Trajectories of Distress from Pregnancy to 15 Months Post-Partum During the COVID-19 Pandemic

• In Event: Perinatal Maternal Depression: Links to Early Childhood Psychological Adjustment and the Role of Father Involvement

Abstract

Introduction: The COVID-19 pandemic has taken a toll on the lives of many around the globe, with a particular burden on pregnant and postpartum women (e.g., Fan et al. 2020; Sun et al. 2020). However, it remains unclear how distress levels of pregnant and postpartum women have changed (or persisted) as the pandemic wages on and which factors may contribute to these trajectories of distress. Using a longitudinal approach, the present study assessed perinatal distress from pregnancy to 15 months postpartum (June 2020 to June 2022).

Aims and Hypotheses: This study had three aims: 1) describe levels of perinatal distress (depression, anxiety, and stress) across two years of the pandemic, 2) examine trajectories of change in distress, and 3) assess whether the subjective impact of COVID-19 and social support were associated with initial levels or change in distress. We hypothesized that (1) levels of distress would be highest during the early phase of the pandemic, coinciding with pregnancy (T1) and would decline thereafter; (2) higher social support during pregnancy would predict lower levels of distress over time; and (3) more negative subjective impact of COVID-19 would predict higher levels of distress over time.

Methods: This longitudinal study included 304 pregnant people from Ontario, Canada, who were followed during pregnancy (T1), 6 weeks postpartum (T2), 6 months postpartum (T3) and 15 months postpartum (T4). At each time point, a latent “distress” factor was estimated using three scale scores: Center for Epidemiologic Studies Depression Scale, Generalized Anxiety Disorder-7 and Perceived Stress Scale. Perceived negative subjective impact of COVID-19 and social support (Multidimensional Scale of Perceived Social Support) were assessed during pregnancy. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time.

Results: Mean distress was relatively stable from the pregnancy (T1) to immediately after birth (T2) (slope mean = 0.109, p = .060) and then declined from 6-months postpartum (T2) to 15-months postpartum (T4) (slope mean = -0.165, p < .001) (see Figure 1). In the final model (Table 1), higher education, greater social support, and lower subjective negative impact of COVID-19 were associated with a lower initial distress during pregnancy. Unexpectedly, greater social support was associated with a larger increase in distress from pregnancy to post-delivery. In addition, more negative subjective impact of COVID-19 was associated with a faster decrease in distress from pregnancy to post-delivery. However, the effects on slope 1 became non-significant after controlling for the distress intercept.

Conclusions: Findings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and subjective impact of the pandemic in pregnancy, but the direction of effects was counter to expectations. These counterintuitive findings are likely because low social support and more negative COVID impact were associated with higher initial levels of distress, with less room for change at subsequent time points. Together, these findings extend prior work by highlighting the continued impact of the pandemic on perinatal mental health.

Authors

• Jennifer Khoury, Mount Saint Vincent University
  Presenting Author

• Marc Jambon, Wilfrid Laurier University

• Lauren Giles, Dalhousie University

• Leslie Atkinson, Ryerson University

• Andrea Gonzalez, McMaster University