Effects of COVID-19 Epidemic Lockdown on Postpartum Depressive Symptoms in a Sample of Italian Mothers

Disparities in spatiotemporal clustering of maternal mental health conditions before and during the COVID-19 pandemic

Mounting evidence indicates the worsening of maternal mental health conditions during the COVID-19 pandemic. Mental health conditions are the leading cause of preventable death during the perinatal and postpartum periods. Our study sought to detect space-time patterns in the distribution of maternal mental health conditions in pregnant women before (2016-2019) and during (2020-2021) the COVID-19 pandemic in North Carolina, USA. Using the space-time Poisson model in SaTScan, we performed univariate and multivariate cluster analysis of emergency department (ED) visits for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), maternal mental disorders of pregnancy (MDP), suicidal thoughts, and suicide attempts during the pre-pandemic and pandemic periods. Clusters were adjusted for age, race, and insurance type. Significant multivariate and univariate PMAD, SMI, and MDP clustering persisted across both periods in North Carolina, while univariate clustering for both suicide outcomes decreased during the pandemic. Local relative risk (RR) for all conditions increased drastically in select locations. The number of zip code tabulation areas (ZCTAs) included in clusters decreased, while the proportion of urban locations included in clusters increased for non-suicide outcomes. Average yearly case counts for all maternal mental health outcomes increased during the pandemic. Results provide contextual and spatial information concerning at-risk maternal populations with a high burden of perinatal mental health disorders before and during the pandemic and emphasize the necessity of urgent and targeted expansion of mental health resources in select communities.

Influence of COVID-19 on mental health of postpartum women, breastfeeding time and infant development

BACKGROUND

The COVID-19 pandemic may have affected the mental health of pregnant and postpartum women, influencing the duration of exclusive breastfeeding and the child's neuropsychomotor development.

RESEARCH AIM

To evaluate the influence of COVID-19 on the mental health of postpartum women, on the protein and antioxidant profile of breast milk, on the duration of exclusive breastfeeding and on the neuropsychomotor development of their infants.

METHODS

Observational study, prospective cohort, with 180 postpartum women. Psychosocial status was assessed by changes in mood and lifestyle; trait and state anxiety, and postpartum depression. Breastfeeding time and neuropsychomotor development were determined at the three-month well-child consultation based on the child's health record and the WHO Anthro software. 5 ml of mature breast milk were collected from the full breast of the lactating women.

RESULTS

There was no difference between the prevalence of anxious traits and states and postpartum depression among seropositive and negative postpartum women for COVID-19. There was no difference in the prevalence of time and type of breastfeeding, and of normal and delayed neuropsychomotor development between seropositive and negative postpartum women for COVID-19. The fact that the baby smiles and raises and keeps his head elevated were associated with lower chances of an anxious state among postpartum women (OR: 0.23; OR: 0.28 and OR: 0.20, respectively).

CONCLUSIONS

The need for more studies to investigate the influence of the COVID-19 pandemic on the mental health of postpartum women, breastfeeding and the neuropsychomotor development of babies is highlighted, given the importance of breast milk for the growth and development of babies.

COVID-19-Related worries mediate the association between attachment orientation and elevated depression levels at 21-month postpartum

BACKGROUND

The study's aims were to examine whether the COVID-19 pandemic was associated with increases in depression levels of 21 months postpartum women who were initially sampled before the pandemic and whether COVID-19-related worries mediated the association between women's attachment orientations and this hypothesized increase.

METHODS

Participants comprised 185 postpartum women sampled in the maternity ward of a tertiary healthcare center in Israel followed from childbirth to 21 months postpartum in four-time points. . We analyzed demographic and obstetric information and the Experiences in Close Relationships (ECR) scale at T1; changes in the Edinburgh Postnatal Depression Scale (EPDS) levels at all timepoints (T1-4); and COVID-19-related worries at T4.

RESULTS

Results showed a significant increase in depression levels at T4 compared to T2 and T3, and an increase in the prevalence of women at the lower clinical EPDS threshold. COVID-19-related worries mediated the association between anxious attachment and depression (indirect effect: B = .21, p < .05, 95% CI = (.015, .47), R2=0.12).

DISCUSSION

The evident effect of COVID-19 on postpartum depression is associated with variability between people. Thus, early assessment of women's attachment orientations might provide a strategy for identifying and treating women at risk.

Coronavirus Disease 2019 Pandemic-Related Long-Term Chronic Impacts on Psychological Health of Perinatal Women in China

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has caused far-reaching changes in all areas of society. However, limited data have focused on the long-term impacts on perinatal psychological health. This study aims to evaluate long-term impacts of COVID-19 pandemic crisis on psychological health among perinatal women and investigate associated factors.

STUDY DESIGN

A multicenter, cross-sectional study, the psychological subproject of China Birth Cohort Study (CBCS), was conducted in 2021. Demographic and obstetric characteristics, pregnancy outcomes, psychological status, and COVID-19-pandemic-related factors were obtained. The symptoms of depression, anxiety, and insomnia of participants were assessed by Patient Health Questionnaire, Edinburgh Postpartum Depression Scale, Generalized Anxiety Disorder Scale, and Insomnia Severity Index, respectively. Multivariate logistic regression was used to identify associated factors of adverse psychological symptoms.

RESULTS

Totally, 1,246 perinatal women were enrolled, with the overall prevalence of depression, anxiety, and insomnia symptoms being 63.16, 41.89, and 44.38%, respectively. Perinatal women who needed psychological counseling and were very worried about the COVID-19 pandemic were 1.8 to 7.2 times more likely to report symptoms of depression, anxiety, and insomnia. Unemployment, flu-like symptoms, younger maternal age, and previous diseases before pregnancy were risk factors for depression, anxiety, or insomnia.

CONCLUSION

Our study revealed that the prevalence of perinatal depression, anxiety, and insomnia symptoms was at a high level even 1 year after the pandemic outbreak, implying pandemic-associated long-term psychological impacts on perinatal women existed. Government should not only pay attention to the acute effects of psychological health but also to long-term psychological impacts on perinatal women after major social events.

KEY POINTS

· The prevalence of perinatal psychological symptoms was at a high level after the COVID-19 outbreak.. · Perinatal women who were very worried about COVID-19 were more often to have psychological symptoms.. · Perinatal women with demands of mental counseling were more likely to report psychological symptoms..

