Communication Across Maternal Social Networks During England's First National Lockdown and Its Association With Postnatal Depressive Symptoms

Social support during pregnancy and the risk of postpartum depression in Polish women: A prospective study

Social support has been proposed as an important determinant of women's physical and emotional well-being during pregnancy and after childbirth. Our study aimed to examine the association between the risk of postpartum depression (PPD) and perceived social support during pregnancy. A web-based prospective study survey was conducted among Polish women. The level of social support was measured with the Berlin Social Support Scales during pregnancy. Four weeks after the birth the risk of PPD was assessed using the Edinburgh Postpartum Depression Scale. Data from 932 mothers aged 19-43 (mean 30.95; SD 3.83) were analyzed using multinomial logistic regression. Higher perceived available support (emotional and instrumental), currently received support (emotional, instrumental and informational), satisfaction with the support, and sum of score were all associated with lower risk of PPD, after controlling for selected covariates (woman's age, socioeconomic status, parity status, place of residency, education, child's Apgar score, type of delivery, complications during birth, kin assisting the labor, breastfeeding). Our results suggest that the more social support the pregnant woman receives, the lower is her risk of PPD. Since humans evolved as cooperative breeders, they are inherently reliant on social support to raise children and such allomaternal help could improve maternal well-being.

The impact of postpartum social support on postpartum mental health outcomes during the COVID-19 pandemic

Social support is an influential component of postpartum recovery, adjustment, and bonding, which was disrupted by social distancing recommendations related to the COVID-19 pandemic. This study reports on changes in the availability of social support for postpartum women during the pandemic, investigates how those changes may have contributed to postpartum mental health, and probes how specific types of social support buffered against poor postpartum mental health and maternal-infant bonding impairment. Participants were 833 pregnant patients receiving prenatal care in an urban USA setting and using an electronic patient portal to access self-report surveys at two time points, during pregnancy (April-July 2020) and at ~12 weeks postpartum (August 2020-March 2021). Measures included an assessment of COVID-19 pandemic-related change in social support, sources of social support, ratings of emotional and practical support, and postpartum outcomes including depression, anxiety, and maternal-infant bonding. Overall self-reported social support decreased during the pandemic. Decreased social support was associated with an increased risk of postpartum depression, postpartum anxiety, and impaired parent-infant bonding. Among women reporting low practical support, emotional support appeared to protect against clinically significant depressive symptoms and impaired bonding with the infant. Decreases in social support are associated with a risk for poor postpartum mental health outcomes and impaired maternal-infant bonding. Evaluation and promotion of social support are recommended for healthy adjustment and functioning of postpartum women and families.

Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study

Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.

First-generation Nigerian mothers living in the UK and their experience of postnatal depression: an interpretative phenomenological analysis

OBJECTIVE

Previous studies emphasise the negative psychological and physical consequences of Postnatal Depression (PND) on mothers and children's health. In the UK, around 10-20% of women can be affected by perinatal mental health problems. Minority ethnic groups such as Black African mothers are considered to be at greater risk of developing PND and data estimates that immigrant mothers are twice more likely to develop PND than native mothers. The unique experiences and needs of this culturally diverse group remain little explored in the UK. To address this gap in the literature, this study aimed to explore the lived experiences of First-Generation Nigerian Mothers (FGNMs) who suffered PND, their coping behaviours and treatment experiences in the UK.

DESIGN

Six FGNMs with a previous diagnosis of PND and treatment experiences were purposefully recruited from GP practices and social groups attended by Nigerian mothers in the UK. Semi-structured interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Three master and seven subordinate themes were identified: (i) Socio-cultural factors (Inter-generational transmission; cultural perceptions: shame and stigma; transitions: adjusting to a new culture); (ii) What about me? The neglected nurturer (experiences of treatment; pretending to be OK); and (iii) Loneliness and coping (lack of support from partner; self-reliance).

CONCLUSIONS

The study provides evidence about the difficulties encountered by FGNMs in relation to PND, including socio-cultural factors, neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that Black ethnic groups do not seek help for their mental health needs, participants' accounts indicated that their attempts to engage with professionals were met with unsatisfactory responses. The findings highlight the need to address barriers affecting access to services by fostering a patient-centred and culturally sensitive approach in healthcare teams to effectively engage mothers at an early stage in the detection pathway.

Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study

Background

Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA.

Methods

Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored.

Results

Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude.

Conclusion

These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.

