Postpartum Depression and Anxiety in COVID-19-Positive and COVID-19-Negative Mothers: Insights From a Dedicated Hospital in Eastern India

TL;DR

The study found that mothers who tested positive for COVID-19 had three times higher rates of postpartum depression and anxiety compared to those who tested negative, with factors like poor family support and societal discrimination playing a key role.

Contribution

This study is novel in comparing mental health outcomes between COVID-19-positive and -negative mothers in Eastern India during the pandemic, identifying unique risk factors specific to each group.

Findings

Postpartum depression prevalence was 39.6% among COVID-19-positive mothers versus 13.5% in negative mothers.

Poor family support and financial crisis were significant predictors of depression in both groups.

Social discrimination and illiteracy uniquely predicted depression in COVID-19-positive mothers.

Abstract

Objective

Women experienced mental health issues during pregnancy and postpartum, with the prevalence of depression and anxiety varying across different regions during the pandemic. A study was conducted to evaluate the symptoms of postpartum depression (PPD) and anxiety in women who tested positive and negative for COVID-19 and delivered in a tertiary-level hospital in Eastern India during the COVID-19 pandemic from 2020 to 2021. The objective was to explore the clinical and socio-demographic risk factors associated with PPD.

Methodology

A questionnaire-based cross-sectional study was conducted among women who were either positive or negative for COVID-19 in the Department of Obstetrics and Gynecology at All India Institute of Medical Sciences (AIIMS), Patna. A semi-structured questionnaire (the Edinburgh Postnatal Depression Scale (EPDS) questionnaire validated in Hindi) was used to collect socio-demographic and clinical details. The questionnaire included sections on socio-demographic characteristics, knowledge, attitudes, and behaviors related to COVID-19.

For the study, the EPDS score was calculated to assess feelings of the last seven days. A score below 8 was indicative of depression not likely, while scores of 9-11 indicated a possibility of depression, and scores of 12-13 suggested a high likelihood of depression. The cut-off score of 12 or higher was used to compare group differences in depression. The anxiety dimension was measured as the cumulative score from items 3, 4, and 5 in the EPDS (EPDS-3A). The sample size was determined to be 51 in each group, assuming a threefold increase in PPD among COVID-19-positive women who delivered at AIIMS Patna, with a study power of 80% and a significance level of 5%.

Results

A total of 327 candidates were invited to participate, of which 290 completed questionnaires were analyzed, comprising 237 COVID-19-negative and 53 COVID-19-positive mothers.

The mean ages, age group distribution, family structure, and residence type were similar in both COVID-19-positive and COVID-19-negative mothers. The prevalence of depression among COVID-19-negative mothers was 13.5% (32/237) with a mean EPDS score of 5.4 ± 3.8 as compared to 39.6% (21/53) with a mean EPDS score of 11.7 ± 3.3 among COVID-19-positive mothers.

A statistically significant association of PPD was noted with financial crisis (59.4%) in COVID-19-negative mothers. Poor family support was associated with both COVID-19-negative (81.2%) and COVID-19-positive (66.7%) mothers. Poor availability of medical services (66.7%), societal discrimination (76.2%), and loss of/minimal leisure activities (81%) were significantly associated with COVID-19-positive mothers.

Financial crisis (adjusted odds ratio (AOR): 4.3; 95% CI: 1.76-10.38; p = 0.001) and poor family support (AOR: 4.1; 95% CI: 1.33-12.29; p = 0.01) emerged as independent predictors of depression among COVID-19-negative mothers. Among COVID-19 positives, illiteracy (AOR: 2.3; 95% CI: 1.5-9.2; p = 0.01) and social discrimination (AOR: 16.5; 95% CI: 1.9-144.2; p = 0.01) were the independent predictors for PPD.

Conclusions

The prevalence of PPD and anxiety was found to be three times higher in COVID-19-positive mothers. Significant contributing factors included poor family support, lack of access to antenatal services, societal discrimination, and limited leisure activities during the pandemic. Low literacy and societal discrimination emerged as key predictors of PPD.