Associations between maternal postpartum depression and infant temperament in treatment-seeking mothers prior to and during the COVID-19 pandemic

It remains unclear how the COVID-19 pandemic has affected the mother-infant relationship and associations between maternal postpartum depression (PPD) and offspring temperament. This study examined the impact of the pandemic on these links and how maternal ratings of the mother-infant relationship mediated associations between PPD and infant temperament in a sample of treatment-seeking mothers in Ontario, Canada before and during the COVID-19 pandemic. Mothers with infants <12 months of age and Edinburgh Postnatal Depression Scale scores ≥10 enrolled in two separate randomized controlled trials of 1-day cognitive behavioral therapy-based workshops for PPD conducted before COVID-19 (n = 392) and during the pandemic (n = 403). Mothers reported on depressive symptomatology, infant temperament, and the mother-infant relationship. Maternal PPD was associated with more infant negative affectivity and mother-infant relationship difficulties. While associations between PPD and infant-focused anxiety were stronger during COVID-19, the pandemic did not otherwise affect associations between PPD and infant temperament. Mediation analyses suggested that aspects of the mother-infant relationship mediated associations between PPD and infant negative affectivity. Findings highlight the importance of detecting PPD and intervening to potentially improve outcomes for mothers and their children.

Prevalence of postpartum depression symptoms in high-income, and low- and middle-income countries in the Covid-19 pandemic: a systematic review with meta-analysis

OBJECTIVE

To perform a meta-analysis and comparison between high-income, and low- and middle-income countries postpartum depression symptoms prevalences.

METHODS

PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO and CINAHL databases were searched until October 2022 for studies that collected data from pandemic. The metaprop command was used in the Stata statistical software v.12.0 to run a random-effects meta-analysis.

RESULTS

A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of postpartum depression symptoms was 31% (95% CI: 21.85-40.99). The pooled prevalence of postpartum depression symptoms among women from high-income countries [30.5% (95% CI: 16.95-46.02)] did not differ significantly from that among women from low- and middle-income countries [31.5% (95% CI: 19.26-45.15)]. However, studies that analyzed women up to one month after childbirth had a lower prevalence of postpartum depression symptoms [17.5% (95% CI: 9.85-26.62)] compared to those that observed them up to one year after childbirth [38.3% (95% CI: 33.96-42.83)].

CONCLUSIONS

The prevalence of postpartum depression symptoms was high regardless of the country's human development index and it must be regularly tracked around the world to assess, discuss, and recommend more assertive steps that may be implemented based on the particular characteristics of each country.

Coping with subjective and objective stress during a pandemic pregnancy: implications for maternal mental health

The COVID-19 pandemic heightened prenatal maternal stress, a risk factor for poorer maternal and infant health. There was substantial variability, however, in the extent to which the stress of pandemic pregnancy influenced maternal mental health. Some of this variability may have been due to the different coping strategies used to manage pandemic stress. In this cross-sectional study of 7,383 pregnant women in the U.S. (M = 25.69 ± 8.71 weeks gestational age) recruited during the first and second U.S. waves of the COVID-19 pandemic, we examined associations of objective stressors, the subjective experience of stress, and the use of four coping strategies with anxiety and depressive symptoms. Spiritual coping, planning/preparation, and avoidant coping were associated with increased subjective and objective stress and with greater mood and anxiety symptoms, whereas coping by positive appraisal was associated with modestly lower subjective stress and with lower mood and anxiety symptoms. We also found small interactions of stress and coping in predicting mood and anxiety symptoms, suggesting that fit between coping strategy and type of stress influences coping outcomes. Specific coping strategy used as well as the fit between coping strategy and stress type may determine whether coping buffers or exacerbates mood and anxiety symptoms. The small magnitude of these associations suggests that individual-level coping may be insufficient in the face of the overwhelming nature of the stress accompanying a global pandemic. This work adds to our understanding of coping with pregnancy stress in the context of population-level stressors (i.e., a pandemic or large-scale disaster).

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

Maternal Mental Health During and Before the COVID-19 Pandemic: A Comparative Analysis in the Kingdom of Bahrain

Introduction The coronavirus disease 2019 (COVID-19) pandemic created a crisis in health care systems worldwide. The maternity services were restricted due to the pandemic regulations. The psychological burden on the pregnant women was to various extents. Individuals and organizations implemented support schemes to understand and support their mental health. In our study, the psychological impact of pregnant women who contracted COVID-19 during pregnancy was compared with pregnancy of the same population before the pandemic as it could be a précised and helpful method to counsel pregnant women effectually. Study design This retrospective study included 111 women and was conducted at Bahrain Defense Force Hospital from January 2021 until December 2021. The researchers distributed a Hospital Anxiety and Depression Scale (HADS) questionnaire to women who delivered babies during the pandemic. The researchers then analyzed these scores and compared them with the scores of a control group of women who completed their pregnancies before the pandemic. The data were analyzed using SPSS Version 25.0 (IBM Corp., Armonk, NY). P-values of less than 0.05 were considered statistically significant. Results The HADS questionnaire results demonstrated that women's anxiety and depression during their pregnancy during the COVID-19 pandemic were significantly higher than that during their pregnancy before the pandemic, with a mean score of 14.97 (95% CI: 14.5 to 15.4) and 9.4 (95% CI: 8.8 to 9.9), respectively, and a p-value of <0.001. Additionally, during the COVID-19 pandemic, 100% of participants were "abnormal" in the anxiety category, and 86.5% were "abnormal" in the depression category, whereas before the pandemic, 0.9% of the studied population were abnormal, 3.6% were borderline abnormal, and 95.5% were normal in the depression category. The comparison of these scores highlighted that the pandemic had a significant negative psychological effect on the mothers during pregnancy, thus increasing their anxiety and depression. The correlated personal, social, and clinical factors were fear of delivery, fear of disease transmission, loss of family support, social isolation, uncertainty of life, and economic crises. Depression scores were significantly correlated to factors such as fear of disease transmission to the baby (p=0.027), fear of delivery (p=0.008), and loss of family support (p=0.001). Contributing factors and anxiety scores yielded significant correlations with fear of delivery (rs =0.258), fear of transmission (rs=0.198), and uncertainty of disease life (rs=0.247). As for depression, it was significantly correlated to one factor: loss of family support (rs=-0.335). Conclusion The mental health, in terms of anxiety and depression, of pregnant women was significantly affected during the COVID-19 pandemic.

Maternal mental health concerns during the COVID-19 pandemic in Iran: a content analysis study

BACKGROUND

As crises occur, attention to physical health usually becomes more than mental health, neglecting mental health, especially in some vulnerable groups such as pregnant women and new mothers, can have adverse consequences. Therefore, it is imperative to recognize and comprehend their mental health needs, particularly during critical situations such as the recent COVID-19 pandemic. The aim of this study was to explain the understanding and experience of mental health concerns faced by pregnant and postpartum women during this pandemic.

METHODS

This qualitative study was conducted from March 2021 to November 2021 in Iran. Data were collected using semi-structured in-depth interviews to understand mental health concerns in pregnancy and the postpartum period during the COVID-19 pandemic. Twenty-five purposefully retrieved and participated in the study. Due to the prevalence of coronavirus, most of the participants preferred tele interviews. When data saturation was achieved, the data were codified manually and analyzed using Graneheim and Lundman's approach 2004.

RESULTS

Based on the content analysis of the interviews, 2 main themes, 8 categories 23 subcategories were identified. The identified themes were as follows: (1) Maternal mental health threats and (2) Inadequate access to the required information.

