Postpartum depression: Another outcome of the COVID-19 pandemic?

Several studies presented at ACOG 2022 have raised the question as to whether postpartum depression (PPD) is one of the mental health outcomes of the COVID-19 pandemic.

In the first retrospective, single-centre study, researchers from the University of Florida College of Medicine, Gainesville, Florida, US, reviewed charts of random patients who received postpartum care and completed Edinburgh Postpartum Depression Scale (EPDS) assessments between April 2019 and February 2020 (pre–COVID-19 cohort; n=448) or between April 2020 and February 2021 (post–COVID-19 cohort; n=468). EPDS scores of <9, 9–11, 12–14, and ≥15 represented negative, mild, moderate, and severe total scores, respectively.

In the post–COVID-19 cohort, the proportion of patients with negative EPDS scores reduced compared with that of the pre–COVID-19 cohort (36.8 percent vs 64.9 percent). In contrast, the proportion of patients with mild, moderate, and severe total scores increased in the post– vs pre–COVID-19 cohorts (31.8 percent vs 17 percent [mild], 18.6 percent vs 11.6 percent [moderate], and 12.8 percent vs 6.5 percent [severe]). [ACOG 2022, abstract A307]

There was a significant increase in the number of patients with positive total EPDS scores in the post–COVID-19 cohort as per ANOVA (F=30.66), particularly with regard to mild (F=12.24) and severe (F=12.26) EPDS levels (p<0.001 for all), with no significant difference noted with moderate EPDS levels.

“This study demonstrates a statistically significant increase in EPDS scores in postpartum patients during the COVID-19 pandemic,” said the researchers, who called for further research into identifying the factors that may have led to these increased levels.

These results echo those of another study, this time conducted by researchers at the University of Texas Southwestern Medical Center, Dallas, Texas, US.

The prevalence of PPD was assessed during six 12-week epochs spanning before and during the COVID-19 pandemic (Epoch 1: December 16, 2019, to March 8, 2020; Epoch 2: March 9, 2020, to May 31, 2020; Epoch 3: June 1, 2020, to August 23, 2020; Epoch 4: August 24, 2020, to November 15, 2020; Epoch 5: November 16, 2020, to January 31, 2021; Epoch 6: February 1, 2021, to May 2, 2021).

All pregnant women (n=2,011) who presented at the Center completed postpartum EPDS screening and Maternal Postpartum Quality of Life Questionnaire (mPQOL). EPDS score of ≥13 was considered positive for depression. The subcategories for the mPQOL were Psychological/Baby, Socioeconomic, Relational/Partner, Relationships/Family, and Health/Functioning, with scores ranging from 1 (very dissatisfied) to 6 (very satisfied).

The proportion of patients with EPDS score ≥13 increased between Epochs 1 and 2 (from 3 percent to 9 percent), peaking at Epoch 5 (11 percent; p=0.007). [ACOG 2022, abstract A239]

The mPQOL Socioeconomic subcategory score significantly decreased between Epochs 2 and 3 (from 5.8 to 5.5; p=0.014), as did the Relational/Partner subcategory score (from 5.5 to 5.4; p=0.041).

“There was a significant increase in positive EPDS screens in pregnant women during the COVID-19 pandemic,” the researchers noted.

“Sub-scores obtained from the mPQOL survey suggest that increasing socioeconomic concerns and relational partner issues may have driven these trends,” they added.

Alternate findings

A study conducted by researchers from the University of South Carolina School of Medicine—Greenville, South Carolina, US, found that the risk of PPD was numerically reduced during vs before the COVID-19 pandemic.

This retrospective study involved 1,097 patients who were evaluated at 1–8 weeks postpartum. Of these, 677 had undergone routine screening for PPD between April and December, 2020 (COVID-19 cohort), while 420 women formed the control cohort, having undergone PPD screening between April and December, 2019 (pre–COVID-19 cohort). All patients had completed EPDS screening with a score ≥11 denoting PPD.

The prevalence of PPD was numerically, but not significantly, higher before vs during the COVID-19 pandemic (13.10 percent vs 10.78 percent; p=0.2474). [ACOG 2022, abstract A235]

“[While] our study revealed no statistically significant difference in the prevalence of PPD before or during the COVID-19 pandemic …, the downward trend of PPD during the pandemic may be due to quarantine recommendations allowing families/spouses to work from home,” the researchers suggested.