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Research Article
Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City.
Michael E. Silverman
Icahn School of Medicine at Mount Sinai
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1297-2865
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
View the published version here.
Introduction: The mental health effects of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Coronavirus disease 2019 (COVID-19) pandemic on postpartum women is of increasing concern among mental health practitioners. To date only a handful of studies have explored the impact of the pandemic during pregnancy and none have attempted explore the impact of pandemic related social restrictions on postpartum mood.
Methods: Postpartum patients appearing to the Mount Sinai Health System for their postpartum appointment between January 2, 2020 and June 30, 2020, corresponding to before and during pandemic imposed social restrictions, were screened for mood symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Each patient’s socioeconomic status (SES; high/low) was determined by their location of clinical service.
Results: 516 postpartum patients were screened. While no differences in EPDS scores were observed by SES prior to social restrictions (t(262)=0.23, p=.82), a significant change in mood symptomatology was observed following COVID-19 restrictions (t(288)=2.32, p<.02), with patients living in lower SES reporting significantly less depression symptomatology (t(321)=4.07, p<.01). There was no change in symptomatology among patients of higher SES (t(191)=0.59, p=0.56).
Discussion: Postpartum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder with significant morbidity. The observed differences in postpartum mood between patients of different SES in the context of temporarily imposed COVID-19 related social restrictions present a unique opportunity to better understand the specific health and social support needs of postpartum patients living in urban poverty. Given that maternal mental illness has negative long-term developmental implications for the offspring, and that poor mental health reinforces the poverty cycle, future policy specifically directed towards supporting urban postpartum women living in low-SES by ameliorating some of the early maternal mental health burdens associated with balancing employment-family-childcare demands may assist in interrupting this cycle while simultaneously improving the long-term outcomes of their offspring.
Keywords
COVID19, postpartum, mood, minority, socioeconomic status
Glenn L. Salkind, MD
commented on 20 August, 2020
Postpartum depression is a significant health issue for patients. It occurs even more frequently in patients of low-SES. Likewise COVID-19 frequency also increases in low-SES populations. This interesting and timely study indicates something unexpected. It demonstrates that another benefit of the necessary societal health restrictions imposed in response to COVID-19, relieves some of the causative stress factors, and thus the severity, of postpartum depression in low-SES families.
View 1 reply
Dibe Martin
commented on 22 August, 2020
Postpartum depression remains significant problem across all socioeconomic populations. Wether It is patients are afraid to ask for help Or because we fail to recognize it. During these unprecedented times during the COVID-19 Pandemic the addition of social isolation to prevent the spread of the virus magnified mental illness. As highlighted in this study depression and maternal mental illness have negative implications for the patient and her offspring perpetuating mental illness and poor socioeconomic developments. I commend the authors on their work and hope it serves as a springboard to better support women in the postpartum period.
Javier Vizoso, MD
commented on 23 August, 2020
Excellent study on postpartum depression- an often ignored yet common mental health condition. It illustrates another significant impact of the COVID-19 pandemic. COVID-19 has already been shown to impact people of low SES in a disproportionate manner. Seeing that postpartum depression during these times more significantly affects mothers of low SES should point health systems and providers to dedicate more resources in supporting this population.
Susan Bender
commented on 23 August, 2020
Single mothers living in low socioeconomic circumstances, who have the pressure to work outside of their homes in order to receive certain government benefits, face a childcare dilemma. The enactment of quarantine and social distancing during Covid19 has enabled these women to remain home and postpone the assignment of childcare to another. Work requirements to receive government support may be a factor in mental health. At the very least, this study underscores the need to find a better plan for supporting single mothers, particularly until their children are of school age (and school is in session).
Amy Kosches MD
commented on 23 August, 2020
Excellent study. As a psychiatrist, Covid has had a tremendous impact on women during the postpartum period. It is stressful enough with the addition of quarantines and fear of contracting the virus. Telemedicine has been a very positive addition as it has allowed single moms to get their mental health addressed without having to worry about leaving their newborn or other children at home with another adult. This article makes us once again take a step back and focus on how we can serve the lower socioeconomic community better.