CONCLUSION

The results of this study showed that the main concern and fear of pregnant and postpartum women in the COVID-19 pandemic was the fear of the possibility of death for themselves and/or their fetus/infant. The knowledge that was obtained from the understanding of pregnant women and new mothers about the mental health concerns during the COVID-19 pandemic can help managers in planning to improve and promote women's mental health, especially in critical situations.

Coping as a Mediator between Attachment and Depressive Symptomatology Either in Pregnancy or in the Early Postpartum Period: A Structural Equation Modelling Approach

Peripartum depression (PPD) is a major complication of pregnancy, and numerous risk factors have been associated with its onset, including dysfunctional coping strategies and insecure attachment styles, both during pregnancy and postpartum. The aim of our study was to investigate the role of coping strategies in mediating the relationship between women's attachment style and depressive symptomatology in pregnancy and one week after giving birth in a large sample of women (N = 1664). Our hypothesis was that the relationship between anxious and avoidant attachment and depressive symptomatology would be mediated by use of maladaptive coping strategies. The assessment instruments were Edinburgh Postnatal Depression Scale (EPDS), Brief Coping Orientation for Problem Experiences (COPE), and Experiences in Close Relationship Scale (ECR). The results indicated that the effect of insecure attachment styles (anxious and avoidant attachment) on antepartum depressive symptomatology was partially mediated by dysfunctional coping styles. Anxious attachment also has an indirect significant effect on postpartum depressive symptomatology through emotional coping; however, avoidant attachment does not seem to be significantly related to postpartum depressive symptoms. Our findings revealed that not only is it important to consider attachment in understanding peripartum depressive symptomatology, but also that coping plays an important role in these relationships. These findings would help a preventive coping-based intervention strategy to enhance the capacity of women with insecure attachment styles to use more adaptive coping during and after pregnancy.

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.

Levels and predictors of postpartum depression and anxiety during the first year of the COVID-19 pandemic in a confined cross-border city

Pregnancy and/or the puerperium involve social, physiological and psychological changes that make women more vulnerable to mental disorders such as anxiety and depression, even more so if these develop in stressful contexts such as the pandemic. The aim of this study is to identify factors associated with the risk of postpartum anxiety and depression during the COVID-19 pandemic. A cross-sectional study was conducted among postpartum women (n = 69) who gave birth between March 2020 and March 2021 in Melilla, a Spanish cross-border city with Morocco whose borders were closed, making it a confined city. The scales used were the State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Results reported an elevated risk of depression (85.5%) and anxiety (63.8%), with severe anxiety reaching 40.6% of cases. Predictors of postpartum depression comprised a personal history of mood disorders (β = 8.421; CI95% = 4.863/11.978) and having been diagnosed with COVID-19 during pregnancy or postpartum (β = 4.488; CI95% = 1.331/7.646). As regards anxiety, it is predicted on the basis of mood antecedents (β = 14.175; CI95% = 7.870/20.479), the fact of having been diagnosed with COVID-19 during pregnancy or postpartum (β = 8.781; CI95% = 2.970/14.592) and the fact of being a multipara (β = 5.513; CI95% = 0.706/10.321). In conclusion, special attention should be paid to women with a history of mood disorders and a positive diagnosis of COVID-19 during pregnancy or postpartum, even more so in the case of multiparous women, because of its impact on mental health during the postpartum period.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04719-6.

Parental Burnout, Quality of Life, and Pregnancy During COVID-19

Background: Parents may be at greater risk to experience parental burnout after experiencing challenges during the COVID-19 pandemic. Given the unique experiences of parents with young children during the first two years of the pandemic, this study explored the relationship between parental burnout, quality of life (QOL), and perceived threat of COVID-19 among a sample of adults who parented at least one child under the age of five. Method: A brief survey was conducted through convenience sampling (N = 48) and included the Brief Parental Burnout Scale, The QOL Scale, and a perceived COVID threat scale. Results: Logistic regression analysis found that pregnancy was a significant predictor of burnout risk even after controlling other effects on burnout risk. Conclusion: Findings suggest that the pandemic negatively impacted parental burnout and pregnancy during the first 2 years of the pandemic increased risk for burnout. Awareness is important for appropriate assessment and intervention by clinicians.

Perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic: A qualitative descriptive study

In this study, we described perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic, guided by the qualitative descriptive methodology. We interviewed 14 women who gave birth during the pandemic. Data were analyzed using inductive qualitative content analysis. Our results showed that perinatal women experienced fear of COVID-19 infection, depression, and difficulties related to childbirth and parenting. They believed that online services and sharing information through social networking were helpful. They were looking forward to participating in outdoor activities to promote children's development and suggested enforcing untact (no contact) services for perinatal women in the post-COVID-19 era.

Social support and mental health in maternity: Effects of the COVID-19 pandemic

BACKGROUND

Motherhood involves a process of adaptation and the perception of social support influences mental health, breastfeeding or newborn care among others. The COVID-19 pandemic has generated a distancing from family, friends and health professionals.

METHODS

Quantitative, descriptive, cross-sectional study. The present study aims to describe and analyze the social support and mental health of mothers during this period.

METHODS

The sample were 179 women with children older than 6 months. The questionnaires used were the DUKE-UNC-11 and GHQ-12. Data analysis was carried out with Spearman's Rho and Mann Whitney U test.

RESULTS

75.8% of the sample perceived normal social support during the pandemic. Within the dimensions of social support, women reported perceiving satisfactory confidential support, while affective support was perceived as low. Correlational analysis reported a significant relationship between mental health, confidential support and affective support. Group comparison noted greater confidential support in primiparous.

CONCLUSIONS

The sample is sensitive to changes originated by COVID-19 constraints influencing perceived social support and mental health. Affective and confidential support as well as the involvement of health professionals and the environment are fundamental for mental health during the first year of maternity.

RELEVANCE TO CLINICAL PRACTICE

Mothers' mental health is sensitive and vulnerable to social changes, in this case, those that occurred as a consequence of the COVID-19 outbreak.

Relationships between Depression, Fear of Childbirth, and Obsessive-Compulsive Symptoms among Pregnant Women under the COVID-19 Pandemic in Japan

Little is known about the causality of antenatal depression (AND). We focused on the causal relationships between AND, fear of childbirth (FOC), and obsessive-compulsive symptoms (OCS) during the COVID-19 pandemic in Japan. We also examined whether the perceived threat of COVID-19 is associated with AND. Participants were recruited for an Internet survey conducted in December 2020. A total of 245 pregnant women completed the online survey at 12 to 15 weeks' gestational age (Time 1) and approximately 10 weeks later (Time 2). AND was estimated using the first two diagnostic items of Major Depressive Episode. The estimated prevalence of AND was 4.5% and 2.9% at Time 1 and Time 2, respectively. At both time points, no association was found between AND and the perception of COVID-19 threat. Structural equation modeling showed that AND predicted OCS (β = 0.16, p < 0.001), which, in turn, predicted FOC (β = 0.09, p = 0.042); FOC, in turn, predicted AND (β = 0.23, p < 0.001). AND, OCS, and FOC were predicted by borderline personality traits. Insecure adult attachment influenced AND and FOC via the perceived negative impact of the current pregnancy. Perinatal care providers should assess the personality and perception of pregnancy to prevent depression and pay attention to symptoms such as FOC and OCS in addition to those of depression.

