COVID-19 pandemic immensely impacts mental health in postnatal women

A UK-based study demonstrated that the COVID-19 pandemic had an important negative impact on the mental health of postnatal women.

 

“Analysis of data from repeated large population-based maternity surveys in England shows that almost one in four women who gave birth during the COVID-19 pandemic experienced postnatal depression 6 months after childbirth, representing a significant burden among postnatal women,” said the researchers.

 

The analysis was conducted using population-based national maternity cohorts in the UK from 2014 (n=4,571), 2018 (n=4,509), and 2020 (n=4,611). Weighted prevalence estimates for postnatal depression (EPDS* score ≥13) were compared across the surveys. [Lancet Reg Health Eur 2023;doi:10.1016/j.lanepe.2023.100654]

 

In 2014, the fraction of women who scored above the EPDS cutoff for probable depression was 10.3 percent. This jumped to 16.0 percent in 2018 and by 2020, the prevalence of postnatal depression was already 23.9 percent which, according to the researchers, was ‘alarmingly high’.

 

“[These] findings suggest that COVID-19 and giving birth during the height of the first national lockdown in the UK … had a negative impact on mental health and may have accelerated a trend of increasing prevalence of postnatal depression,” said the researchers.

 

The increases in prevalence between 2014 and 2018 (difference, +5.7 percent; risk ratio [RR], 1.55) and between 2018 and 2020 (difference, +7.9 percent; RR, 1.49) were statistically significant (p<0.001).

 

“The marked increase in the prevalence of postnatal depression between 2018 and 2020 is concerning. The stress, uncertainty, disruption, and reduced access to services and support caused by COVID-19, particularly during the early stages of the pandemic, are likely to have contributed to this increase,” the researchers noted.

 

On multivariate analysis, the presence of a long-term mental health problem (adjusted RR [aRR] range, 1.48–2.02), antenatal anxiety (aRR range, 1.73–2.12), and antenatal depression (aRR range, 1.44–2.24) were associated with an increased risk of postnatal depression. Conversely, satisfaction with birth (aRR range, 0.89–0.92) and social support (aRR range, 0.73–0.78) were tied to decreased risk before and during the pandemic.

 

“These are all well-known psychosocial risk and protective factors for perinatal mental health,” the researchers said. Social support may help in diluting the effects of some other risk factors, such as having an unplanned pregnancy, being a single parent, living apart from the kid’s father, and having a long-term physical health issue, they added.

 

“The importance of social support to women during the perinatal period cannot be underestimated … For women who have inadequate support networks or who would benefit from additional provision, peer interventions may also offer a valuable source of support and should be valued, nurtured, and encouraged by practitioners,” they said.

 

These findings are important in view of the subsequent health implications – not just for the mother but for the partner and the offspring as well, the researchers noted.

 

Timely detection, assessment, intervention, and follow-up are thus key to support women at risk and those who are experiencing symptoms. In some cases, poor mental health in the postnatal period is an extension of symptoms that could have manifested prior to or during pregnancy, thus underlining the value of early detection and appropriate management.

 

“Policymakers and healthcare leaders must urgently investigate robust strategies for early identification, intervention, and follow-up of women at risk of and experiencing postnatal mental health problems. It is essential that mechanisms to identify and support women remain in place, and ideally are strengthened, during times of heightened risk such as the pandemic,” they concluded.