A multi-center survey on the postpartum mental health of mothers and attachment to their neonates during COVID-19 in Hubei Province of China

Abstract

Background: There is an emerging literature on the mental health of both pre-and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic.Methods: As of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days).Results: The period of mother-child separation among the confirmed group (33.9±20.9 days) was significantly longer than that of suspected group (16.7±12.2 days) and control group (10.7±8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5±4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5±4.7) and control (48.8±4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman's ρ =−0.33, 95% CI: −0.095 to −0.538, P=0.005; Subscale score of attachment: Spearman's ρ =−0.40, 95% CI: −0.163 to −0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups.Conclusions: Decreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

“…In Cojocaru’s study [86] , most COVID-positive mothers still opted to room in with their newborns and continue with skin-to-skin contact. In contrast, Peng and colleagues [87] reported a longer period of mother-infant separation and lower infant attachment score among COVID positive mothers than COVID negative mothers did. The concerns and difficulty of neonatal separation faced by COVID positive mothers were flagged in qualitative studies, where mothers mentioned a lack of updates on their baby and the fear of infecting their baby [83] , [88] .…”

“…In Liu’s study [70] , 45.8% of mothers did not have a support person during birth, and another study [49] found lower birth satisfaction in mothers who did not have a birth support partner than those who had. Qualitative findings often reported negative experiences of mothers who did not have a support partner present during labour [30] , [36] , [39] , [45] , [46] , [61] , [66] , [68] , [87] . Some mothers perceived the absence of a birth partner as a loss of reassurance and advocate [55] , [78] while others felt alone, stressed, anxious, and that their mental health was at stake [44] , [45] , [52] , [65] .…”

A case-control study on the severity postpartum depression among COVID19 positive mother

“…Collins, Fruhman [ 20 ] reported that postpartum depression among COVID positive mothers is significantly greater than COVID negative women, with the odds ratio of 3.7. In Chinese population, Peng, Zhang [ 21 ] stated that COVID positive mothers have lesser Maternal Postnatal Attachment Scale score. However, the anxiety and depression scores among COVID confirmed, suspected and control cases did not differ significantly.…”

“Worn-out but happy”: Postpartum Women's Mental Health and Well-Being During COVID-19 Restrictions in Australia

“…Recent studies across the world have reported mixed findings on the mental health and well-being of perinatal women during COVID-19 (11)(12)(13)(14)(15)(16)(17)(18). Six studies in postpartum mothers across the world, North-eastern Italy, Belgium, China, and America have found increased depressive and anxiety symptoms (11,12,(14)(15)(16)(17), whilst another study in postpartum women in Japan reported normal levels of mental health and well-being (13). In addition, emerging evidence suggests the amount of physical activity women across the world partake in is also an important factor when considering maternal mental health during the pandemic (11).…”