The Impact of the COVID-19 Pandemic on the Level of Physical Activity, Emotional State, and Health Habits of Women in Late Pregnancy and Early Puerperium

The aim of the study was to determine the impact of the Covid-19 pandemic on the level of physical activity in the last trimester, the risk of developing postnatal depression, and general health habits in late pregnancy and the early postpartum period.

METHODS

The study population was women 1-8 days postpartum. Participants were divided into three groups depending on when they were recruited: (1) prepandemic (Ppan: n = 252, December 2019-March 2020), (2) COVID1 group (Cov1: n = 262, May 2020-September 2020), and (3) COVID2 group (Cov2: n = 226, June 2021-September 2021). The Ppan group included women from before the pandemic. The Cov1 group included patients after some restrictions were lifted. The Cov2 group included women after vaccinations became available. Research tools included a demographical questionnaire (age, education, childbirth details), the Pregnancy Physical Activity Questionnaire (PPAQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Health Behavior Inventory (IZZ).

RESULTS

Regression analysis showed that regardless of other variables, women who gave birth during the pandemic spent less energy on total physical activity compared to the prepandemic group (Cov1: β = -18.930, 95%CI: -36.499 to -1.361; Cov2: β = -26.527, 95%CI: -44.322 to -8.733). We also found that as the risk of depression increased, engagement in general health habits decreased during the pandemic.

CONCLUSIONS

The Covid-19 pandemic decreased the level of some subdomains of physical activity in pregnant women, with a general negative correlation between emotional state and healthy habits.

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.

Joys or Sorrows of Parenting During the COVID-19 Lockdown: A Scoping Review

Objectives: The aim of this scoping review was to map out the existing evidence of the impact of the COVID-19 lockdown on parents of children and adolescents. We sought to: 1) identify parenting domains that were particularly affected by lockdown measures, 2) describe the challenges and opportunities of lockdown measures in these domains, and 3) define protective and exacerbating factors modulating the effect of lockdown measures on parents. Methods: We identified five main domains investigated in the context of parenting during the early COVID-19 lockdown derived from 84 studies: health and wellbeing, parental role, couple functioning, family and social relationships, and paid and unpaid work. For each domain, we listed challenges and opportunities, as well as discriminant factors. Results: The lockdown impacted all five different but interconnected domains, introduced new roles in parents' lives, and particularly affected women and vulnerable populations. Conclusion: This scoping review highlights the importance of approaching public health policymaking from a social justice perspective. Such an approach argues for social and public health policies to promote health accounting for its social, economic, political, and commercial determinants.

The Impact of the COVID-19 Pandemic on Postpartum Maternal Mental Health

OBJECTIVES

There are reports of mental health worsening during the COVID-19 pandemic. We aimed to assess whether this occurred in women who were pregnant at baseline (late 2019) and unaware of the pandemic, and who delivered after the implementation of COVID-19 restrictions and threat (March-April 2020). To compare the pandemic period with the pre-pandemic, we capitalized on a retrospective 2014-2015 perinatal sample which had had affective symptoms assessed.

METHODS

The COVID sample were administered the Postnatal Depression Scale (EPDS), Zung Self-Rating Anxiety Scale (SAS), Hypomania Checklist-32 (HCL-32), Pittsburgh Sleep Quality Index (PSQI), and Perceived Stress Scale (PSS) at T0 (pregnancy) and T1 (post-delivery). The Non-COVID sample had completed EPDS and HCL-32 at the same timepoints.

RESULTS

The COVID sample included 72 women, aged 21-46 years (mean = 33.25 years ± 4.69), and the Non-COVID sample included 68 perinatal women, aged 21-46 years (mean = 34.01 years ± 4.68). Our study showed greater levels of mild depression in T1 among the COVID sample compared to the Non-COVID sample. No significant differences in terms of major depression and suicidal ideation were found. The levels of hypomania were significantly different between the two groups at T1, with the COVID sample scoring higher than the Non-COVID sample. This may be related to the high levels of perceived stress we found during the postpartum evaluation in the COVID sample.

LIMITATIONS

There was a relatively small sample size.

CONCLUSIONS

New mothers responded to the pandemic with less mental health impairment than expected, differently from the general population. Women delivering amidst the pandemic did not differ in depressive and anxiety symptoms from their pre-pandemic scores and from pre-pandemic women. Because stress responses have high energy costs, it is optimal for maternal animals to minimize such high metabolic costs during motherhood. Evidence suggests that reproductive experience alters the female brain in adaptive ways. This maternal brain plasticity facilitates a higher purpose, the continuation of the species. This may point to the recruitment of motherhood-related resources, for potentially overcoming the effects of the pandemic on mental health.

Psychological health status in postpartum women during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis pooled the prevalence of psychological symptoms during the COVID-19 pandemic and examined the effects of the pandemic on psychological health in postpartum women.

METHODS

A systematic literature search and identification were performed in PubMed, EMBASE, Web of Science, and PsycINFO databases until June 16th, 2021. The fixed or random effect models to estimate the pooled prevalence of postpartum psychological symptoms during the COVID-19 pandemic and the odds ratio (OR) of COVID-19 for psychological symptoms.

RESULTS

A total of 29 articles including 20,225 postpartum women during the COVID-19 pandemic and 8312 before the COVID-19 pandemic were identified. During the COVID-19 pandemic, the prevalence of postpartum depressive, anxiety, stress, and post-traumatic stress disorder symptoms were 26.7 % (95 % CI: 22.0-31.9 %), 33.8 % (95 % CI: 21.1-49.4 %), 55.0 % (95%CI: 27.9-79.5 %), and 33.7 % (95%CI: 19.6-51.5 %), respectively. The ORs of COVID-19 pandemic for postpartum depressive and anxiety symptoms were 1.54 (95 % CI: 1.00-2.36) and 2.56 (95%CI: 1.62-4.04). Subgroup analyses revealed that women with >6 weeks after delivery, younger than 35 years old, low income, less education and without breastfeeding experienced a higher risk of depressive or anxiety symptoms after delivery.

LIMITATIONS

Only a few of prospective studies were included, and significant but inevitable heterogeneities were found in some analyses.

CONCLUSION

A significantly higher proportion of postpartum women were suffered from psychological symptoms during COVID-19 pandemic, particularly in those with >6 weeks after delivery, younger than 35 years old, low income, less education and formula feeding.

