health issues among pregnant and postpartum women, healthcare professionals should implement community programs aimed at preventing, promptly identifying, and providing appropriate intervention for pregnant women. This is crucial as pregnant women are particularly vulnerable to psychological distress during infectious disease outbreaks.

Caregiver and Child Mental Health During 3 Years of the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Coronavirus disease 2019 (COVID-19) lockdowns (stay-at-home orders) had significant mental health consequences in 2020 to 2021 for caregivers and children. Little is known about "postlockdown" periods in 2022 to 2023. We investigated the mental health experiences of Australian families throughout the 3 years of the COVID-19 pandemic (2020-2023), by demographic characteristics and lockdown length.

METHODS

A total N = 12 408 caregivers (N = 20 339 children, aged 0-17 years) completed Australia's only representative, repeated, cross-sectional, National Child Health Poll across 6 waves (June 2020-April 2023). Caregivers reported mental health for themselves (Kessler-6, poor versus not) and each child (self-rated mental health, poor/fair versus good/very good/excellent), and perceived impacts of the pandemic on own/child mental health (negative versus none/positive). Binary logistic models were fitted to predict marginal probabilities of each mental health measure by state/territory group (proxy for lockdown length), over time, adjusted for potential demographic confounders.

RESULTS

Poor caregiver Kessler-6 was similar between genders but more common for sole caregivers, and those with a home language other than English and lower education. Poor/fair child self-rated mental health was similar between genders and increased with child age. Perceived negative impacts were more common for females and socially advantaged caregivers. Overall, negative mental health experiences increased with lockdown length, peaking with the height of lockdown in July 2021, before declining.

CONCLUSIONS

Negative mental health experiences of Australian caregivers and children decreased during postlockdown periods of 2022-2023; however, social gradients persisted. These data can inform more precise mental health policies that enable better use of limited mental health infrastructure.

Correlation of lifestyle behaviors during pregnancy with postpartum depression status of puerpera in the rural areas of South China

Background

Postpartum depression (PPD) is among the most common postpartum complications. Its prevalence is associated with strong regional variability. Women in rural areas of China have a high risk of PPD. The aim of this study was to investigate the PPD status of women in rural South China and explore the effects of modifiable lifestyle behaviors during pregnancy on their PPD status, thereby providing a scientific basis for the prevention and intervention of PPD in rural China.

Methods

A cohort study was conducted on 261 women from four maternal health institutions situated in rural areas of Guangdong Province and the Guangxi Zhuang Autonomous Region from October 2021 to December 2022. The questionnaires were administered to these women to obtain data about sociodemographic characteristics, health literacy, physical activity during pregnancy, and sleep and dietary status during pregnancy, as well as depression status on the 42nd day after delivery. The lifestyle behaviors during pregnancy and the PPD status of the study population were analyzed. Multiple linear regression models were used to determine the correlation between lifestyle behaviors and PPD status. Path analysis was performed to explore the interaction between various lifestyle behaviors.

Results

A total of 14.6% of women had a PPD status. Women who continued to work during pregnancy had an Edinburgh Postpartum Depression Scale (EPDS) score of 1.386 points higher than that of women who did not (В = 1.386, β = 0.141, p = 0.029). For every 1-point increase in the infant feeding-related knowledge score and pregnancy diet diversity score, the EPDS score decreased by 0.188 and 0.484 points, respectively, and for every 1-point increase in the Pittsburgh sleep quality index score, the EPDS score increased by 0.288 points. Age was related to infant feeding-related knowledge (indirect path coefficient = 0.023). During pregnancy, sedentary time was correlated with sleep quality (indirect path coefficient = 0.031) and employment status (indirect path coefficient = 0.043).

Conclusion

Employment status, infant feeding-related knowledge, sleep quality, and diet diversity during pregnancy directly influenced the PPD status, while age and sedentary time during pregnancy indirectly influenced the PPD status. Promoting healthy lifestyle behaviors, including reducing sedentary time, improving sleep quality, and increasing dietary diversity, may be effective in reducing PPD occurrence.

Effect of Postpartum Depression on Infant Safety Practices in Korea

OBJECTIVE

To describe the prevalence of postpartum depression in a sample of Korean women and to examine the effect of postpartum depression on their adoption of safety practices for their infants.

DESIGN

Secondary, cross-sectional.

SETTING

South Korea.

PARTICIPANTS

A total of 3,127 women who gave birth in 2020.

METHODS

We applied a complex sample design analysis using the national survey data on postpartum care in South Korea. We analyzed the data using weighted multivariate logistic regression to determine the association between postpartum depression and the adoption of five safety practices for infants.

RESULTS

A total 42.7% (n = 1,319) of our participants had symptoms of postpartum depression during the initial 7 days after birth. Participants who had postpartum depression were less likely to engage in certain safety practices for infants.

CONCLUSION

We propose a proactive approach to promote an improved policy for postpartum depression screening alongside a comprehensive program that offers guidance and education to mothers suffering with postpartum depression. The primary objective is to empower these mothers with essential skills that can effectively ensure the safety of their infants.

Knowledge, attitude, and practice toward postpartum depression among the pregnant and lying-in women

BACKGROUND

Postpartum depression (PPD) is considered an important public health problem, and early recognition of PPD in pregnant and lactating women is critical. This study investigated the knowledge, attitude, and practice (KAP) toward PPD among pregnant and lying-in women.

METHODS

This cross-sectional study was conducted at Binzhou Medical University Hospital between September 2022 and November 2022 and included pregnant and lying-in women as study participants. A questionnaire was designed by the researchers that included demographic data and knowledge, attitude, and practice dimensions. Correlations between knowledge, attitude, and practice scores were evaluated by Pearson correlation analysis. Factors associated with practice scores were identified by multivariable logistic regression.

RESULTS

All participants scored 6.27 ± 2.45, 36.37 ± 4.16, and 38.54 ± 7.93 93 from three sub-dimensions of knowledge, attitudes, and practices regarding PPD, respectively, with statistical differences in the three scores by age, education, and job status (p < 0.05). There were no significant differences between maternal (6.24 ± 2.34, 36.67 ± 3.82 and 38.31 ± 7.27, respectively) and pregnant women (6.30 ± 2.49, 36.00 ± 4.53 and 38.83 ± 8.69, respectively) in the total scores of knowledge, attitude, and practice dimensions. According to the results of multivariate logistic regression, the knowledge (OR = 1.235[1.128-1.353], P < 0.001) and attitude (OR = 1.052[1.005-1.102], P = 0.030) dimension scores were factors influencing the practice dimension scores.

CONCLUSION

The KAP of pregnant and lying-in women toward PPD is low. This study suggests that maternal awareness of PPD should be increased through the knowledge and attitudinal dimensions. Preventing PPD in pregnant and lying-in women can be achieved by improving both dimensions, thus enhancing practice.

The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014-2020)

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.

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis

Background

While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors.

Methods

This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included.

Results

Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I ² = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I ² = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I ² = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I ² = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I ² = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I ² = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I ² = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I ² = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I ² = 0%) showed an increase of PPDS during the COVID-19 period.

Conclusions

The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.