This investigation showed that incidence of prenatal depression was 5.6%, in the median split groups which rose markedly to 34.9% at 6 weeks postpartum, indicating that participants were strongly prone to emotional disorders in the early period after cesarean section. Chinese women tend to postpone marriage and childbearing contributing to older parturients and higher PD morbidity than before.
The etiology of PD is complex, while involvement of biological factors may play an important role in triggering PD [4]. In this study, we found no significant correlation between the occurrence of PD and the collected demographic factors, possibly because, in this single-center study in a Chinese public hospital, parturients were sociodemographically relatively homogenous. Additionally, with the improvement of economic conditions and preventive health care capabilities, complications among older pregnant women are gradually reducing and prenatal psychological preparation is becoming more adequate, which further reduces parturients’ psychological burden.
Pain and depression are common in the population and co-morbid with each other [18, 19]. A series of reports indicated that occurrence of psychological disorders was directly related to postoperative pain [20]. The incidence of depression in patients with higher pain levels can be twice as high as those without pain or with low pain levels [20], although there is not a linear correlation between pain and overall depression [21]. It is possible that different depressive symptoms are related in different ways to postpartum pain [20]. Here, postoperative pain and pruritus were correlated with PD. Specifically, mild pain was negatively associated with PD morbidity, which has not been mentioned previously. Catecholamines including adrenaline and dopamine, which are kinds of neurochemical secreted during pain and stress [21], play a role in making you happy and preventing depression [22]. Experimentally induced mild pain can diminish perception of pain by increasing pain thresholds which may contribute to depression prevention [23]. This may explain the low incidence of PD in parturients with mild postoperative pain, which would require further studies to confirm.
Social support plays an important role in promoting or mitigating the effect of postpartum mood disorders on mothers and children [1, 5]. Indeed, compared with many other psychosocial risk factors, social support provided by maternal social networks and participants, such as financial support or assisting with infant care, had the greatest impact on PD [24]. The incidence of depression increased significantly at 6 weeks postpartum, which were strongly correlated with maternal total dissatisfaction during “doing the month”. Among which dissatisfaction with mother-in-law was an independent risk factor of PD. The postpartum period is accompanied with numerous physical, emotional, financial, and social stressors, many of which may increase the risk of PD [25]. Social support and relevant skills training can lower the risk of PD by reducing the impact of stressors [26]. But always, families focused on the baby and ignored maternal emotional changes, thus increasing the psychological burden of the maternal. Especially while typical differences in lifestyle, parenting concept, and education mode between two generations led to a series of contradictions and conflicts existed further aggravating the occurrence of depression. Therefore, family members should focus on the psychological and emotional changes of the mother during “doing the month” period, and have more understanding and companionship for the mother. Besides, we should focus on the factors of maternal dissatisfaction, strengthen postpartum social support treatment, properly extend father's paternity leave to increase father's participation in taking care of baby, and reduce the occurrence of PD [27].
Since the outbreak of COVID-19 pandemic worldwide this year, the domestic epidemic prevention policy is to stay at home and be far away from crowd resulting in limited social activities. New mothers had less opportunity to communicate with other mothers or friends and were harder to relieve their feelings. Besides, they even cannot go to see a doctor for neither infants’ examination nor mothers’ discomfort for the protection against COVID-19. Online meetings and telecommuting have become popular during the new crown epidemic. Similarly, psychological support treatment for patients with PD can also be treated with remote intervention and consultation, which not only saves time and costs but also reduces the risk of infection. At the same time, their friends can communicate and chat through online video calls, which is helpful for the relief of PD. A single prospective cohort study of telephone based interpersonal psycho-therapy for PD has been published and found that remotely delivered therapies often represent a feasible alternative [28]. Although most studies have been conducted in non-clinical populations, the available evidence suggests that most remotely delivered therapies are superior to treatment as usual [29].