The impact of the Covid-19 pandemic on postnatal depression: analysis of three population-based national maternity surveys in England (2014–2020)
Date
2023-05-15
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Abstract
Background Few studies have evaluated postnatal depression before and during the Covid-19 pandemic using
comparable data across time. We used data from three national maternity surveys in England to compare
prevalence and risk factors for postnatal depression before and during the pandemic.
Methods Analysis was conducted using population-based surveys carried out in 2014 (n = 4571), 2018 (n = 4509), and
2020 (n = 4611). Weighted prevalence estimates for postnatal depression (EPDS score ≥13) were compared across
surveys. Modified Poisson regression was used to estimate adjusted risk ratios (aRR) for the association between
sociodemographic, pregnancy- and birth-related, and biopsychosocial factors, and postnatal depression.
Findings Prevalence of postnatal depression increased from 10.3% in 2014 to 16.0% in 2018 (difference = +5.7% (95%
CI: 4.0–7.4); RR = 1.55 (95% CI: 1.36–1.77)) and to 23.9% in 2020 (difference = +7.9% (95% CI: 5.9–9.9); RR = 1.49
(95% CI: 1.34–1.66)). Having a long-term mental health problem (aRR range = 1.48–2.02), antenatal anxiety (aRR
range = 1.73–2.12) and antenatal depression (aRR range = 1.44–2.24) were associated with increased risk of
postnatal depression, whereas satisfaction with birth (aRR range = 0.89–0.92) and social support (aRR
range = 0.73–0.78) were associated with decreased risk before and during the pandemic.
Interpretation This analysis indicates that Covid-19 had an important negative impact on postnatal women’s mental
health and may have accelerated an existing trend of increasing prevalence of postnatal depression. Risk factors for
postnatal depression were consistent before and during the pandemic. Timely identification, intervention and followup are key to supporting women at risk, and it is essential that mechanisms to support women are strengthened
during times of heightened risk such as the pandemic.
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Keywords
Postnatal depression; Perinatal mental health; Maternal mental health; Pregnancy and childbirth; Maternity survey; COVID-19 pandemic; Prevalence; Risk factors