Annals of Indian Psychiatry

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 6  |  Issue : 1  |  Page : 57--62

How coronavirus disease 2019 is affecting the mental health of postpartum women: A cross-sectional study


Santosh Iranna Ramdurg1, Subhashchandra R Mudanur2, Sanjeevkumar Bentoor3, Rajashri Yaliwal2, Shreedevi Kori2, Lata Varma2,  
1 Department of Psychiatry, BLDE (DU). Shri B M Patil Medical College, Hospital and Research Centre, Vijayapur, Karnataka, India
2 Department of Obstetrics and Gynaecology, BLDE (DU). Shri B M Patil Medical College, Hospital and Research Centre, Vijayapur, Karnataka, India
3 Department of Medicine, BLDE (DU). Shri B M Patil Medical College, Hospital and Research Centre, Vijayapur, Karnataka, India

Correspondence Address:
Dr. Santosh Iranna Ramdurg
Department of Psychiatry, BLDE (DU). Shri B M Patil Medical College, Hospital and Research Centre, Bangaramma Sajjan Campus, Solapur Road, Vijayapur - 586 103, Karnataka
India

Abstract

Aims: We aimed to study the prevalence of mental health problems in postpartum women during coronavirus disease 2019 (COVID-19) pandemic and to evaluate various parameters affecting it. Methods: Data were collected from May 15, 2020, to October 15, 2020, and during this period, 311 postpartum women were enrolled in the study. Sociodemographic data and obstetric-related information and Depression, Anxiety, and Stress Scale-21 were administered. Data were analyzed for the prevalence of depression, anxiety, and stress among postpartum women and various factors that affect mental health. Results: Postpartum women showed a higher prevalence of depression (38%), anxiety (42%), and stress (21%). It was more in rural background women, single mother, having 4–5 children, and from higher socioeconomic (lower socioeconomic status) background. Conclusion: This study assessed the prevalence of mental health problems in postpartum women and highlighted the high prevalence rates of anxiety, depression, and stress among this population.



How to cite this article:
Ramdurg SI, Mudanur SR, Bentoor S, Yaliwal R, Kori S, Varma L. How coronavirus disease 2019 is affecting the mental health of postpartum women: A cross-sectional study.Ann Indian Psychiatry 2022;6:57-62


How to cite this URL:
Ramdurg SI, Mudanur SR, Bentoor S, Yaliwal R, Kori S, Varma L. How coronavirus disease 2019 is affecting the mental health of postpartum women: A cross-sectional study. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Jun 29 ];6:57-62
Available from: https://www.anip.co.in/text.asp?2022/6/1/57/344420


Full Text



 Introduction



The coronavirus disease 2019 (COVID-19) has pandemic in 2020 and spreads to even India. All of us are fighting against this virus since the beginning. Still, a lot of research is going on finding safe and effective treatment and an adequate safety vaccine. Thus, many women are going through pregnancy and postpartum and caring baby during this COVID-19 pandemic.

The postpartum period brings a lot of changes in the mother both in terms of physical and mental health. Systematic review and meta-analysis by Dennis et al.'s study, 2017, on 221,974 pregnant and postpartum women from 34 countries found that the pooled prevalence of anxiety disorder was 15.2%.[1] Another systematic review and meta-analysis by Woody et al., 2017, found that the prevalence of depression was 11.9%.[2]

Many studies have done during disasters or natural calamities before and they have found that higher prevalence of mental disorders among postpartum women compared to the general population.[3],[4],[5] Mental health issues in mother during these corona pandemics have severe adverse influences on mothers and fetuses. They may range from disturbances in the daily physical activity, nutritional aspect, sleep pattern to the disturbance in the development of the baby. Timely interventions addressing mental health issues are helpful.[6],[7] Assessing the effect of the COVID-19 pandemic on the psychological well-being of postpartum women and applying specific interventions on the basis of data are urgent. Thus, the aim of our study was to assess the prevalence of mental health problems during postpartum women in COVID-19 pandemic and to explore the specific vulnerable groups among these populations of women.

 Materials and Methods



Sample size calculation

Sample size was calculated by Raosoft software assuming a response rate of 80%, confidence interval 95%, Z as 1.96, and margin of error as 5%. The sample size is 243. Considering an additional 20% (n = 48) for any error in questionnaire filling, a final sample size of 291 will be required.

Ethical approval

The institutional ethics committee approval was obtained for this study with reference number BLDE (DU)/IEC/430/2019-20 dated May 13, 2020.