The impact of COVID-19 lockdown on postpartum mothers in London, England: An online focus group study

Aims

This study examines the impact of COVID-19 lockdown on postpartum mothers in England, with the aim of identifying opportunities to improve maternal experience and wellbeing. The postpartum/postnatal period is widely acknowledged as a time when mothers require greater levels of support from multiple sources. However, stay-at-home orders, commonly known as "lockdown," deployed in some countries to limit COVID-19 transmission reduced access to support. In England, many postpartum mothers navigated household isolation within an intensive mothering and expert parenting culture. Examining the impact of lockdown may reveal strengths and weaknesses in current policy and practice.

Subject and methods

We conducted online focus groups involving 20 mothers living in London, England, with "lockdown babies," following up on our earlier online survey on social support and maternal wellbeing. We thematically analysed focus group transcripts, and identified key themes around Lockdown Experience and Determinants of Lockdown Experience.

Results

Participants raised some positives of lockdown, including fostering connections and protection from external expectations, but also raised many negatives, including social isolation, institutional abandonment, and intense relationships within the household. Potential reasons behind variations in lockdown experience include physical environments, timing of birth, and number of children. Our findings reflect how current systems may be "trapping" some families into the male-breadwinner/female-caregiver family model, while intensive mothering and expert parenting culture may be increasing maternal stress and undermining responsive mothering.

Conclusions

Facilitating partners to stay at home during the postpartum period (e.g., increasing paternity leave and flexible working) and establishing peer/community support to decentre reliance on professional parenting experts may promote positive postpartum maternal experience and wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01922-4.

Prevalence and Factors of Postpartum Depression During the COVID-19 Pandemic: A Review

The COVID-19 (Coronavirus Disease 2019) pandemic has led to several mandatory prevention regulations, changes in healthcare services, unprecedented unemployment rates, financial stress, and emotional worries. Given the increasing cases of COVID-19, coupled with the drastic physical and psychological changes within postpartum mothers during the postpartum period, this paper aims to present an overview of the postpartum depression (PPD) among postpartum women during the COVID-19 pandemic. The postpartum period is characterized by drastic physical changes and substantial demands on parental role adjustment, and it places enormous stress on the mothers and makes them vulnerable to mental health problems. A literature search was conducted in four electronic databases (ScienceDirect, Scopus, Wiley, and SAGE) with different combinations of keywords were used. As the result, 25 articles that involved 10,515 postpartum women from 14 countries were extracted. Results have recorded PPD prevalence ranged from 6.4% to 56.9% during the COVID-19 pandemic. Limited social support, social isolation, fear of COVID-19 exposure, or infection for themselves, newborns, have worsening PPD symptoms among postpartum women. In brief, early detection, appropriate and timely intervention is needed to prevent and identify PPD among postpartum women during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04181-w.

Insights into women's experiences of giving birth during the coronavirus disease-19 pandemic in Jordan, a cross-sectional survey

BACKGROUND

Since 2019, the coronavirus disease-19 pandemic and its consequences from restrictions to risks have impacted our lives in all aspects. Pregnant women are especially vulnerable to the changes that were implemented as a result of the shift in healthcare priorities and the medical and social implications of the lockdown.

OBJECTIVES

This study aimed to assess the experience of giving birth during the pandemic, how this is affected by acquiring coronavirus disease-19 infection, and its effect on postnatal mood.

DESIGN

A cross-sectional study was conducted which involved 490 women who gave birth during the pandemic across the Hashemite Kingdom of Jordan.

METHODS

An electronic questionnaire was distributed among women experiencing childbirth during this period in Jordan by advertising it on social media platforms targeting pregnant women and mothers. The sample size was statistically determined to be representative of the population. Statistical analysis was performed using Statistical Package for the Social Sciences for Windows v.27.

RESULTS

The study demonstrated that getting infected with the virus throughout the pregnancy did not affect the childbirth experience with respect to the parameters measured, but other factors during the pandemic such as the type of hospital and mode of delivery did. Positive interaction with staff in the delivery suite was a major determinant of a positive birth experience. Women associated low mood post-delivery with giving birth in pandemic circumstances, and it affected first-time mothers more than multiparous women.

CONCLUSION

Although the acquisition of coronavirus disease-19 infection did not have a significant impact on women's childbirth experience, several pandemic-related factors did. Given the importance of a woman's perception and evaluation of events surrounding her birth experience in determining her postnatal physical and psychological well-being, having to give birth during the pandemic circumstances, especially for first-time mothers, can have potentially detrimental consequences that may affect her health and reproductive choices in the future. The results of this study offer a better understanding of the effect of pandemic and lockdown circumstances on the perceived experience of mothers during childbirth and postnatally and factors that should be taken into consideration when planning healthcare provision to this population in future similar conditions.

