The point prevalence of postpartum women with an EPDS score of ≥ 9 was 28.66% for primiparas and 25.83% for multiparas. Exploring the scores and the point prevalence for each month after delivery by groups, primiparas and multiparas, the depressive symptoms were prevalent throughout. For primiparas, the highest prevalence was at 1 month (37.2%) and the lowest was at 3 months (20.7%), and a continuous and steady increase was observed after 6 months up to 10 months. For multiparas, there was an increasing trend after 3 months of delivery, and it reached the highest at 11 months (36.8%). When comparing the average point prevalence of depressive symptoms, primiparas was higher than multiparas, showing 29.9% and 22.1%, respectively. Nevertheless, after 3 months of delivery, the average percentage became higher for multiparas (29.2%) than for primiparas (27.7%). These results are shown in Fig 1.
The trends for three factors are shown in Figure 2. For primipara, the lowest total EPDS scores at 3 months were 2.728 (anxiety), 0.315 (anhedonia), and 1.000 (depression), and the highest total EPDS scores at 1 month were 3.769 (anxiety), 0.500 (anhedonia), and 1.769 (depression). For multiparas, the lowest total EPDS scores at 2 months were 2.309 (anxiety), 0.573 (anhedonia), and 1.136 (depression), and the total EPDS scores at 11 months were 3.500 (anxiety), 0.789 (anhedonia), and 1.579 (depression). Among the three factors, the anxiety score was the highest, even when it was divided by the number of factors,[3] and it showed a general increasing trend for mothers having older infants. At 11 months after delivery, the anxiety and anhedonia scores of multiparas were higher than for primiparas.
Seven types of experiences during the COVID-19 crisis were listed. The top three most frequently experienced unintended events during COVID-19 were as follows: for primiparas, lifestyle changes with a partner working from home (35.96%), the prohibition of visitors at hospitals (34.12%), and cancellation of planned formal support experienced (32.97%); and for multiparas, the prohibition of visitors at hospitals (46.02%), cancellation of planned formal support experienced (35.96%), and cancellation of parenting classes (34.01%). Although less than 3%, some mothers needed to change the place of delivery, and more that 15% of people were affected by the cancellation of informal support.
Another COVID-19-related variable was the perceived risk. The highest perceived risk pertained to not being able to receive formal childcare support, followed by COVID-19 infection, financial difficulties, and not being able to receive informal childcare support.
The respondents’ socio-demographic/economic variables showed that nearly 40% were in the age range of 30–34 years with multipara being older in general, and nearly 98% were married. About 80% of the respondents had more than 16 years of education with a higher percentage among the primiparas. More than 40% had an annual income (including taxes) of above 5 million yen with a higher percentage among the multiparas. Regarding working status, approximately 55% and 45% of the primiparas and multipara,s respectively, were working full-time.
Analysis of Primiparas
Table 2 shows the results of the analysis on primiparas. Logistic regression analysis for primiparas revealed the significant effects of COVID-19-related issues. Concerning experiences of unexpected changes, participants who had experienced cancellation of planned informal support and formal support had a higher risk of having depressive symptoms (odds ratio [OR], 1.358; 95% confidence interval [CI], 1.024–1.802 and OR, 1.292; CI, 1.013–1.647, respectively). For perceived risk variables, mothers perceiving higher risks of financial difficulties and those who were not able to receive informal childcare support were independently associated with an EPDS score of ≥ 9 (OR, 1.099; 95% CI, 1.030–1.173 and OR, 1.227; CI, 1.142–1.319, respectively). Postpartum mothers who lived in areas with a longer duration of the state of emergency had a higher probability of EPDS ≥ 9 than the regions that had the shortest duration of the state of emergency (OR, 1.405; 95% CI, 1.066–1.851 for Tokyo/Kanagawa/Saitama/Chiba). Except for COVID-19-related variables, only those with lower incomes were associated with a higher probability of having depressive symptoms.
For further analysis, anxiety, anhedonia, and depression were considered. Change in the place of delivery, the prohibition of permitting partner into the delivery room, cancellation of planned informal support, and living in Osaka/Kyoto/Hyogo were the variables that did not show significant associations with EPDS ≥ 9. The coefficients suggested that women who experienced a change in the place of delivery were likely to demonstrate an increase in the anxiety and depression score by 0.854 and 1.433, respectively. These coefficients were larger than other variables of experience during the COVID-19 crisis. Other notable findings were: having a partner at home and having more people who were involved with childcare daily, which reduced the depression score. Additionally, anhedonia score decreased with an increase in the number of people engaged in childcare support, whereas being unemployed resulted in an increase in all the factor scores. Although not significant associated with EPDS ≥ 9, the additional analysis suggested a higher risk for unemployed mothers.
Analysis of Multiparas
Table 3 shows the results of the analysis of multiparas. Logistic regression revealed that similar to primiparas, COVID-19-related variables had a significant association with elevated depression symptoms. Additionally, these associated variables could be categorized as childcare support and financial issues. Those who experienced cancellation of planned formal support and those who perceived higher risk of not receiving informal childcare support had a higher probability of exhibiting depressive symptoms (OR, 1.39; 95% CI, 1.017–1.815, and OR, 1.253; 95% CI, 1.146–1.369, respectively). Having a higher perceived risk of financial difficulties, lower income group, and being unemployed also contributed to having depressive symptoms (OR, 1.084; 95% CI, 1.002–1.173, OR, 1.377; 95% CI, 1.033–1.835, and OR, 3.142; 95% CI, 1.224–8.964, respectively). In addition to these variables, the variable, residential area, suggested that a mother living in Tokyo/ /Kanagawa/Saitama/Chiba had a higher probability of EPDS ≥ 9 (OR, 1.424; 95% CI, 1.030–1.969 for Tokyo). Furthermore, the dummy variable indicating the baby’s age as being 6 months or over shows a higher probability of having depressive symptoms.
Analyses of factors added more evidence that COVID-19-related variables had a significant association with elevated anxiety, anhedonia, and depression; change in the place of delivery and cancellation of parenting classes both increased anxiety scores by 0.678 and 0.426, respectively. Cancellation of planned formal support increased anhedonia and depression scores by 0.141 and 0.241, respectively. As the results of logistic regression indicated, higher perceived risk towards financial difficulties and not receiving informal childcare support also increased all the factor scores. A lower income level was associated with anhedonia and depression, although it did not show a statistically significant association with anxiety. Compared to the never-married individuals, mothers who were either divorced, widowed, or in a different marital status had a lower score for anhedonia, and married women had a lower score for depression. Consistent with the results of logistic regression, mothers with older babies recorded higher scores for all the factors.
[3] Each factor scores consist of the following: EPDS items 1 and 2 for anhedonia, EPDS items 3, 4, and 5 for anxiety, and EPDS items 7, 8, and 9 for depression.