Study participants

Initially, semi-structured questionnaires were prepared to cover sociodemographic data, pregnancy, and postpartum-related problems, Depression, Anxiety, and Stress Scale-21 (DASS-21), and other relevant questions related to COVID-19 pandemic in the Google Forms: https://docs.google.com/forms/d/1wvR2uZSlnLX_xn3BS71-hN3JKWg3zFD3w9feGgKDUMg. The study questionnaire was comprised of demographic characteristics, pregnancy, and postpartum-related problems, DASS-21, and other relevant questions related to COVID-19 pandemic. Depression, anxiety, and stress levels were assessed using DASS-21 (LP, LS, 1995), which was a validated screening instrument for use among patients and general populations.[8] It was a self-reported 21-item scale developed by the University of New South Wales, Australia, which provides independent measures of depression, stress, and anxiety with recommended severity thresholds for the depression, stress, and anxiety subscales. The scores for each of the three components were calculated by adding up the scores for the relevant items. On the DASS-21 depression subscales, scores of 10–13 were considered as “mild,” 14–20 as a “moderate,” 21–27 as a “severe,” and 28–42 as a “extremely severe” depression. The anxiety was assessed as “mild” (8–9), “moderate” (10–14), “severe” (15–19), and extremely severe” (20–42). The stress was assessed on the score of “mild” (15–18), “moderate” (19–25), “severe” (26–33), and “extremely severe” (34–42) (Tay et al., 2020).[4] These questionnaires were asked to all the women who were delivered in our hospital before they were being discharged. Most of them were between 5 and 7 days of the postpartum period. They were included in the study after taking informed consent. Questionnaires were converted into Kannada and retranslated back to English to minimize the error. This translation was done to help the patients who were speaking Kannada. We have included the patients who can able to read and write Kannada or English as a language. We excluded the patients who were on psychotropics, antidepressants, or preexisting psychiatric illnesses. This study was being cross-sectional study we administered the question only once. One postgraduate student was involved in assisting them to understand the questions and also helping them to fill the questionnaires. Total 311 postpartum women have participated in the study. The duration of the study was from May 15, 2020, to October 15, 2020. During this time, COVID-19 pandemic reached the peak and started coming down.

Statistical analysis

Statistical analysis of the data was performed with SPSS 26.0(IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). The independent t-test was used for comparing stress, anxiety, and depression between urban and rural and ANOVA was used to compare the socioeconomic status, type of family, and number of living children. Descriptive statistics were used to present the data collected from the survey and included the mean and standard deviation of the data collected for all the sections. P < 0.05 was considered to be statistically significant.

 Results



We collected a total of 311 responses from postpartum women seeking postnatal care during 5-month period. The sociodemographic profile [Table 1] is as follows. The mean age was 26.07 ± 5.5 with a minimum of 18 years and a maximum 40 of years. The majority were belonging to middle socioeconomic status (50%) and rural background (57%). Fifty-six percent were belonging to a joint family and the majority were homemakers (70%). One hundred and seventy-five (61%) women were having 2–3 children and 120 (54%) were having a single child. The most common mode of delivery was cesarean section 150 (47%). Two hundred and fifteen (69%) of women were had difficulty in getting medical care during the pandemic. One hundred and fifty-four women said that COVID-19 has affected their personal/family life. One hundred and nineteen said that COVID-19 pandemic has affected their pregnancy (not able to carry on regular antenatal care/getting regular medicine) and 144 said that they got affected financially and the common reason was their spouse/other members of the family are not earning or they were not getting salary due to COVID-19 pandemic{Table 1}

In terms of mental health, depressive symptoms were reported in 129 (42%), anxiety in 133 (43%), and stress in 56 (18%) of postpartum women [Table 2]. The mean score of depression was 3.55 ± 4.0, anxiety was 3.5 ± 3.9, and stress was 3.7 ± 3.8 [Table 3]. Anxiety symptoms were the most commonly reported psychological problem by postpartum women during the pandemic. In terms of mental health, rural background women were having more anxiety and stress compared to urban and it was not statistically significant (P < 0.05) [Table 4].{Table 2}{Table 3}{Table 4}

Level of depression (6.44 ± 4.927 vs. 3.58 ± 4.035), anxiety (4.22 ± 4.738 vs. 3.68 ± 4.002), and stress (5.56 ± 4.531 vs. 3.83 ± 3.950) were lower among higher socioeconomic status (lower socioeconomic status [LSES]) compared to mean value of other socioeconomic status and it was not statistically significant [Table 5]. Single mothers had significant high-level depression (6.56 ± 1.248), anxiety (6.33 ± 4.743), and stress (6.11 ± 2.759) compared to nuclear and joint families [Table 6]. Depression (3.45 ± 4.097 vs. 3.59 ± 4.037), anxiety (3.43 ± 3.956 vs. 3.69 ± 4.003), and stress (3.48 ± 3.993 vs. 3.84 ± 3.950) were low among those who have single compared more than one child [Table 7].{Table 5}{Table 6}{Table 7}

 Discussion



This is the first study from India on the prevalence of mental health problems during COVID-19 pandemic on postpartum women to our best knowledge. Because of increase in spreading and increased mortality and media created hype all have adversely affected the mental status of postpartum women. This pandemic has a negative impact on mental well-being both in mothers and their offspring, thus this study was set out to investigate the prevalence of depression, anxiety, and stress among postpartum women. Pregnancy and the postpartum period could be an extra risk factor for the onset of certain mental disorders or aggravation of certain mental disorders during the COVID-19 pandemic or other similar infectious outbreaks.[9] Although some studies have been published with pregnancy and postpartum women samples.[10],[11],[12],[13],[14],[15],[16] To date, none of them were from India.