Mothers' and fathers' stress and severity of depressive symptoms during the COVID-19 pandemic: actor-partner effects with parental negative emotions as a moderator

BACKGROUND

In the face of the coronavirus disease 2019 (COVID-19) pandemic, families with young children are bombarded with new challenges and stressors. This study examined the additive and interactive effects of parental stress and negative emotions during COVID-19 on parents' severity of depressive symptoms.

METHODS

Participants were 221 Chinese families involving maritally intact mothers and fathers of preschool-aged children.

DISCUSSION

Path analysis indicated that mothers' parental stress interacted with their negative emotions, such that their stress was related to their severity of depressive symptoms only when negative emotions were high. By comparison, fathers' stress and negative emotions were additively associated with their severity of depressive symptoms. Supporting the cumulative risk model, parental stress during COVID-19 and negative emotions were linked to parents' severity of depressive symptoms additively or interactively, depending on the gender of the parent. These findings inform practitioners about the relevance of parents' stress and negative emotions to their severity of depressive symptoms during the pandemic.

Italian validation of the situational Brief Cope Scale (I-Brief Cope)

The Brief COPE (Coping Orientation to Problems Experienced) inventory is 14 faced scales used to assess coping strategies. It has been administered on different population samples and translated into several languages. Nonetheless, the Italian validation of its situational format is missing, and the present study aimed to fill this gap. To this end, the original English version of the scale was translated into Italian and administered to a sample of 682 Italian healthcare workers (HCWs), during the first wave of COVID-19. The Exploratory and Confirmatory Factor Analysis (EFA and CFA) were performed and led to the validation of the Italian Brief COPE (I-Brief COPE) scale, consisting of 21 items, loading properly on 6 factors, which range from activation (F1) to deactivation (F2), via social support (F3), humorous reframing (F4), religious/spiritual reliance (F5), substances use (F6). The six factors identified represent, according to our analyses, the relevant dimensions of coping in a stressful situation such as COVID-19. The results of this study reveal that the I-Brief Cope can be considered as a valid tool for measuring coping strategies in facing stressful, unpredictable, and damaging events.

Association of COVID-19 Lockdown during the Perinatal Period with Postpartum Depression: Evidence from Rural Areas of Western China

COVID-19 lockdown has posed unique challenges to postpartum women, but its association with postpartum depression is not well understood in the Global South. This study aims to evaluate the association between COVID-19 lockdown and postpartum depression in rural areas of western China. A multi-stage random cluster sampling method was used to select a cohort of pregnant and postpartum women with infants aged 0-6 months. We conducted an in-person survey before the COVID-19 lockdown and a phone survey right after the lockdown ended. We used multivariate regression models to evaluate the association between lockdown and postpartum depression. Subgroup analysis was performed to explore the role of social support. The overall prevalence of postpartum depression was 13.3%. Postpartum women who experienced the lockdown were less likely to be depressed than those who did not (adjusted odds ratio (aOR) = .43, 95% confidence interval (CI) = [.27, .70]). Lockdown was negatively associated with postpartum depression among postpartum women with low level of social support (aOR = .30, 95% CI = [.18, .51]). COVID-19 lockdown was associated with lower likelihood of postpartum depression, potentially due to increased support from family. Future research is needed to explore targeted interventions to prevent postpartum depression among women from migrant worker families in rural China.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (βc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (βa = −0.283, SE = 0.07, t = −2.61, p < 0.05) and between resilience and prenatal depression (βb = −0.585, SE = 0.07, t = −6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (βc′ = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Mattering and Depressive Symptoms in Portuguese Postpartum Women: The Indirect Effect of Loneliness

BACKGROUND

Postpartum depression is described as the most prevalent clinical condition in the postpartum period, with several negative consequences. The current study aimed to understand the relationship between mattering, loneliness and depressive symptoms in Portuguese postpartum women and to examine the potential mediating role of loneliness in the relationship between mattering and depressive symptomatology among postpartum women.

METHODS

This cross-sectional study included a sample collected online composed of 530 Portuguese women in the postpartum period, who answered self-report questionnaires to assess depressive symptoms, mattering, and loneliness.

RESULTS

It was found that the relationships between mattering, loneliness, and depressive symptoms were significant, p < 0.001: (a) higher levels of mattering were associated with lower levels of loneliness and depressive symptomatology and (b) higher levels of loneliness were associated with higher levels of depressive symptomatology. The relationship between mattering and postpartum depressive symptoms occurred directly and indirectly through loneliness, 95% CI = [-0.75, -0.46].

CONCLUSIONS

These results highlight the importance of studying loneliness as a possible risk factor for postpartum depression and alert to the pertinence of considering mattering and loneliness in the assessment and intervention with women in the perinatal period.

Infant regulation during the pandemic: Associations with maternal response to the COVID-19 pandemic, well-being, and socio-emotional investment

In the transition to parenthood, the COVID-19 pandemic poses an additional strain on parental well-being. Confirmed infections or having to quarantine, as well as public health measures negatively affect parents and infants. Contrary to previous studies mainly focusing on the well-being of school-aged children and their parents during lockdown periods, the present study investigated how mothers of infants respond to the COVID-19 pandemic and whether this is related to maternal well-being, maternal socio-emotional investment, and infant regulation. Between April and June 2021, 206 mothers of infants (M_age  = 7.14 months, SD_age  = 3.75 months) reported on COVID-19 infections, their response to the COVID-19 pandemic, their well-being, socio-emotional investment, and their infant's regulation. Exploratory factor analyses yielded five dimensions of maternal response to the COVID-19 pandemic: social distancing, worrying about the child, birth anxiety, distancing from the child, and information on COVID-19-related parenting behavior and support. These dimensions were related to mother-reported infant regulatory problems. Path analyses revealed paths via reduced maternal well-being and maternal socio-emotional investment. Maternal perceptions of infant regulatory problems are related to how the mothers respond to the COVID-19 pandemic. Better information about COVID-19-related parenting behavior and support might buffer against these effects.

The Impact of COVID-19 on Anxious and Depressive Symptomatology in the Postpartum Period

Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.

Generalized anxiety disorder among mothers attending perinatal services during COVID-19 pandemic: using ordinal logistic regression model

Background

Generalized anxiety disorder is characterized by excessive and uncontrollable worry about a variety of events. It is critical to ensure a pregnant mother's mental health in order to reduce pregnancy and birth-related problems. The major goal of current study was to identify the factors associated with generalized anxiety disorder among mothers attending perinatal services in the study area during COVID-19 using ordinal logistic regression.

Methods

The institution-based cross-sectional study was conducted from July 10^th, 2020 to August 10^th, 2020 at Kembata Tembaro zone, Southern Ethiopia. The current study included 423 mothers. The GAD-7 scale was used to assess the anxiety level among mothers. An Ordered logit model was used to identify the determinants of GAD. Brant test of the parallel line was utilized to check proportionality assumption. The statistical significance was determined using an adjusted proportional odd ratio with a 95%CI, and a p-value <5%. STATA software version 14 was used to analyze statistical data.

