Peripartum Mood Clinic Referral Rates Pre- and Post-COVID

Main Article Content

Victoria Rone, MD Rebeka Mercker, MD Nancy Githere, MPH Emma Ryan Caroline Rouse Anthony Shanks, MD, MS, MEd

Abstract

Background: Peripartum depression is a common complication of pregnancy with the potential for dangerous consequences to maternal and infant health if left untreated. The COVID-19 pandemic increased the incidence of mental health disorders globally with an even greater effect on peripartum mothers. Disparities in access to mental health services may further exacerbate health care outcomes for affected individuals.


Aims: The aim of this study is to evaluate Edinburgh Postpartum Depression Scale (EPDS) scores pre- and post-COVID-19 to determine if mental health worsened post-COVID and assess how certain demographics were affected compared to others.


Methods: This is a retrospective cohort study of all pregnant patients referred to the Perinatal Mood Disorder Program at a large academic hospital in Indianapolis between March 1, 2019 to March 1, 2021. March 1, 2020 was the date used to determine our pre- and post-COVID groups, as it was near this time an official coronavirus outbreak was declared. Referral criteria were based on EPDS score and clinical gestalt. A convenience The sample of the population was assessed with EPDS score as the primary outcome. Demographic information including zip code of residence, psychiatric history, obstetric and newborn outcomes were also captured. Descriptive analysis, t-test and χ2 test were performed with statistical significance determined as p<0.05.


Results: There were 1,487 total pregnant patients referred with 733 referred pre-COVID and 754 post-COVID. Six hundred patients were sampled for analysis – 288 pre-COVID and 312 post-COVID. There were no statistically significant differences in age, ethnicity and race between groups. The mean EPDS score was not statistically significant between the groups (9.71 and 9.81, p 0.84). The four zip codes with the highest referral rates to the mood clinical also corresponded to areas within Indianapolis with the highest levels of poverty.


Conclusion: Edinburgh Postpartum Depression Scale scores were not different between pregnant patients pre- and post-COVID. There was also no difference in demographic characteristics between groups. The pandemic exacerbated existing barriers to treatment of peripartum mood disorders, highlighting the responsibility of clinicians and policymakers to support, identify, and facilitate treatment for this vulnerable population to prevent both short and long-term repercussions.

Article Details

How to Cite
RONE, Victoria et al. Peripartum Mood Clinic Referral Rates Pre- and Post-COVID. Medical Research Archives, [S.l.], v. 12, n. 6, june 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5327>. Date accessed: 21 dec. 2024. doi: https://doi.org/10.18103/mra.v12i6.5327.
Section
Research Articles

References

1. Becker M, Weinberger T, Chandy A, Schmukler S. Depression during pregnancy and postpartum. Curr Psychiatry Rep. 2016;18:32. Doi:10.1007/s11920-016-0664-7
2. US Preventative Services Task Force, Curry SJ, Krist AH, et al. Interventions to prevent perinatal depression: US Preventive Services Task Force recommendations statement. JAMA. 2019; 321:580-7. Doi:10.1001/jama.2019.0007
3. Yang K, Wu J, Chen X. Risk factors of perinatal depression in women: a systematic review and meta-analysis. BMC Psychiatry. 2022; 22:63. Doi:10.1186/s12888-021-03684-3
4. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020; 91:157-60. Doi:10.23750/abm.v91i1.9397
5. Patel K, Robertson E, Kwong ASF, et al. Psychological distress before and during the COVID-19 pandemic among adults in the United Kingdom based on coordinated analyses of 11 longitudinal studies. JAMA Netw Open. 2022; 5:e227629. Doi:10.1001/jamanetworkopen.2022.7629
6. COVID-19 Mental Disorder Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021;398:1700-12. Doi:10.1016/S0140-6736(21)02143-7
7. Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, psychological responses and associated correlates of depression, anxiety and stress in a global population, during the Coronavirus disease (COVID-19) pandemic. Community Ment Health J. 2021;57(1):101-110. Doi:10.1007/s10597-020-00728-y
8. Hawes MT, Szenczy AK, Klein DN, Hajcak G, Nelson BD. Increases in depression and anxiety symptoms in adolescents and young adults during the COVID-19 pandemic. Psychol Med. 2022;52(14):3222-3230. Doi:10.1017/S0033291720005358
9. Phipps JE, Whipps MDM, D'Souza I, et al. Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19. Matern Child Health J. 2023;27(7):1254-1263. Doi:10.1007/s10995-023-03657-w
10. Akgor U, Fadıloglu E, Soyak B, et al. Anxiety, depression and concerns of pregnant women during the COVID-19 pandemic. Arch Gynecol Obstet. 2021;304(1):125-130. Doi:10.1007/s00404-020-05944-1
11. Almeida M, Shrestha AD, Stojanac D, Miller LJ. The impact of the COVID-19 pandemic on women's mental health. Arch Womens Ment Health. 2020;23(6):741-748. Doi:10.1007/s00737-020-01092-2
12. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786. Doi:10.1192/bjp.150.6.782
13. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Doi:10.1016/j.jbi.2019.103208
14. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381. Doi:10.1016/j.jbi.2008.08.010
15. Zip codes with the highest poverty level in Indianapolis, IN: ZipAtlas. (2024). Accessed: April 2, 2024: https://zipatlas.com/us/in/indianapolis/zip-code-comparison/highest-poverty.htm
16. Mateus V, Cruz S, Costa R, et al. Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data. J Affect Disord. 2022;316:245-53. Doi:10.1016/j.jad.2022.08.017
17. FitzPatrick KM, Brown SJ, Hegarty K, et al. Experiences of physical and emotional intimate partner violence during the COVID-19 pandemic: a comparison of prepandemic and pandemic data in a longitudinal study of Australian mothers. BMJ Open. 2024;14(4):e081382. Doi:10.1136/bmjopen-2023-081382
18. Esser MB, Sherk A, Liu Y, et al. Deaths from excessive alcohol use — United States, 2016–2021. MMWR Morb Mortal Wkly Rep. 2024;73:154–161. Doi:10.15585/mmwr.mm7308a1
19. Pollard MS, Tucker JS, Green HD Jr. Changes in adult alcohol use and consequences during the COVID-19 pandemic in the US. JAMA Netw Open. 2020;3(9):e2022942. Doi:10.1001/jamanetworkopen.2020.22942
20. Chen PJ, Pusica Y, Sohaei D, Prassas I, Diamandis EP. An overview of mental health during the COVID-19 pandemic. Diagnosis (Berl). 2021;8(4):403-412. Doi:10.1515/dx-2021-0046
21. Lindert J, Jakubauskiene M, Bilsen J. The COVID-19 disaster and mental health-assessing, responding, and recovering. Eur J Public Health. 2021;31(Supplement_4):iv31-iv35. Doi:10.1093/eurpub/ckab153
22. Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. Lancet Glob Health. 2021;9:e759-e72. Doi:10.1016/S2214-109X(21)00079-6
23. Wisner KL, Murphy C, Thomas MM. Prioritizing maternal mental health in addressing morbidity and mortality. JAMA Psychiatry. 2024;81(5):521-526. Doi:10.1001/jamapsychiatry.2023.5648