Mark Grenitz, MD
commented on 23 August, 2020
Postpartum Depression remains a serious and frequent mental health complication of childbirth. This study sheds surprising new light on some possible risk factors. The fact that the lower SES group experienced less depression symptoms in the quarantine "era" that the higher SES group begs for more research to determine why. The author's postulates in this regard seem sound. I hope for more research on this very important topic.
Edward Fidalgo, MD
commented on 23 August, 2020
The ongoing Covid restrictions has negatively impacted our society in many ways. Not surprising to me the authors have demonstrated that a supportive home environment despite low SES seems to mitigate PPD. Further studies need to be done in order to better understand this phenomena, the authors seem on the right track.
ROBERT BASS
commented on 23 August, 2020
We are just seeing the tip of the iceberg regarding the health sequelae of the Covid 19 pandemic. This well conducted study is important as it brings to light the mental health consequences (postpartum depression) and an interesting finding of a reduced incidence among lower SES subjects. In a population which has experienced a disproportionate incidence of domestic violence this is perplexing , but invites further investigation as to the socioeconomic factors which have resulted from this crisis and it's influence on all aspects of health.
Joyce Miller MD
commented on 24 August, 2020
The Covid 19 pandemic serves as a prime example of how additional restrictions and stressors placed on an already comprised population can deleteriously effect the outcomes of mother/baby emotionally, physically and in turn mentally. Great article to further support and identify populations at high risk and implement programs for early intervention and assistance. More research in this area needed.
Brian Price, MD
commented on 24 August, 2020
Every clinician is aware of how social determinants of health affect the well-being of patients and their families. This study has been able to actually quantify one aspect of those determinants with regards to post-partum anxiety and depression in the face of social isolation as a result of a pandemic. Increased parental presence in the lives of their children can lead to improved mental health for both parents and children. This study should certainly be followed-up with further research.
Cecilia Grande, MD,FACOG
commented on 24 August, 2020
Postpartum depression is quite prevalent across all socioeconomic spheres. This research article should be replicated in other centers in order to compare data and make recommendations to help our patients with future pandemics or in the individual cases when patients will need isolation due to special circumstances.
Juan Carlos Millon
commented on 25 August, 2020
As a pediatrician, I see the direct consequences of postpartum depression has on the children and family. This study's look at the effects of the COVID-19 pandemic on separate SES populations had some unexpected results. It shows the need for further study on early intervention/support for families in the lower SES group.
Kerry Kuhn
commented on 25 August, 2020
This paper is another measured example of how the Covid 19 pandemic is adversely affecting lower income populations in America compared to the general population. Greater financial and social support is needed in America for this population to break the cycle of longitudinal poverty.
Michael Augustino
commented on 27 August, 2020
Clearly social support will impact many aspects of mental health. As a clinician I continue to be disappointed in the availability of support for these patients who clearly are in need, and would have impact on future care. No doubt that recognition exists, the issue is putting the access to care in place
Lona Sasser
commented on 30 August, 2020
The study on postpartum depression was not only timely but insightful. Postpartum depression continues to be a major issue for all women particularly those of lower SES. Hopefully this article will open the door to more dialogue and Help us find new ways to intervene.
Wilfredo J Alvarez MD
commented on 31 August, 2020
This excellent article highlights the potential benefits for pregnant women in a low SES class when adequate support is provided to decreases the unique burdens in their daily lives. Further studies would lend support to providing policies that can extend these benefits to this population further and help break the poverty cycle and its effects on mental health and quality of life.
Liz Landau
commented on 25 September, 2020
This is a very important study in order to address key mental health issues among this vulnerable demographic.
Rona Davis
commented on 26 September, 2020
This study brings to light the need to support mothers and their children, especially in lower SES groups. This has further repercussions on the children who do not have their mothers with them at these very early stages.
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This is a preprint. It has not completed peer review.
Research Article
Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City.
Michael E. Silverman
Icahn School of Medicine at Mount Sinai
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1297-2865
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 20 Aug, 2020
Published
On 24 Dec, 2020
Community comments: 19
Metrics
Comments: 19
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Declarations:
Declarations
- This study involved human subjects.
- The author confirmed that all appropriate ethical guidelines for the use of human subjects have been followed, any necessary IRB and/or ethics committee review has been obtained, and information about the IRB/ethics committee is included in the manuscript.
