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

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.

Association Between Postpartum Depression and Personality Traits Among Japanese Postpartum Mothers and Fathers

Background/Objectives: Although numerous investigations have been conducted on postpartum depression, studies on the association between postpartum depression and personality traits of mothers and fathers are lacking. This study aimed to examine the association between postpartum depression and the Big Five personality models among Japanese mothers and fathers at one-month health check-ups. Methods: The participants were 82 couples, and they responded to the Edinburgh Postnatal Depression Scale (EPDS), the Japanese version of the Ten-Item Personality Inventory, and the Quality of Marriage Index (QMI). We examined the correlations among variables and analyzed the data using structural equation modeling (SEM). Results: Maternal neuroticism was significantly associated with maternal depression (β = 0.50, p < 0.001), and maternal extraversion was significantly associated with paternal depression (β = -0.64, p < 0.001). In addition, we found that maternal postpartum depression was associated with maternal marital satisfaction (r = -0.29, p = 0.037); however, this association disappeared in SEM. Conclusions: Our findings suggest that health practitioners should pay attention to depression and personality traits in both postpartum mothers and fathers. Moreover, we should consider the different associations between depression and personality in parents when initiating interventions.

Prevalence and treatment of perinatal anxiety: diagnostic interview study

BACKGROUND

Anxiety affects around one in five women during pregnancy and after birth. However, there is no systematic information on the proportion of women with perinatal anxiety disorders who want or receive treatment.

AIMS

To examine (a) the prevalence of anxiety disorders during pregnancy and after birth in a population-based sample, and (b) the proportion of women with anxiety disorders who want treatment and receive treatment.

METHOD

This study conducted 403 diagnostic interviews in early pregnancy (n = 102), mid-pregnancy (n = 99), late pregnancy (n = 102) or postpartum (n = 100). Participants also completed self-report measures of previous/current mental health problems and desire for treatment at every time point.

RESULTS

The prevalence of anxiety disorders over all time points combined was 19.9% (95% CI 16.1-24.1), with greatest prevalence in early pregnancy (25.5%, 95% CI 17.4-35.1). The most prevalent disorders were obsessive-compulsive disorder (8.2%, 95% CI 5.7-11.3) and generalised anxiety disorder (5.7%, 95% CI 3.7-8.4). The majority of women with anxiety disorders did not want professional help or treatment (79.8%). Most women with anxiety disorders who did want treatment (20.2%) were receiving treatment. The majority of participants with anxiety disorders had a history of mental health problems (64.6%).

CONCLUSIONS

Prevalence rates overall are consistent with previous research, lending validity to the findings. However, findings challenge the assumption that everyone with a psychological disorder wants treatment. These findings highlight the importance of relationship-based care, where individual needs and contextual barriers to treatment can be explored.

Prevalence and risk factors of perinatal depression among mothers and fathers in Pakistan: a systematic review and meta-analysis

Background

Perinatal mental health issues affect approximately 10% of women in high-income countries and 30% in low- or middle-income countries. This review aims to determine the prevalence of perinatal depression among mothers and fathers in Pakistan and identify associated risk factors.

Methods

We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included quantitative studies on the prevalence or incidence of maternal and paternal perinatal depression, including antenatal or postnatal depression in Pakistan, with or without associated risk factors. We performed an electronic search, dual-title/abstract and full-text screening, and data extraction. Analysis was conducted on Revman and JBI SUMARI software. The quality of the included studies was assessed with the NHLBI tool. This review updated a previously published review that included 43 studies, with the last search date of 31st May 2019, now extended to literature published up to June 30, 2023.

Results

Consistent with the previous review, our analysis of 61 studies indicated a pooled prevalence of 37% (95% confidence interval (CI): 30.6-43.6) for maternal antenatal depression. Postnatal depression at different time points, revealed rates of 34.2% (95% CI: 22.7-46.7), 40.9% (95% CI: 0-97.4), and 43.1% (95% CI: 24.4-62.9) at 3, 6 and 12 months, respectively. Paternal postnatal depression was observed at 40.5% (95% CI: 14.9-69) based on two studies. Risk factors for maternal perinatal depression include multiparity, contraceptive failure, inadequate antenatal care, pregnancy-induced hypertension, previous psychiatric illness, passive smoking, drug abuse, low socio-economic status, marital problems, family hardships, recent bereavement, housing difficulties, food insecurity, husband's illiteracy, his unemployment, and being blamed for child disability.

Conclusion

The findings reveal a high prevalence of perinatal depression among mothers with very limited evidence of fathers residing in Pakistan, emphasising the need for prospective studies addressing mental health challenges.

Registration

This review is registered on PROSPERO (CRD42023442581).

The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England

BACKGROUND

Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS.

METHODS

Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS.

FINDINGS

Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk.

INTERPRETATION

Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.

Everyday discrimination and satisfaction with nature experiences

Introduction

There is growing interest in creating public green spaces to promote health. Yet, discussions about these efforts often overlook how experiences of chronic discrimination-which may manifest as racism, sexism, or homophobia, and more-could undermine satisfaction with nature experiences.

Methods

Using data from the 2018 wave of the National Opinion Research Center (NORC) General Social Survey (GSS), we quantified associations of frequency of everyday discrimination, operationalized using the Everyday Discrimination Scale (EDS, the primary independent variable), with respondents' perceptions of nature experiences and with their reported time spent in nature. Specifically, we quantified associations with the following three variables: (1) dissatisfaction with day-to-day experiences of nature, (2) not spending as much time as they would like in natural environments, and (3) usually spending at least one day per week in nature. We used survey-weighted robust Poisson models to estimate overall associations, and also stratified analyses by racial/ethnic and gender identity categories.

Results

Of 768 GSS respondents, 14% reported dissatisfaction with nature experiences, 36% reported not spending as much time as they would like in nature, and 33% reported that they did not spend at least one day per week in nature. The median non-standardized EDS, coded such that a higher value indicates greater frequency of discrimination, was 11 (interquartile range: 8, 15). Prevalence of reporting dissatisfaction with day-to-day experiences in nature was 7% higher in association with every one unit increase in EDS score above the median (PR: 1.07, 95% CI: 1.02-1.11). The prevalence of reporting not spending as much time as one would like in nature was 2% higher for every unit increase in higher than median everyday discrimination frequency (PR: 1.02, 95% CI: 1.00-1.05). Higher than median frequency in everyday discrimination was not associated with spending less than one day per week in nature. Race/ethnicity and gender identity did not modify associations.

Conclusion

Greater frequency of everyday discrimination is associated with less satisfaction with experiences in nature. This relationship could undermine efforts to promote health equity through green interventions.