key: cord-0699567-9ujuqoj9
authors: Lewkowitz, Adam K.; Schlichting, Lauren; Werner, Erika F.; Vivier, Patrick M.; Kahn, Linda G.; Clark, Melissa A.
title: Risk factors for new-onset postpartum depression or anxiety symptoms during the COVID-19 pandemic
date: 2021-10-09
journal: Am J Obstet Gynecol MFM
DOI: 10.1016/j.ajogmf.2021.100502
sha: 5e97a654a4b4c864654dbe71f1a9fe586e70d99e
doc_id: 699567
cord_uid: 9ujuqoj9

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Objective: Rates of postpartum depression (PPD) or anxiety have increased during the 2019 coronavirus (COVID-19) pandemic 1 ; for example, in Canada, rates of pre-pandemic depression and anxiety ranged from 10-15% but are 37% during the pandemic. 2 To date, however, data remain scant on risk factors for developing symptoms of PPD or anxiety during the pandemic, particularly among women who did not have preexisting mental health issues, though these data could help providers provide targeted support for women delivering during the pandemic who are at increased risk for postpartum depression or anxiety symptoms. This study aimed to investigate factors associated with developing PPD or anxiety symptoms during the COVID-19 pandemic among women who delivered during the prior year who did not report having symptoms of depression or anxiety.

Study Design: From July 29 to October 23, 2020, women were recruited from the Hassenfeld Study, an ongoing, IRB-approved large, diverse prospective cohort study in Rhode Island examining the effect of environmental factors on maternal and pediatric outcomes during pregnancy and early childhood. Participants who delivered within the prior 12 months and maintained primary custody of their child were eligible for this study, which was a survey administered via telephone. Women completed the validated psychometric screening tools-Patient Health Questionnaire-2 (PHQ-2) and the Generalized Anxiety Disorder-2 (GAD-2)-to assess for self-reported symptoms of PPD and anxiety, respectively. The PHQ-2 has high sensitivity for PPD symptoms, 3 while the GAD-2 has high specificity for perinatal anxiety symptoms 4 : by focusing on self-reported symptoms neither scale can diagnose Major Depressive Disorder or anxiety disorder per DMS5 criteria. Women who endorsed symptoms of depression or anxiety before the pandemic were excluded from analysis as the aim of the study was to identify risk factors for symptoms of postpartum depression or anxiety among women who did not have these symptoms during or prior to pregnancy. To identify risk factors for developing new PPD or anxiety symptoms, women self-reported on COVID-19 symptoms and exposures, perceived stress before and during the pandemic (using the Perceived Stress Score-4 5 ), and employment, financial or general concerns. Predictors were compared between those who did versus did not endorse new-onset PPD or anxiety symptoms during the pandemic.

Results: A total of 329 women were eligible; of these, 241 (73%) participated and 204 did not endorse pre-pandemic symptoms of depression or anxiety. Of the 204 included women, 54 (26.7%) endorsed new-onset PPD or anxiety symptoms during the pandemic.

There were no sociodemographic or obstetric differences between women who did versus did not endorse PPD or anxiety; overall, 36% were Hispanic ( Table 1) . Although rates of reported stress prior to the COVID-19 pandemic were similar between the two groups, women who developed PPD or anxiety symptoms had higher perceived stress at survey completion (PSS-4 Mean (Standard Deviation (SD)) 7.7 (2.1) versus 4.6 (2.6); p<0.0001).

Those with PPD or anxiety symptoms were more likely to endorse being concerned about the availability of food or household supplies or lack of social distancing. Women who had PPD or anxiety symptoms were more likely to report that their own job or the job of someone they depended on financially had been designated as essential (64.9% versus 45.8%; p=0.03), to believe this job increased risk of COVID-19 exposure (59.3% versus 42.8%; p=0.04), or to report that a family member had been diagnosed with or presumed to have COVID-19 (27.8% versus 12.8%; p=0.01) ( Table 2) .

In this diverse cohort of postpartum women who did not report having symptoms of depression or anxiety before the COVID-19 pandemic, more than one fourth developed PPD or anxiety symptoms during the pandemic. The high rate of new onset PPD or anxiety symptoms may be due to stressors associated with the COVID-19 pandemic, potentially compounded by social distancing practices isolating mothers with young infants from in-person support from those who do not live in their households. By identifying risk factors such as being concerned about food availability or having a household member employed as an essential worker, these findings can help guide future public health initiatives aiming to mitigate the risk of PPD or anxiety symptoms and provide targeted support for women who deliver during the current or future pandemics.

Works Cited: 

Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China

Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic

Can we effectively use the twoitem PHQ-2 to screen for postpartum depression

Prevalence and identification of anxiety disorders in pregnancy: The diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2)

Development of a Postpartum Stressor Measure