- The author has confirmed that all necessary patient/participant consent or assent has been obtained and the appropriate institutional forms have been archived. If the IRB/ethics committee waived the requirement for patient/participant consent or assent, an explanation for the waiver is included in the text.
- The author has confirmed that a statement listing potential conflicts of interest or lack thereof is included in the text.
View the published version here.
Introduction: The mental health effects of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Coronavirus disease 2019 (COVID-19) pandemic on postpartum women is of increasing concern among mental health practitioners. To date only a handful of studies have explored the impact of the pandemic during pregnancy and none have attempted explore the impact of pandemic related social restrictions on postpartum mood.
Methods: Postpartum patients appearing to the Mount Sinai Health System for their postpartum appointment between January 2, 2020 and June 30, 2020, corresponding to before and during pandemic imposed social restrictions, were screened for mood symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Each patient’s socioeconomic status (SES; high/low) was determined by their location of clinical service.
Results: 516 postpartum patients were screened. While no differences in EPDS scores were observed by SES prior to social restrictions (t(262)=0.23, p=.82), a significant change in mood symptomatology was observed following COVID-19 restrictions (t(288)=2.32, p<.02), with patients living in lower SES reporting significantly less depression symptomatology (t(321)=4.07, p<.01). There was no change in symptomatology among patients of higher SES (t(191)=0.59, p=0.56).
Discussion: Postpartum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder with significant morbidity. The observed differences in postpartum mood between patients of different SES in the context of temporarily imposed COVID-19 related social restrictions present a unique opportunity to better understand the specific health and social support needs of postpartum patients living in urban poverty. Given that maternal mental illness has negative long-term developmental implications for the offspring, and that poor mental health reinforces the poverty cycle, future policy specifically directed towards supporting urban postpartum women living in low-SES by ameliorating some of the early maternal mental health burdens associated with balancing employment-family-childcare demands may assist in interrupting this cycle while simultaneously improving the long-term outcomes of their offspring.
Glenn L. Salkind, MD
commented on 20 August, 2020
Postpartum depression is a significant health issue for patients. It occurs even more frequently in patients of low-SES. Likewise COVID-19 frequency also increases in low-SES populations. This interesting and timely study indicates something unexpected. It demonstrates that another benefit of the necessary societal health restrictions imposed in response to COVID-19, relieves some of the causative stress factors, and thus the severity, of postpartum depression in low-SES families.
View 1 reply
Mauricio Bitran, MD, FACOG
replied on 22 August, 2020
In times we have become more aware of the importance of the postpartum period, as per this study ,Covid 19 has multiplied the severity of mental disease and depression. This must awaken a stronger response scrim our health care system. I commend this very well done and timely study results.
Dibe Martin
commented on 22 August, 2020
Postpartum depression remains significant problem across all socioeconomic populations. Wether It is patients are afraid to ask for help Or because we fail to recognize it. During these unprecedented times during the COVID-19 Pandemic the addition of social isolation to prevent the spread of the virus magnified mental illness. As highlighted in this study depression and maternal mental illness have negative implications for the patient and her offspring perpetuating mental illness and poor socioeconomic developments. I commend the authors on their work and hope it serves as a springboard to better support women in the postpartum period.
Javier Vizoso, MD
commented on 23 August, 2020
Excellent study on postpartum depression- an often ignored yet common mental health condition. It illustrates another significant impact of the COVID-19 pandemic. COVID-19 has already been shown to impact people of low SES in a disproportionate manner. Seeing that postpartum depression during these times more significantly affects mothers of low SES should point health systems and providers to dedicate more resources in supporting this population.
Susan Bender
commented on 23 August, 2020
Single mothers living in low socioeconomic circumstances, who have the pressure to work outside of their homes in order to receive certain government benefits, face a childcare dilemma. The enactment of quarantine and social distancing during Covid19 has enabled these women to remain home and postpone the assignment of childcare to another. Work requirements to receive government support may be a factor in mental health. At the very least, this study underscores the need to find a better plan for supporting single mothers, particularly until their children are of school age (and school is in session).
Amy Kosches MD
commented on 23 August, 2020
Excellent study. As a psychiatrist, Covid has had a tremendous impact on women during the postpartum period. It is stressful enough with the addition of quarantines and fear of contracting the virus. Telemedicine has been a very positive addition as it has allowed single moms to get their mental health addressed without having to worry about leaving their newborn or other children at home with another adult. This article makes us once again take a step back and focus on how we can serve the lower socioeconomic community better.
