Moms Are Not OK: COVID-19 and Maternal Mental Health

Abstract

Introduction: Depression and anxiety affect one in seven women during the perinatal period, and are associated with increased risk of preterm delivery, reduced mother-infant bonding, and delays in cognitive/emotional development of the infant. With this survey we aimed to rapidly assess the influence of the COVID-19 pandemic and subsequent physical distancing/isolation measures on the mental health and physical activity of pregnant and postpartum women.Methods: Between April 14 and May 8, 2020, we recruited women who were pregnant or within the first year after delivery to participate in an online survey. This included questionnaires on self-reported levels of depression/depressive symptoms (Edinburgh Postnatal Depression Survey; EPDS), anxiety (State-Trait Anxiety Inventory; STAI-State), and physical activity. Current and pre-pandemic values were assessed for each.Results: Of 900 eligible women, 520 (58%) were pregnant and 380 (42%) were in the first year after delivery. Sixty-four percent of women reported reduced physical activity with the onset of isolation measures, while 15% increased, and 21% had no change to their physical activity. An EPDS score >13 (indicative of depression) was self-identified in 15% of respondents pre-pandemic and in 40.7% currently (mean ± SD; 7.5 ± 4.9 vs. 11.2 ± 6.3, respectively; p < 0.01, moderate effect). Moderate to high anxiety (STAI-state score >40) was identified in 29% of women before the pandemic (mean STAI = 34.5 ± 11.4) vs. 72% of women currently (mean STAI = 48.1 ± 13.6; p < 0.01, large effect). However, women engaging in at least 150 min of moderate intensity physical activity (meeting current guidelines) during the pandemic had significantly lower scores for both anxiety and depression than those who did not (p < 0.01, large and small effect, respectively).Discussion: This rapid response survey identifies a substantial increase in the likelihood of maternal depression and anxiety during the COVID-19 pandemic. This highlights the strong need for heightened assessment and treatment of maternal mental health. However, these data also suggest that physical activity, which has previously been shown to reduce depression and depressive symptoms in pregnancy, may be associated with better mental health during the pandemic.

Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study.

“…The present study ndings show that the prevalence of postpartum depressive and post-traumatic stress symptoms among the women experiencing childbirth during the Covid-19 pandemic was higher than that reported in previous studies before the pandemic. Literature data report that approximately 10-16% of women met major depression's criteria at 3 months postpartum [24,[33][34][35][36]. The ndings for our cohort (30.7%) are shared by a recent study that reported that 30% of the mothers who delivered during the Covid-19 pandemic had a global EPDS score > 12 compared with 11.9% in an antecedent matched group of postpartum women [36].…”

“…The ndings for our cohort (30.7%) are shared by a recent study that reported that 30% of the mothers who delivered during the Covid-19 pandemic had a global EPDS score > 12 compared with 11.9% in an antecedent matched group of postpartum women [36]. An EPDS score > 13 was self-identi ed by another online survey in 15% of women before and in 40.7% during the outbreak for the same cohort of women who were pregnant or within the rst year after delivery [35].…”

Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City.

“…Importantly, the distinction between our method of universally screening all postpartum patients and previous studies exploring maternal mood during the COVID-19 pandemic (25-28) likely explains, at least in part, the differences in our ndings compared to theirs. That is, they not only did not differentiate between SES, but in addition likely suffered from well understood methodological limitations associated with sampling bias in choosing only to study individuals who independently responded to social media announcements (25,26), anonymously e-mailed online survey requests (27) or other voluntary participation requests (28). Second, we were unable to analyze the data for demographic differences beyond SES.…”

“…Reduced pollution levels, a decline in the rates of automobile accidents, and a lower incidence of non-COVID infectious disease (24) all appear secondary to imposed social, educational and employment restrictions. Unsurprisingly, early explorations into the impact of the COVID-19 pandemic on maternal populations have reported increases in anxiety and depression (25)(26)(27)(28). While these ndings represent valuable contributions to the literature, the majority of these studies have suffered from important methodological limitations, including relying solely on self-selection recruitment methods, such as social media advertisements (25,26) and e-mailed online surveys (27) that are prone to biased sampling, may directly in uence outcome measures, and are well understood threats to the generalizability of the ndings.…”

Newly Mothers' Mental Health and Breastfeeding Rates During 2019 Coronavirus Disease Outbreak

“…Higher scores indicate greater anxiety. A score >=40 is considered indicative of clinically signi cant anxiety symptoms [13].…”