Associations between breastfeeding intention, breastfeeding practices and post-natal depression during the COVID-19 pandemic: A multi-country cross-sectional study

Associations between breastfeeding intention, duration and post-natal depression (PND) have been shown in pre-COVID-19 studies. However, studies during COVID-19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post-natal women, taking into consideration COVID-19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID-19, and have important long-term effects on women's and infant's health. A cross-sectional internet-based survey was conducted with 3253 post-natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID-19-related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic.

Beware the "loneliness gap"? Examining emerging inequalities and long-term risks of loneliness and isolation emerging from COVID-19

Emerging evidence suggests COVID lockdowns have not only increased the social problem of loneliness but widened the 'loneliness gap' between the most and least lonely people. Qualitative investigation can reveal why this gap might have increased, for whom, and whether the loneliness gap will remain long term. Using multi-wave qualitative survey data conducted during Australia's 2020 lockdown period and beyond, we examine personal experiences of interaction transitioning out of lockdown. We find substantial and uneven impacts of COVID lasting well beyond lockdown. Participants reported heightened loneliness attributable to: physical isolation, health anxieties, ceased activities, reduced connection quality, and poor motivation. COVID also created new interactive difficulties for singles, those with physical and mental disabilities, their carers, and those with low social capital. There was also reported 'pruning' of social networks (i.e. reduced bridging, increased bonding social capital), and evidence that increased digital interaction did not substitute for lost physical contact. Younger people also experienced isolating COVID-induced life disruptions (e.g. travel, university attendance etc). Findings suggest COVID has increased potential long-term inequalities in loneliness, highlight the post COVID risks faced by vulnerable groups, and suggest caution in advocating digital solutions as a panacea for diminished physical interaction in the post-pandemic world.

"Showing Everybody's True Colors": Informal networks of low-income single mothers and their young children during the COVID-19 pandemic

Extensive evidence suggests low-income mothers depend upon their families and friends for emotional, practical, and economic support in times of need. This is the first study to examine the operation of low-income mothers' informal support networks and the impact of such networks on maternal well-being during the COVID-19 pandemic. We interviewed low-income, single mothers of young children (<12 years; N = 34) twice over Summer 2020 to consider mothers' decisions around network engagement and how their interactions contributed to their well-being. Consistent with the social capital framework and previous studies, most mothers turned to their networks and exchanged support. Thematic analysis uncovered 4 inter-related themes of mothers' experiences: (1) discovering emotionally-available networks, (2) navigating resource-limited networks, (3) reassessing network member relationships, and (4) establishing boundaries for in-person contact. Although emotionally valuable, networks could not meet increased economic and child care needs. The COVID-19 pandemic's economic impact and its impact on time use tested network relationships with some relationships strengthening and others dissolving. Widely-available emotional support was essential to mothers adapting to the pandemic. Safe, affordable child care options coupled with accessible, economic supplements can promote well-being among single mothers and their children.

Mental Health in Obstetric Patients and Providers During the COVID-19 Pandemic

Psychiatric morbidity is the most common childbirth complication with 1 in 5 women experiencing a perinatal mood or anxiety disorder. The cost of this psychiatric morbidity is pervasive, contributing to devastating maternal health, child developmental, and economic consequences. The coronavirus disease 2019 (COVID-19) pandemic, and associated changes to perinatal experiences, resulted in profound psychological reactions including increased anxiety, depression, stress disorders, and sleep disturbance, further impacting obstetric patients. Providers' mental health has been challenged by moral injury and shared trauma. This article reviews mental health outcomes in regard to the COVID-19 pandemic for obstetric patients and their providers.

Prevalence of postpartum depression in women amid the COVID-19 pandemic: A systematic review and meta-analysis