Results

Of all 423 mothers attending perinatal service during COVID-19; 134(31.7%), 171(40.4%), 85(20.1%), and 33 (7.8%) had non/minimal to severe generalized anxiety disorder respectively. The results of multivariable proportional odds model (POM) showed that the variables town residents [aPOR = 1.827; 95% CI:1.233-2.708], having alcohol habit [aPOR = 3.437, 95% CI = 1.397-8.454], having occupation [aPOR = 0.509, 95% CI: 0.303-0.857], being health care worker [aPOR = 0.117, 95% CI = 0.044-0.311], having chronic illness [aPOR = 7.685, 95% CI = 3.045-19.39], having family history of anxiety/mood disorder [aPOR = 7.839, 95% CI = 2.656-23.12], fear of contracting COVID-19 [aPOR = 1.704, 95% CI = 1.152-2.521], having moderate social support [aPOR = 0.648, 95% CI = 0.425-0.989], having strong social support [aPOR = 0.495, 95% CI = 0.272-0.901] were significantly associated with generalized anxiety disorder at 5% level of significance.

Conclusion

Current findings concluded that the prevalence of GAD among mothers attending perinatal service during COVID-19 was high. The covariates like being town resident, lower-income status, occupation status, having a chronic illness, having a positive family history of anxiety or mood disorder, perceived social support, and fear of the COVID-19 were significantly associated with generalized anxiety disorder among mothers. Mothers who visit perinatal services should be given special consideration to improve health care services and ensure their mental health.

Mental Health of Postpartum Women During the COVID-19 Pandemic: An Integrative Review

Objective: To identify and analyze the scientific evidence on the mental health of postpartum women during the COVID-19 pandemic. Method: This integrative review was carried out using the VHL, CINAHL, PubCovid, Scopus, and Web of Science databases, whose research question was “What is the scientific evidence on the mental health of postpartum women during the SARS-CoV-2 pandemic?” Results: Ten articles in English were included, identifying a higher frequency of cross-sectional research (n = 4), publications in November 2020 (n = 3), conducted in Italy (n = 3), with level VI evidence (n = 6). The study found that postpartum women feel depressed, lonely, and afraid; attention is drawn to the worsening risk of postpartum depression with significant prevalence values. It points out factors that negatively influence the mental health of this population in the current pandemic and discloses care measures. Conclusions: In addition to previous characteristics, socioeconomic conditions (e.g., living in highly infected areas, unemployment) and elements inherent to this pandemic (e.g., distance and fear of contagion) negatively influence the mental health of postpartum women. Means of dealing with the conditions imposed by the COVID-19 pandemic are available, such as relaxation techniques, physical exercise, and professional support. The relevance and need for research on this theme, mostly nationally, are highlighted.

COVID-19 related worry moderates the association between postpartum depression and mother-infant bonding

The aim of this study was to ask whether a substantial external stressor, such as the COVID-19 pandemic, affects the association between postpartum depression (PPD) and mother-infant bonding. Specifically, we aimed to determine whether worry regarding such an external threat differentially affected PPD and bonding by analyzing a longitudinal sample of postpartum women assessed before and during the pandemic. One-hundred forty women responded to online questionnaires at (T1) Pre-COVID-19: Six months postpartum (February 2018 to December 2019), and (T2) During COVID-19: Twenty-one months postpartum (April 2020 to January 2021). The strength of correlation between mother-infant bonding and PPD significantly declined from before (T1: R = 0.64, p < 0.00) to during the pandemic (T2: R = 0.44, p < 0.001; Difference = 0.20, p = 0.05). Furthermore, only PPD correlated with the worry due to the pandemic; thus the PPD-bonding association was weaker among women who were less concerned about the pandemic (F(3, 136) = 15.4, R² = 0.25). The study suggests that emotions and cognitions related to motherhood, such as mother-infant bonding, may be more resilient to external pressures such as a pandemic than affective states such as PPD. (174 words).

COVID-19-related anxieties in first-time mothers during the first wave of the COVID-19 pandemic and after 6 months: A descriptive study

BACKGROUND

The changes accompanying the transition to motherhood, joined by the stress aroused by the COVID-19 pandemic, may lead to high levels of parental anxieties. This study, conducted in two phases-in the midst of the first wave of the pandemic and after six months-explores differences in the level of COVID-19-related anxieties of Israeli mothers in their first year of parenthood.

DESIGN AND METHODS

A cross-sectional study carried out with 198 first-time mothers aged 22-48 who completed self-report questionnaires on April 2020 and again on October 2020. The questionnaire was distributed through social networks and included a demographic scale and the COVID-19-related anxieties questionnaire.

FINDINGS

In the first phase, mothers reported higher anxieties concerning economic damage (M = 3.42; 3.11), being in public places (M = 4.34; M = 3.51), using public transportation (M = 4.80; M = 4.31), and going for infant checkups (M = 4.13; M = 3.06). In the second phase, mothers reported higher anxiety about being infected (M = 3.19; M = 3.48).

DISCUSSION

The results suggest the need to be attentive to the double stress of new mothers in a dynamic time of crisis, especially at the beginning of the crisis when anxiety levels may be highest.

APPLICATION TO PRACTICE

The findings may aid in developing interventions for new mothers in times of crisis. The finding that the COVID-19-related anxieties of new mothers may decrease over time points to the urgency of making interventions by health and medical professionals available to women in the first months after the birth of their first child.

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.

Estimating the Impact of COVID-19 Pandemic Related Lockdown on Utilization of Maternal and Perinatal Health Services in an Urban Neighborhood in Delhi, India

Objective

To estimate utilization of maternal, perinatal healthcare services after the lockdown was implemented in response to the COVID-19 pandemic compared to the period before.

Methods

This study conducted in Dakshinpuri, an urban neighborhood in Delhi, reports data over a 13-month period which includes the period “before lockdown” i.e., October 1, 2019 to March 21, 2020 and “after lockdown” i.e., March 22 to November 5, 2020. The period “after lockdown” included the lockdown phase (March 22 to May 31, 2020) and unlock phase (June 1 to November 5, 2020). Mothers delivered during this period in the study area were interviewed using semi-structured questionnaires. In-depth interviews (IDIs) were conducted in a subsample to understand the experiences, challenges, and factors for underutilization of healthcare services.

Findings

The survey covered a total population of 21,025 in 4,762 households; 199 eligible mothers (mean age 27.4 years) were interviewed. In women who delivered after lockdown against before lockdown, adjusted odds of having >2 antenatal care visits in the third trimester was 80% lower (aOR 0.2, 95% CI 0.1–0.5); proportion of institutional deliveries was lower (93 vs. 97%); exclusive breastfeeding during first 6 months of birth (64.5 vs. 75.7%) and health worker home visitation within 6 weeks of birth (median, 1 vs. 3 visits) were substantially lower. Fear of contracting COVID-19, poor quality of services, lack of transportation and financial constraints were key issues faced by mothers in accessing health care. More than three-fourth (81%) of the mothers reported feeling down, depressed or hopeless after lockdown. The major factors for stress during lockdown was financial reasons (70%), followed by health-related concerns.

