To our knowledge, this study was among one of the first studies with respect to the psychological responses of the delivery women in mainland China. Since the pandemic is not over yet and there's a further spread of the pandemic to cities in China such as Guangzhou, we hypothesized that the COVID-19 pandemic would cause excessive anxiety in this vulnerable group because of the increasing number of imported cases in Guangzhou, China. However, interestingly, the prevalence of PPD during this period was 30.0%, which was comparable to the level observed in our previous study. One possible reason for this finding is that a special tradition in China after childbirth could help promote the psychosomatic recovery of the mother. This tradition, called 'doing the month' is a cultural imperative in China and includes a set of practices involving prescribed diet, clothing, cleanness and other cautions. It's a highly valued ritual that requires the support of a woman's mother, mother-in-law and other female relatives. Additionally, the COVID-19 outbreak in Guangzhou may not be regarded as severe despite the number of imported cases is increasing during the time the study was conducted. Our city, Guangzhou was not locked down as had happened in Wuhan. The focus of epidemic control and prevention in our city was constantly adjusted to meet new challenges such as preventing imported cases and domestic re-infections. A joint-work mechanism comprising different departments such as aviation, customs, public security, health, foreign affairs, border inspection and airports was established to prevent transmission of the virus at the point of first entry. Therefore, these factors might have helped to reduce the stressful impact of the COVID-19 pandemic during the postpartum period. Considering the mortality rate is still increasing around the world, it's impact on mental health of delivery women needs further study.
The findings of this study show that immigrant women were significantly more likely to develop PPD compared to local women, which is consistent with the findings of previous studies that immigrant women were at increased risk of depression prenatally and postnatally. Because the utility and allocation of public resources are based on household registration policy, immigrants do not have the same rights and benefits as local residents in a variety of areas, such as healthcare, social services, off-spring education and housing. Social exclusion resulting from this policy as well as other economic and cultural factors contribute to the adverse mental health consequences of immigrants. We also reported a strong association between social support and PPD which is consistent with previous reviews focused on the overall postpartum population. One possible reason was that during the pandemic, the pace of the whole society was slowed down. This could have been created more opportunities and time among family member to support and care for each other. In addition, there was increased communication with community members and friends because people were asked to avoid going to public places and stay at home. These positive impacts may have helped women cope with the challenges surrounding the postpartum period.
In addition, we explored the relationship between mental health and physical symptoms as well as concerns about COVID-19 among delivery women during the pandemic. The presence of a persistent fever was significantly associated with PPD. Similarly, a higher perceived likelihood of contracting COVID-19 during the current outbreak was significantly associated with PPD. Amid this moment, women were bombarded with various discomforting network information about COVID-19, including clinical signs, routes of transmission, medicines or vaccines, et al. After presentation to the clinic with a fever, they may be sent home, hospitalized for further observation, or quarantined. Some evidence suggests that up-to-date and accurate information during the pandemic are responsible for lower levels of stress, anxiety and depression. Moreover, higher satisfaction with the health information received by the whole population is contributing to reduce the impact of rumors and this may avoid adverse psychological reactions.
Also, our findings suggest that precautionary measures adopted to prevent the spread of COVID-19 have had a positive psychological effect. Women who had avoided the sharing of utensils (e.g, chopsticks) during meals were significantly less likely to develop PPD. There has been no evidence to suggest the reason for the difference, but saliva is one of the most common ways for food-borne diseases to spread. Communal eating habits have been a part of Chinese culture for centuries. Chinese people prefer to use chopsticks to pick up food commonly shared in the table during meal times to show their respect and cleanness. The experiences of the SARS-COV epidemic in 2013 may have changed the perception of the general public towards precautionary measures. Many cities in China have already launched initiatives to order separate meals. As this healthy habit is related to people's health and safety during the pandemic, it's not unexpected that avoidance of sharing utensils during meals is significantly associated with less psychological impact on women.
Our findings will provide vital guidance for health care professionals to tackle mental health issues among delivery women during a pandemic. First, health authorities need to identify high-risk groups such as immigrants for early intervention. Second, accurate and up-to-date health information during the pandemic need to be provided, especially on the number of recovered individuals to alleviate the concern and reduce the impact of rumors. Third, government and health authorities need to expand public awareness of healthy lifestyle.
This study has several limitations. First, the cross-sectional study using snowballing sampling strategy did not allow for establishing causal relationships between PPD and the factors associated with it. Second, a self-reported scale was employed to define PPD instead of clinician administered structured interview. Participants might have provided responses they feel socially desirable. Third, the short time frame might not allow us to observe it's long-term impacts on mental health among delivery women.