Incidence of Postpartum Depression in a Tertiary Care Hospital in Navi Mumbai amid COVID-19 Pandemic

Abstract

Introduction: Coronavirus disease-2019 (COVID-19) pandemic has changed health care drastically, especially looking at how obstetrics functions. This places mothers in a situation of greater psychological vulnerability and heightens the risk of postpartum depression and disrupted mother– infant bonding, which may be weighted or worsened by the balance of the couple. We expect this impact to be even greater in vulnerable mothers in the context of dysfunctioning social services. This study intends to identify the incidence of postpartum depression in women delivering during COVID-19 pandemic among lockdown protocols in a tertiary center in Navi Mumbai and identify its sociocultural triggers so that strategies may be evolved to reduce the morbidity costs attributable to the mother and child in the future. Materials and methods: This study was a cross-sectional study, performed over a period of 2 months from June 2020 to August 2020 at DY Patil School of Medicine and Dr DY Patil Hospital, a teaching hospital in Western India. Two hundred postnatal mothers were recruited for the study in the postpartum period from 1 to 6 weeks after delivery. A specially designed questionnaire was used to record various determinants to assess the risk factors, which could contribute to postpartum depression. A predesigned and pretested questionnaire (EDPS—Edinburgh Postnatal Depression Scale) was used to detect the depressive symptoms in postnatal mothers. The results for qualitative data were presented in frequency and percentage. Binary logistic regression was used to predict the contribution of each independent risk factor to arrive at the depression level, which happens to be the dependent risk factor in this study. The statistical analysis was done by using SPSS 21.0. The significant level was used at p <0.05. Results: A total of 200 cases were studied. The average age of the study group was 27.5, with the average duration of postpartum period being 8 days. The total score obtained using EDPS was less than or equal to “8” in only “92” cases (46%). However, 20% of the cases studied had a score between 9 and 12, suggesting the possibility of depression. Thirty-four percent of the cases had a score of more than 12, indicating the presence of postpartum depression. Of the 200 women, 49% were primigravida, while 51% were multigravida. Fifteen percent of the women had a history of infertility. Forty-four percent of the women had a history of miscarriage. Six percent of the women had a history of intrauterine fetal demise. Forty-nine percent of the women had one living child. Of the 200 women, 55.5% of the women were living in a nuclear family setup (with husband and any existing children). One hundred percent of the women studied were aware of the prevalence of COVID-19. Sixty-seven percent were aware that their newborns were at risk of infection by this disease and 72.5% said they were worried about them and their newborns contracting COVID-19. Sixty-five percent said they were feeling significantly more anxious about their postpartum period due to COVID-19 pandemic. Discussion: In the current study, the prevalence of postpartum depression was noted in 34% of the women studied. A prevalence of 20.4% was found in a study conducted in Western India by Modi et al. A rural study conducted in South India showed a prevalence of 19.8%. A study conducted in a military hospital in North India had a prevalence of 21.5%. The prevalence in our study was comparable, if not a little higher to these studies; however, the factor of a pandemic and the anxiety associated with it confirms our suspicions about COVID-19 and a worldwide lockdown causing widespread psychological problems as well as physical ones. Conclusion: COVID-19 pandemic has had a significant impact on human history, especially that of medical history. Countless women with both planned and unplanned pregnancies have been thrown into a state of extreme fear and stress due to the unpredictability of the virus. Doctors should be concerned that if this disease was common before the pandemic, now it can affect even more women. A support system, plenty of transparent medical advice, and compassion must be applied to doctor visits—may they be in person or virtual. Doctors also need to familiarize themselves with postpartum depression scoring systems and also clinical symptoms to be able to reassure and diagnose women ahead of severe maternal morbidity.