Conclusion

COVID-19 pandemic-related lockdown substantially affected maternal and perinatal healthcare utilization and service delivery.

A Longitudinal Study on Maternal Depressive Symptoms During the COVID-19 Pandemic: The Role of Strict Lockdown Measures and Social Support

Objectives: This study examined the trajectory of perinatal depressive symptoms in Portuguese women during the COVID-19 pandemic and the role of individual, relational, and contextual risk and protective factors.

Methods: This 3-wave longitudinal study followed 290 pregnant women from the third trimester of pregnancy until 6-months postpartum. Women self-reported on depressive symptoms, psychological (anxiety, perceived stress, mindfulness), relational (perceived social support, dyadic adjustment, sexual wellbeing), and contextual (lockdown status) factors.

Results: Women who were under strict lockdown presented significantly higher scores of depressive symptoms at baseline (by 1.38 EPDS points) than women who were not under strict lockdown measures. Mixed Growth Models showed that trajectories of depressive symptoms were explained by differences in women’s baseline depression. Differences in women’s depressive symptoms at baseline were mainly explained by higher anxiety and lower social support (22% and 24% for women under lockdown; 39% and 6% for women not on lockdown, respectively).

Conclusion: Preventative interventions targeted at pregnant women should aim to reduce anxiety and enhance women’s social support to prevent depression in pregnancy and postpartum during the COVID-19 pandemic.

Maternal Self-Efficacy Buffers the Effects of COVID-19-Related Experiences on Postpartum Parenting Stress

OBJECTIVE

To examine the associations of maternal self-efficacy (MSE) and perceived social support with parenting stress during the postpartum period during the COVID-19 pandemic and whether these two psychosocial factors account for variance in parenting stress in addition to the effects of COVID-19-related experiences and sociodemographic factors.

DESIGN

Cross-sectional survey.

SETTING

Online survey, the Perinatal Experiences and COVID-19 Effects (PEACE) study, launched in May 2020.

PARTICIPANTS

Participants included 310 women who gave birth in the past 24 weeks.

METHODS

The survey included self-report quantitative measures of MSE, social support, COVID-19-related experiences, parenting stress, symptoms of depression and anxiety, and a range of sociodemographic factors.

RESULTS

Hierarchical multiple regression analysis indicated that MSE and social support were negatively associated with postpartum parenting stress in addition to the effects of COVID-19-related experiences, maternal symptoms of depression and anxiety, and a range of demographic factors. Furthermore, MSE interacted with COVID-19-related experiences such that higher levels of MSE mitigated the effects of COVID-19-related experiences on parenting stress.

CONCLUSION

Our findings underscore the importance of protective factors at the individual and interpersonal levels and provide insights for prevention and intervention programs aimed at mitigating postpartum parenting stress during a wide-scale disaster such as the COVID-19 pandemic.

Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis

Background: Owing to the high prevalence and detrimental consequences, postpartum depression (PPD) has been identified as one of the severe global public health issues in the last decade. Prior research found that during disasters or events, the prevalence rates of mental disorders among postpartum women are significantly high. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on PPD and its risk factors remained unclear for postpartum women. Therefore, the present systematic review and meta-analysis aimed to estimate the influence of the COVID-19 pandemic on the prevalence of PPD and to summarize risk factors for PPD during the COVID-19 pandemic. Methods: Three electronic databases of MEDLINE, EMBASE, and Cochrane library databases were systematically searched for articles from their commencements until 1 November 2021. Quality assessment of included studies, random-effects meta-analysis, and sensitivity analysis were performed. Results: A total of eight studies with 6480 postpartum women during the COVID-19 pandemic were included, and most studies were conducted in developed countries. The pooled prevalence of PPD was 34% (95% CI: 21–46%) during the COVID-19 pandemic, much higher than the incident of previous research during the non-pandemic period. Risk factors for PPD during the COVID-19 pandemic were defined as socio-demographic and clinical characteristics, stress and anxiety, lack of various supports, and the COVID-19 related factors. Conclusion: The research findings indicated that the COVID-19 pandemic could make detrimental effects on maternal mental wellbeing among women after childbirth. Investigating the prevalence and risk factors of PPD among postpartum women could shed some light on their mental and emotional states; so that support measures and tailored interventions from health professionals and policymakers could be offered to improve the maternal and infant outcomes, especially during the COVID-19 pandemic. Much more research on maternal psychological wellbeing during the COVID-19 pandemic was strongly recommended to undertake in the middle and low-income countries.

Impact of COVID-19 on Women Who Are Refugees and Mothering: A Critical Ethnographic Study

Refugee women often experience trauma and social disconnection in a new country and are at risk of experiencing reduced physical, mental, and emotional well-being. Globally, COVID-19 has affected the health and well-being of the population at large. This critical ethnographic study aimed to explore the effects of COVID-19 on women who are refugees and mothering in Saskatchewan, Canada. In-depth interviews were undertaken with 27 women who are refugees and mothering young children aged 2 years and under. This study suggests that during COVID-19, refugee women are at high risk of experiencing add-on stressors due to isolation, difficulty in accessing health care, COVID-19-related restrictions in hospitals, limited follow-up care, limited social support, financial difficulties, and compromised nutrition. During COVID-19, collaborative efforts by nurses, other health-care professionals, and governmental and non-governmental organizations are essential to provide need-based mental health support, skills-building programs, nutritional counseling, and follow-up care to this vulnerable group.

When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children ( Collapse

Key Words

• Angs
• COVID-19
• Depression
• Mütter
• ansiedad
• anxiety
• anxiété
• depresión
• depression
• dépression
• madres
• maternal mental health
• mères
• psychische Gesundheit
• salud mental
• santé mentale
• young children
• الكلمات الأساسية: كوفيد-19، الصحة النفسية ، الأمهات ، الاكتئاب ، القلق
• キーワード:COVID-19、メンタルヘルス、母親、抑うつ、不安
• 关键词:2019冠状病毒病
• 心理健康
• 抑郁
• 母亲
• 焦虑

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MESH Headings

• Anxiety/epidemiology
• COVID-19
• Child
• Child, Preschool
• Depression/epidemiology
• Female
• Humans
• Mental Health
• Mothers
• Pandemics
• Prevalence
• SARS-CoV-2

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Grants Collapse

Affiliation(s)

Nicole Racine Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Rachel Eirich Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jessica Cooke Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jenney Zhu Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Paolo Pador Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
Nicole Dunnewold Health Sciences LibraryLibraries and Cultural ResourcesUniversity of CalgaryCalgaryAlbertaCanada
Sheri Madigan Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada

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Risk Factors for Postpartum Depression During COVID-19 Pandemic: A Systematic Literature Review

INTRODUCTION

The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises.