COVID‐19 outbreaks appear to be related to exacerbation of psychological problems such as depression and anxiety in high‐risk population such as pregnant women and the postpartum period due to stress and life‐threatening illnesses. The aim of this study was to evaluate the prevalence of postpartum depression (PPD) during COVID‐19. This study protocol is registered in PROSPERO with CRD42021278425 code. Data sources including Google Scholar, ISC, Magiran, Scopus, PubMed, Embase, and Web of Science and reference list of included articles were used to identify related studies. Observational studies that reported the prevalence of PPD in both Persian and English during COVID‐19 between January 20, 2020 and August 31, 2021 were included. Data were collected and analyzed with a random effects model for meta‐analysis. In this study, 671 initial articles were identified and after removing duplicates, 454 studies were screened and finally 24 studies entered the meta‐analysis stage. According to this study results PPD based on Edinburgh Postnatal Depression Scale (EPDS) ≥9, EPDS ≥10, EPDS ≥11, EPDS ≥12, EPDS ≥13, Postpartum Depression Screening Scale‐Short Form (PDSS‐SF) ≥17 and total prevalence was reported 12% (95% confidence interval [CI] = 0.07–17, I² = 97%), 27% (95% CI = 15–39, I² = 99%), 44% (95% CI = 40–49, I² = 0.0%), 27% (95% CI = 0.06–49, I² = 97.4%), 28% (95% CI = 18–39, I² = 98.5%), 37% (95% CI = 32–42), 28% (95% CI = 23–33, I² = 98.5%). The findings of this study showed that the prevalence of PPD in women is relatively high during COVID‐19. Therefore, considering the psychological consequences of the COVID‐19 pandemic and the importance of pregnancy and the postpartum period in terms of the emergence of mental disorders, especially depression, it seems necessary to perform interventions and physical and psychological support.

The present study found that the prevalence of postpartum depression( PPD) in women is relatively high during COVID‐19.

Health visiting in England: The impact of the COVID-19 pandemic

This focused review of evidence considers the impact of the pandemic in 2020 on families with children under 5 years in England, and the health visiting (HV) service that supports them. . Data were drawn from national surveys of health visitors (HVs) and parents, a freedom of information request of employers, published research, and national data. Framework analysis and triangulation, using the Key Elements of an effective HV service, were used to categorize the key findings. The findings from the review indicate that the impacts of the pandemic were wide-ranging and disproportionately affected the most disadvantaged families, increasing demand for HV support. HVs' ability to respond was compromised due to national policy decisions to partially stop the service and variations in local implementation including the redeployment of HVs, pre-existing workforce capacity issues, and the effectiveness of innovations to identify and support vulnerable families. The pandemic exacerbated factors that can lead to poorer outcomes for families. Key learning from the pandemic response, including the need to prioritize the HV service, must be acted upon to reduce ongoing impacts now and ensure that the service is equipped for future emergencies.

Welcoming new life under lockdown: Exploring the experiences of first-time mothers who gave birth during the COVID-19 pandemic

Objectives

This study aimed to explore how first‐time mothers in the UK experienced new parenthood during the coronavirus (COVID‐19) pandemic.

Design

This study used a cross‐sectional exploratory, qualitative interview design.

Methods

Semi‐structured interviews were conducted with ten first‐time mothers who had given birth since COVID‐19 was declared as a pandemic. Verbatim transcripts were analysed using reflexive thematic analysis.

Result

Experiences of new, first‐time mothers during the COVID‐19 pandemic were organized around two themes. First, new mothers felt an overwhelming sense of responsibility for their baby which was heightened by the pandemic. The challenge of meeting this responsibility was heightened in the context of societal expectations to do the ‘right’ thing and uncertainty and distrust around official guidance about COVID‐19. Secondly, the expected transition into motherhood was altered by the pandemic. Disruption to the birthing experience, an inability to connect with close friends and family, and limited healthcare support was perceived to be detrimental. However, altered social expectations and the increased presence of the partner were perceived as positives.

Conclusion

Many of the common challenges experienced by new, first‐time mothers have been amplified by the COVID‐19 pandemic. Public policy and scientific research must target this group in order to protect this population from the negative impact of the remaining COVID‐19 pandemic and any future pandemics.

Behavioral Ecology of the Family: Harnessing Theory to Better Understand Variation in Human Families

Researchers across the social sciences have long been interested in families. How people make decisions such as who to marry, when to have a baby, how big or small a family to have, or whether to stay with a partner or stray are questions that continue to interest economists, sociologists, demographers, and anthropologists. Human families vary across the globe; different cultures have different marriage practices, different ideas about who raises children, and even different notions of what a family is. Human behavioral ecology is a branch of anthropology that is particularly interested in cultural variation of family systems and how these differences impact upon the people that inhabit them; the children, parents, grandparents. It draws on evolutionary theory to direct research and generate testable hypotheses to uncover how different ecologies, including social contexts, can explain diversity in families. In this Special Issue on the behavioral ecology of the family, we have collated a selection of papers that showcase just how useful this framework is for understanding cultural variation in families, which we hope will convince other social scientists interested in family research to draw upon evolutionary and ecological insight in their own work.