In our study, 31% of postpartum women had moderate-to-severe depression while a meta-analysis by Yan et al., 2020, has shown that the prevalence rate of depression was 22%. In many studies, the prevalence of depression in COVID-19 pandemic data is not available.[17] Compared to general antepartum and postpartum women before the pandemic, the prevalence of depression was in low-and-middle-income countries was 19%–25%, and in developed countries, 7%–15%, but in our study during the pandemic, the prevalence was 31%, which suggests that it was higher than the routine.[2],[18] However, the prevalence recorded in this study was similar to that found by other studies around the world during the COVID-19 pandemic. For example, in Canada, it was 37%, in Colombia 25%, in China values are close to 30% (29.6%: Wu et al., 2020, and 33.71%: Sun et al., 2020), in Belgium 25.3%, and in Turkey 35.4%.[12],[19],[20],[21],[22],[23] The reason for heightened depression could be due to social isolation, feeling of less social support, sadness due to separation from loved ones when they need love and affection during this time, loss of freedom, restriction in movements and pervasive loneliness could increase the risk of depression. A recent study done by Corbett et al. identified that almost 35% of pregnant women got self-isolated to avoid the transmission of COVID-19.[24] On the other hand, lockdown, less care to postpartum compared to corona patients, and difficulty in getting proper care during this pandemic could also generate negative effects, since the suspension of prenatal/natal/postnatal care could cause extra concern in postpartum women.[25],[26] In many cases, pregnancy and delivery itself is a risk factor for the development of a mental disorder, such as depression. These studies suggest that symptoms of depression have increased significantly during the COVID-19 pandemic. The study by Ramdurg et al. on health-care workers showed that the prevalence of depression was 12.4% during COVID-19 pandemic. Compared to this, depression is more among postpartum women.

The prevalence of anxiety in our study was 43% while a meta-analysis by Yan et al., 2020, has shown that there were no data on postpartum anxiety problems during COVID-19 pandemic, but there are data on the prevalence of anxiety among pregnancy.[17] This suggests a higher prevalence of anxiety in our study during this pandemic. The increase in anxiety is probably associated with the daily restrictions, the social isolation, the feelings of uncertainty regarding future, and the fear regarding a new and unknown infectious agent. In postpartum women, anxiety could be further increased due to concerns regarding the health of the baby. The study by Ramdurg et al., 2021, on health-care workers showed that the prevalence of anxiety was 19.1% during COVID-19 pandemic. Compared to this, anxiety was more among postpartum women.[26]

The prevalence of stress in our study was 18% while a meta-analysis by Yan et al., 2020, has shown that the prevalence rate of stress among pregnancy was 66%, but data on postpartum stress were not available due to limited data.[17] The cause could be the effect of sociodemographic variables on psychopathology, such as financial or work problems, age, and social support.[21],[22],[23] In our study, we found more and severe psychopathology (depression, anxiety, and stress) among women having more than one child compared to single children and also from lower socioeconomic status (higher socioeconomic status). However, no research data is available on the number of children with mental health problems during the pandemic. During disasters/pandemics, the prevalence rates of mental disorders in pregnancy and postpartum women increased significantly compared to the general population.[3] Similarly, in 2020, pregnant and postpartum women have to face the COVID-19 pandemic and its accompanying preventive measures. This has led to disruptions in medical practices. This could lead to adverse mental health outcomes in postpartum women. Before the COVID-19 pandemic, the estimated prevalence of anxiety among antenatal and postnatal women was 15.2%, and the pooled prevalence of depression among women in the perinatal period was 11.9%.[2]

We found a high level of mental health problems in single mothers compared to the family from joint and nuclear. Hence, for good mental health during the postpartum period, good social support is most important. Yan et al.'s study, 2020, has said the same things on family support and psychopathology. It shows that support from partners, families, and societies is most important.[17],[22] This study assessed the prevalence of mental health problems in postpartum women and highlighted the high prevalence rates of anxiety, depression, and stress among this population. High risk groups are single mother, mother of more than one child and women from LSES. We have to give medication, counseling, or family support to these susceptible individuals. In our hospital, we had a collaborative team of obstetrician and psychiatrist to identify these susceptible individuals and treated with medication, counseling. We recommend timely intervention on susceptible individuals by counseling, psychotherapy by psychiatrist and psychologist can lead to smoother postpartum recovery.

 Conclusion



We found a higher prevalence of mental health problems in postpartum women during COVID-19 pandemic compared to the prepandemic. The high-risk group was rural women, single and working mothers, and women from the lower socioeconomic background. These women need psychological intervention.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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