Mark Grenitz, MD
commented on 23 August, 2020
Postpartum Depression remains a serious and frequent mental health complication of childbirth. This study sheds surprising new light on some possible risk factors. The fact that the lower SES group experienced less depression symptoms in the quarantine "era" that the higher SES group begs for more research to determine why. The author's postulates in this regard seem sound. I hope for more research on this very important topic.
Edward Fidalgo, MD
commented on 23 August, 2020
The ongoing Covid restrictions has negatively impacted our society in many ways. Not surprising to me the authors have demonstrated that a supportive home environment despite low SES seems to mitigate PPD. Further studies need to be done in order to better understand this phenomena, the authors seem on the right track.
ROBERT BASS
commented on 23 August, 2020
We are just seeing the tip of the iceberg regarding the health sequelae of the Covid 19 pandemic. This well conducted study is important as it brings to light the mental health consequences (postpartum depression) and an interesting finding of a reduced incidence among lower SES subjects. In a population which has experienced a disproportionate incidence of domestic violence this is perplexing , but invites further investigation as to the socioeconomic factors which have resulted from this crisis and it's influence on all aspects of health.
Joyce Miller MD
commented on 24 August, 2020
The Covid 19 pandemic serves as a prime example of how additional restrictions and stressors placed on an already comprised population can deleteriously effect the outcomes of mother/baby emotionally, physically and in turn mentally. Great article to further support and identify populations at high risk and implement programs for early intervention and assistance. More research in this area needed.
Brian Price, MD
commented on 24 August, 2020
Every clinician is aware of how social determinants of health affect the well-being of patients and their families. This study has been able to actually quantify one aspect of those determinants with regards to post-partum anxiety and depression in the face of social isolation as a result of a pandemic. Increased parental presence in the lives of their children can lead to improved mental health for both parents and children. This study should certainly be followed-up with further research.
Cecilia Grande, MD,FACOG
commented on 24 August, 2020
Postpartum depression is quite prevalent across all socioeconomic spheres. This research article should be replicated in other centers in order to compare data and make recommendations to help our patients with future pandemics or in the individual cases when patients will need isolation due to special circumstances.
Juan Carlos Millon
commented on 25 August, 2020
As a pediatrician, I see the direct consequences of postpartum depression has on the children and family. This study's look at the effects of the COVID-19 pandemic on separate SES populations had some unexpected results. It shows the need for further study on early intervention/support for families in the lower SES group.
Kerry Kuhn
commented on 25 August, 2020
This paper is another measured example of how the Covid 19 pandemic is adversely affecting lower income populations in America compared to the general population. Greater financial and social support is needed in America for this population to break the cycle of longitudinal poverty.
Michael Augustino
commented on 27 August, 2020
Clearly social support will impact many aspects of mental health. As a clinician I continue to be disappointed in the availability of support for these patients who clearly are in need, and would have impact on future care. No doubt that recognition exists, the issue is putting the access to care in place
Lona Sasser
commented on 30 August, 2020
The study on postpartum depression was not only timely but insightful. Postpartum depression continues to be a major issue for all women particularly those of lower SES. Hopefully this article will open the door to more dialogue and Help us find new ways to intervene.
Wilfredo J Alvarez MD
commented on 31 August, 2020
This excellent article highlights the potential benefits for pregnant women in a low SES class when adequate support is provided to decreases the unique burdens in their daily lives. Further studies would lend support to providing policies that can extend these benefits to this population further and help break the poverty cycle and its effects on mental health and quality of life.
Liz Landau
commented on 25 September, 2020
This is a very important study in order to address key mental health issues among this vulnerable demographic.
Rona Davis
commented on 26 September, 2020
This study brings to light the need to support mothers and their children, especially in lower SES groups. This has further repercussions on the children who do not have their mothers with them at these very early stages.
Mauricio Bitran, MD, FACOG
replied on 22 August, 2020
In times we have become more aware of the importance of the postpartum period, as per this study ,Covid 19 has multiplied the severity of mental disease and depression. This must awaken a stronger response scrim our health care system. I commend this very well done and timely study results.