METHODS

We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba.

RESULTS

Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation.

CONCLUSION

It is extremely vital to care for women's mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.

COVID-19 related fear and depression of pregnant women and new mothers

OBJECTIVE

To explore factors associated with depression and COVID-19 related fear among pregnant women and new mothers.

DESIGN

A cross-sectional survey was conducted in China from July 2020 to July 2021.

SAMPLE

A total of 3027 pregnant and new mothers were recruited.

MEASUREMENT

Sociodemographic characteristics and the perceptions of the COVID-19 pandemic were collected. The Patient Health Questionnaire-9 (PHQ-9) and the Fear Scale was used to assess the depressive and fear level towards the COVID-19 pandemic, respectively.

RESULTS

Approximately 17.2% of the participants had depression (PHQ-9 ≥10). In Hong Kong, participants who perceived that they have increased knowledge to prevent infection were less likely to have depression (adjusted odds ratio [aOR] = 0.83; 95% confidence interval [CI] = 0.74-0.94). There was no association between perceived severity if infected and severity of spread and the depression level in our sample. An inverse relationship was found between the COVID-19 related fear level and perceived knowledge to prevent infection (Beta-coefficient [β] = -0.20; 95% CI = -0.38 to -0.02).

CONCLUSION

Public health nurses need to promote accurate and up to date COVID-19 related information at clinical and community settings and implement effective screening for depression and fear symptoms to identify these high-risk groups to improve women's psychological well-being.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

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.

The impact of the COVID-19 pandemic on the mental health of women seeking treatment for postpartum depression

BACKGROUND

While research has examined the mental health of general population samples of postpartum women during the COVID-19 pandemic, the pandemic's impact on women seeking treatment for postpartum depression (PPD) is not well known. This study compared levels of depression and anxiety, the quality of social relationships, and the temperament of infants of treatment-seeking mothers in Ontario, Canada prior to and during the pandemic.

METHODS

Mothers with Edinburgh Postnatal Depression Scale scores ≥10 and seeking treatment for PPD prior to COVID-19 (n = 100) were compared to those who sought treatment during the pandemic (n = 120). Mothers self-reported symptoms of depression, worry/anxiety, partner relationship quality, social support, as well as aspects of the mother-infant relationship and infant temperament.

RESULTS

There were no statistically significant differences in symptoms of depression, anxiety, or the quality of social relationships between women seeking treatment for PPD before or during the pandemic. However, mothers reported poorer relationships with their infants, and there was evidence of more negative emotionality in their infants during COVID-19.

CONCLUSIONS

The pandemic may not have worsened depression, anxiety, relationships with partners, or social support in mothers seeking treatment for PPD, but appears to have contributed to poorer mother-infant interactions and maternal reports of more negative emotionality in their infants. These findings highlight the importance of identifying women with possible PPD, supporting mother-infant interactions, and monitoring their infants during COVID-19 and beyond.

Impact of COVID-19 pandemic on postpartum depression among mothers of extreme and early preterm infants

Objective

To examine the impact of the coronavirus disease 2019 (COVID‐19) pandemic and the resulting isolation measures on the risk of postpartum depression (PPD) after preterm birth.

Methods

This is a cross‐sectional study of mothers of extreme and early preterm infants who completed the Edinburgh Postnatal Depression Scale (EPDS) at the standardized 3–6 months follow‐up consultation for preterm infants. Mothers assessed during the COVID‐19 pandemic (n = 34; from April 1, 2020 to March 31, 2021) were compared with an antecedent control group (n = 108; from January 1, 2017 to December 31, 2019). A multivariable logistic regression model was used to examine the relationship between the pandemic and the risk of PPD (EPDS score ≥13).

Results

The prevalence of depressive symptoms was significantly higher in the COVID‐19 study group (26% versus 12%, P = 0.043). The multivariable logistic regression model showed a significant association between the COVID‐19 pandemic and the risk of PPD (adjusted odds ratio 3.60, 95% confidence interval 1.06–12.59, P = 0.040).

Conclusion

Among mothers of extreme and early preterm infants, the COVID‐19 pandemic was independently associated with a higher risk of PPD. This confirms the need for a close and long‐term follow up of maternal psychological health after preterm birth.

The COVID‐19 pandemic was independently associated with a higher risk of postpartum depression among mothers of extreme and early preterm infants.

The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during Pregnancy: A Rapid Evidence Review

BACKGROUND

The perinatal period is a particularly vulnerable period in women's lives that implies significant physiological and psychological changes that can place women at higher risk for depression and anxiety symptoms. In addition, the ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase this vulnerability and the prevalence of mental health problems. This review aimed to investigate the existing literature on the psychological impact of the COVID-19 pandemic on women during pregnancy and the first year postpartum.

METHOD

The literature search was conducted using the following databases: Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the total of 116 initially selected papers, 17 have been included in the final work, according to the inclusion criteria.

RESULTS

The reviewed contributions report a moderate to severe impact of the COVID-19 outbreak on the mental health of pregnant women, mainly in the form of a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up to 72% in Canada. In addition to the common psychological symptoms, COVID-19-specific worries emerged with respect to its potential effects on pregnancy and the well-being of the unborn child. Social support and being engaged in regular physical activities appear to be protective factors able to buffer against the effects of the pandemic on maternal mental health.

CONCLUSIONS

Despite the limitations of the study design, the evidence suggests that it is essential to provide appropriate psychological support to pregnant women during the emergency in order to protect their mental health and to minimize the risks of long-term effects on child development.

One Year Into the Pandemic: A Systematic Review of Perinatal Mental Health Outcomes During COVID-19

Obstetric guidelines have rapidly evolved to incorporate new data and research on the novel coronavirus disease (COVID-19), with data on perinatal mental health building over the last year. Our aim in the present manuscript is to provide a systematic review of mental health outcomes in pregnant and postpartum women during the COVID-19 pandemic in the context of neonatal and obstetric guidelines addressing symptoms and complications of COVID-19 during pregnancy, mother-to-neonate transmission, Cesarean-section delivery, neonatal prematurity, maternal/neonate mortalities, maternal-neonatal separation, and breastfeeding. We summarize data from 81 mental health studies of pregnant and postpartum women and underscore protective and risk factors identified for perinatal mental health outcomes amidst the COVID-19 pandemic. Data reviewed here suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID-19. Our systematic review integrates the most current obstetric and neonate guidelines, along with perinatal mental health outcomes associated with COVID-19, highlighting the best available data for the care of women and their neonates amidst the current COVID-19 pandemic.

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers' parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman's body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan.

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

Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother's social network related to her experience of postnatal depressive symptoms during the first "lockdown" in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still "takes a village" to raise children in high-income populations and mothers are struggling in its absence.