key: cord-0930713-wzdxorcd
authors: An, Ran; Chen, Xiaoli; Wu, Yuanyuan; Liu, Juan; Deng, Che; Liu, Yanqun; Guo, Hongxia
title: A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19
date: 2021-02-17
journal: Arch Psychiatr Nurs
DOI: 10.1016/j.apnu.2021.02.001
sha: 2cfedc436fda5d44cd48182ac782ccfd8d66d5c0
doc_id: 930713
cord_uid: wzdxorcd

BACKGROUND: The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women. Aim To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic. METHODS: In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis. RESULTS: With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R(2) = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05). CONCLUSIONS: Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25–34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.

Especially during pregnancy and childbirth, there are a series of changes in the physiological-psychological-social environment of pregnant and postpartum women (Moya et al., 2014) . Pregnant and postpartum women as a special susceptible group are more likely to suffer from psychological problems after experiencing emergencies, which will increase the risk of mental illness (Thapa et al., 2020) . Most of the current studies showed an increased incidence of prenatal anxiety and depressive symptoms among pregnant women in the outbreak period of and pregnant women reported fear at the thought of childbirth during the COVID-19 pandemic (Lebel et al., 2020; Liu et al., 2020; Ravaldi et al., 2020; Wu et al., 2020) . According to four existing studies conducted in Canada, Belgium, Italy and Japan, the COVID-19 pandemic exacerbated maternal anxiety, depressive symptoms and the worse mother-infant bonding (Cameron et al., 2020; Ceulemans et al., 2020; Suzuki, 2020; Zanardo et al., 2020) . But there are few studies about Chinese postpartum women's mental health status. Lebel et al. (2020) found that depressive symptoms among pregnant women were significantly related to unmet health care needs because of the pandemic. In a survey of antenatal health care needs in Shanghai of China, pregnant women were highly concerned about preventive measures and needed online services during the COVID-19 epidemic (Du et al., 2020) . Thus, the management of perinatal health care during the COVID-19 pandemic may face different challenges. Perinatal women expressed that they actively sought information from multiple sources, but the information could be ambiguous

The average EPDS score was 10.51 ± 5.31, ranging from 0 to 25. There were 56.9% of postpartum women had an EPDS scored 10 points or higher, of which 23.4% scored 10-12 (n = 49, depressive tendency) and 33.5% scored higher than 12 (n = 70, depressive symptoms).

As shown in Table 2 , univariate analysis of EPDS scores indicated that there were statistically outbreaks are emerging in other cities, and the pandemic prevention and control work has never been lax. Thus, a prolonged pandemic and related prevention and control measures may have a great impact on maternal mental health, leading to a higher incidence of postpartum depression. Therefore, it is necessary for medical workers to pay attention to the mental health problems among postpartum women during the COVID-19 pandemic.

Our study indicated that women aged 25-34 was a risk factor for the level of postpartum depression. This probably because most Chinese women mainly play the role of caregiver in the family. The mothers aged 25-34 are also mostly working women and therefore they often need to balance career and family. Similarly, a study found that pregnant women aged < 35 were at increased risk of experiencing depressive symptoms during the COVID-19 outbreak in China (Wu et al., 2020).

However, most studies prior to the COVID-19 outbreak suggested that advanced maternal age was a risk factor for postpartum depression (Matsumoto et al., 2011; Youn et al., 2017) . Therefore, medical workers should not ignore postpartum depression levels in women aged 25-34 during the COVID-19 pandemic.

Women with a history of abortion increase their risk of postpartum depression, and women with multiple abortions have a higher risk of major depression than women with a history of one abortion (Giannandrea et al., 2013) . Similarly, our study discovered that compared with women without a history of abortion, women with a history of abortion had significantly higher levels of postpartum depression. Women experienced high levels of depression after abortion, although it declined over time, it remained at a high level after 9 months (moderate to severe depression accounted for 6%) (Farren et al., 2020) . Therefore, abortion has a long-term psychological impact on postpartum women.

Due to the negative impact of abortion on re-pregnancy and newborns, women may worry about the J o u r n a l P r e -p r o o f Journal Pre-proof neonatal health status from the first trimester to childbirth. And pregnant women and children are susceptible to the COVID-19, which can aggravate the depressed mood of postpartum women and lead to increased levels of depression. Studies have highlighted the importance of using EPDS to screen for depression in women with a history of abortion, whether spontaneous or induced (Mutiso et al., 2018) . This suggests that medical workers can provide early screening for women with a history of abortion and increase maternal confidence in feeding newborns through health education during the COVID-19 pandemic.

We found that the higher the stress perceived by postpartum women, the higher the level of postpartum depression during the COVID-19 pandemic. A prospective study of postpartum women at 6 months postpartum reported that high levels of perceived stress were a risk factor for postpartum depression (r = .72, p < .001) (Ahn & Corwin, 2015) , which was similar to the results of our study. Luo et al. (2020) found that 39.9% of Chinese residents were under health risk stress during the COVID-19 outbreak. A large-scale survey of the psychological distress among Chinese people during the COVID-19 pandemic emphasized that women were significantly more stressed than men and were more susceptible to stress (Qiu et al., 2020) . The percentage of postpartum women in a state of health risk stress in our study was as high as 45.5%. Firstly, the possible reason was that postpartum women had the fear of COVID-19 infection. There was 52.2% of the postpartum women surveyed in our study expressed concern about COVID-19 infection, which was higher than a previous study in prenatal and postnatal women (37.7%) (Lee et al., 2020). There is a possibility that the mother has to go to the hospital on time for postnatal checkups or vaccinations of her newborn during the COVID-19

pandemic. As a result, the postpartum woman may be more concerned about the health of herself, her newborn and her family members than ever before (Lee et al., 2020). Secondly, mental health J o u r n a l P r e -p r o o f Journal Pre-proof problems were related to frequently social media exposure (Gao et al., 2020) . Only 48.8% of the postpartum women knew a lot about the COVID-19 in this study. Therefore, whether it is real news report or false information on the Internet, to some extent, too much exposure to the negative news due to social isolation may lead to more stress symptoms. Thirdly, previous studies support that high levels of psychological stress were closely associated with more exposure to adverse daily life events (Clout & Brown, 2015) . Some industries were greatly affected by the COVID-19 pandemic, such as catering, transportation and tourist industries. In severe cases, some families would be at risk of temporary or even permanent unemployment. People on furlough had higher levels of distress because of employment instability during the COVID-19 pandemic (Mimoun et al., 2020) . The economic income of maternal families may be affected to different degrees at once, leading to high economic pressures. Scheyer and Urizar (2016) found that high levels of postpartum perceived stress were significantly correlated with postpartum depressive symptoms among low-income women. J o u r n a l P r e -p r o o f Journal Pre-proof 

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