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Heterogeneity in Maternal Perinatal Depression Symptom Change in Response to the COVID-19 Pandemic

Wed, April 7, 4:20 to 5:50pm EDT (4:20 to 5:50pm EDT), Virtual

Abstract

Introduction: Previous research suggests that major stressful events, such as natural disasters and terrorist attacks, during the perinatal period are associated with increased maternal depressive symptoms and a subsequent long-term influence on child development (Buthmann et al., 2019; Yehuda et al., 2005). However, these studies have rarely captured maternal mental health-related symptom change (particularly not as the event is ongoing), which is insufficient to provide a comprehensive picture of the processes responsible for potential sustained effects on the mother and child, and how these may differ between individuals over time.

Hypotheses: The current study addressed this gap by examining (a) whether the COVID-19 pandemic and associated social distancing regulations influenced the trajectories of women’s depressive symptoms across the perinatal period; and (b) the mechanisms through which COVID-19 influenced maternal depression symptoms. Hypotheses centered on isolation/social support; concern about health and finances; reduced access to healthcare; and changes to birth plans.

Population: Data came from N=319 women living in Portland, Oregon. At enrollment, participants were pregnant (n=178) or within 12 months postpartum (n=141); they completed questionnaires every two weeks for twelve weeks. We also have data from an ongoing cohort (N=176), which we use as a pre-pandemic comparison group.

Methods: A comprehensive battery of questionnaires developed by the COVGEN alliance (covgen.org) was administered at enrollment. These questionnaires capture distress, concerns (e.g., about access to food/resources, healthcare, social supports), and behavioral modifications made in response to the COVID-19 pandemic. We collected follow-up data every two weeks to assess changes in maternal mental health, social support, and COVID-related symptoms and stresses, including the CES-D (Radloff, 1977). Latent curve modeling (LCM) and latent class growth analysis (LCGA) were used to examine the average trajectory of depressive symptoms and whether there are subgroups of women who differed from one another in their trajectory and/or slope.

Results: The LCM analysis suggested that on average, pregnant women began with heightened but subclinical levels of depressive symptoms (intercept=14.18), which decreased over time (slope=-.79, p<.001). This is in contrast to the pattern typically seen in the literature and observed in our pre-COVID sample (N=176), where women typically started with fewer symptoms and increased across gestation. Results from the LCGA suggest that there are meaningful subgroups. Prenatally, three classes emerged (Fig1). Postpartum, five classes emerged (Fig2).

The prenatal classes did not differ demographically (income, race, ethnicity, parity) or in adherence to social distancing or number of individuals they knew who had contracted COVID-19. The “high, stable” and “very-high, increasing” classes differed from the “low, decreasing” class in concern about access to resources (e.g., food and medical/hygiene products) and to health and mental healthcare, and in reports of sleep quality and daily energy. Interestingly, the three groups differed from one another on their perception of overall social support (“low, stable”=5.28, “high, stable”=4.40, and “very-high, increasing”= .82, p<.001), despite reporting equivalent levels of pre-pandemic social support (p=.11).

Conclusion: We observed substantial heterogeneity in women’s psychological response to the COVID-19 pandemic. Withdrawal of social support may help to distinguish individuals at highest risk.

Authors