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

Abstract

Background Trauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style. Methods Women who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores.Results The survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥11) and the PTSS rate was 42.9% (IES-R cut-off score ≥24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors. Conclusion This study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.

The effect of social restrictions, loss of social support, and loss of maternal autonomy on postpartum depression in 1 to 12-months postpartum women during the COVID-19 pandemic

“…When using the cutoff value of 9, the prevalence of postpartum depression was 28.7% in the current study, which is much higher than the prevalence of 14.4% among postpartum women during the pandemic (Suzuki, 2020) or a recent meta-analysis for Japanese women: 14.3% (Tokumitsu et al, 2020). On the other hand, when used higher cut off points (≥ 11 or 13), the prevalence of postpartum depression in the current study (18.6% or 13.1%) was much lower than other studies in the countries with high death tolls due to COVID-19: 28.6% or 44.2% (both EPDS ≥ 13) in Italy (Ostacoli et al, 2020; Zanardo et al, 2020); 56.9% (EPDS ≥ 10) in China (An et al, 2021). However, the prevalence was similar to other studies with the same definition (EPDS ≥ 13): 17% among Japanese pregnant women during the pandemic (Matsushima and Horiguchi, 2020), or 13-17% in meta-analyses before the pandemic (Hahn-Holbrook et al, 2017; O’hara and Swain, 1996).…”

“…So far, the percentages of pregnant women who obtained scores higher than 13 on the Edinburgh Postpartum Depression Scale (EPDS) were reported to be 17% in Japan (Matsushima and Horiguchi, 2020); 29.6% in China (Wu et al, 2020); 35.4% in Turkey (Durankus and Aksu, 2020); 37% in Canada (Lebel et al, 2020). However, the prevalence of postpartum depression among postpartum women who delivered during the COVID-19 pandemic has not been fully investigated and most of them are single-site studies (An et al, 2021; Ostacoli et al, 2020; Suzuki, 2020; Zanardo et al, 2020).…”

Obstetric challenges during COVID-19 pandemic: A narrative review

“…Worldwide, there is notable diversity in the severity of postpartum psychological changes among women. A cross-sectional study in Torino, Italy reported the high incidence of postpartum depression and post-traumatic stress symptoms in women who delivered during the COVID-19 pandemic [ 29 ]. However, in Israel, the post-partum risk for depression was lower in women delivering during the pandemic compared to women who did not [ 30 ].…”

An Exploration of Midwives’ Experiences of Reducing Maternal Morbidity and Mortality From Postpartum Haemorrhage (PPH) in Rural Communities in Eastern Nigeria.

“…The midwives' understanding and appreciation of PPH as a life-threatening and frightening condition served as an enabling factor for the effective management of PPH that involved a holistic approach to care and collaborative multidisciplinary team approach where possible. Studies have shown that to prevent physical deterioration and psychological distress, it is important to utilise timely holistic approaches involving effective team collaboration when managing life-threatening conditions or other complications associated with childbirth (19)(20)44).…”