Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study

Seeking Help for Postpartum Depression: The Behavioral Model of Health Service Use as a framework for predicting Treatment Utilization for Postpartum Depression

Postpartum depression is a serious disorder that affects many women globally, as well as their children and entire families. Although various treatment methods for postpartum depression have been found to be helpful, very few women actually utilize these treatments. The Jewish Israeli ultra-orthodox community (48.5% of the sample) is known for its utmost under-utilization of mental health services, therefore putting the ultra-orthodox postpartum depressed women at high risk for going untreated. The reasons for the under-utilization of treatment for postpartum depression are unclear, and deserve a close investigation. The Behavioral Model of Health Service Use was used as a comprehensive framework for predicting and explaining seeking help for postpartum depression. One thousand and fifty nine (1059) women who were recruited from a large hospital in Jerusalem, Israel one to two days postpartum completed the baseline survey; 805 (76%) of them participated at the 6-week follow up, of which 12% (N= 94) screened positive for postpartum depression symptoms and were referred for help. Of the 88 referred for help, 69% utilized some sort of help (34% utilized professional help and 90% utilized non-professional help); 31% of the women did not utilize any form of help. Predictors of screening positive for postpartum depression at the 6-week follow-up included being older, having fewer previous pregnancies, a lower income, and a history of depression. Levels of postpartum depression symptomatology significantly decreased from 6-weeks to 6-months postpartum, overall. Utilization of non-professional help and lower postpartum depression symptomatology at 6-weeks postpartum predicted lower depression symptoms at the 6-month follow-up. Finally, confidence in mental health professionals and higher level of postpartum depression symptomatology predicted utilization of professional help. Several implications for future research, theory building and social work practice are provided

The Role of Organizational Factors in Nurses’ Perceived Preparedness to Screen, Intervene and Refer in Cases of Suspected Postpartum Depression

Routine screening for postpartum depression (PPD) is widespread, yet little attention has been given to the perceived preparedness of health providers to perform screening procedures, or to the role of organizational factors in their preparedness, although these are crucial elements for optimal implementation. The aim of this study was to examine organizational factors associated with public health nurses’ (PHNs) perceived preparedness to screen women for PPD, intervene, and refer them in cases of suspected PPD. Two hundred and nineteen PHNs completed a self-report survey regarding their perceived preparedness to carry out a screening program (including screening, intervening, and referring women), and their perceived organizational support, supervisor’s support, colleagues’ support, and colleagues’ preparedness. A path analysis model was used to analyze the data. The results showed that perceived colleagues’ preparedness was significantly associated with the three perceived preparedness constructs (screen, intervene, and refer). Perceived supervisor’s support was positively associated with perceived preparedness to screen, and perceived organizational support was positively associated with perceived preparedness to intervene. This paper highlights the manner in which formal and informal organizational factors play an important role in the perceived preparedness of PHNs to carry out a PPD screening program, and how these factors impact the three different aspects of the screening program. Organizations implementing PPD screening should support PHNs in all aspects of the implementation process, provide guidance, and enhance peer-group continued learning through which PHNs could share knowledge, discuss barriers, and foster professional development

Elevated Perinatal Depression during the COVID-19 Pandemic: A National Study among Jewish and Arab Women in Israel

This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19–45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises

Good Practices in Perinatal Mental Health during the COVID-19 Pandemic: A Report from Task-Force RISEUP-PPD COVID-19

Due to the changes that occur to the immunity and physiological state of women during pregnancy, they are at increased risk of suffering issues with both their physical and mental health (Liu et al., 2020). It is estimated that 1 in 5 women develop a mental health problem in the perinatal period (Hahn-Holbrook et al., 2018; World Health Organization, 2015), with depression and anxiety among the most prevalent conditions (Shorey et al., 2018). Importantly, these conditions have long lasting adverse effects on women and their babies, and place a heavy burden on families and society as a whole (Bauer et al., 2014; Gavin et al., 2005). Conditions such as extreme stress, conflict situations, emergencies, and natural disasters can increase the risk of developing specific mental illnesses (World Health Organization, 2016)

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

BackgroundCorona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study.MethodsThis is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V).DiscussionThis study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions.Trial registrationClinicalTrials.gov Identifier: NCT04595123.COST Action RiseupEuropean Cooperation in Science and Technology (COST) [PPD CA 18138]; COST under COST Action Riseup [PPD CA18138]; Spanish Ministry of HealthInstituto de Salud Carlos IIISpanish Government; Institute of Health Carlos IIIInstituto de Salud Carlos III; European Regional Development Fund > by the Prevention and Health Promotion Research Network 'redIAPP' [RD16/0007]; FSEEuropean Social Fund (ESF); FCTPortuguese Foundation for Science and TechnologyEuropean Commission [SFRH/BPD/117597/2016]; Bar-Ilan Dangoor Centre for Personalized Medicine, Israel; Portuguese Foundation for Science and Technology (FCT)Portuguese Foundation for Science and Technology; EU through the European Social Fund; Human Potential Operational Program [IF/00750/2015]; CAPES/ProexCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES) [0653/2018]; CAPES/PrInt grant [88887.310343/2018-00]The project is part of the COST Action Riseup-PPD CA 18138 and was supported by COST under COST Action Riseup-PPD CA18138; also, by the Spanish Ministry of Health, the Institute of Health Carlos III, and the European Regional Development Fund > by the Prevention and Health Promotion Research Network `redIAPP' (RD16/0007). Raquel Costa is supported by the FSE and FCT under an individual Post-Doctoral Grant SFRH/BPD/117597/2016. Rena Bina and Drorit Levy received funding from the Bar-Ilan Dangoor Centre for Personalized Medicine, Israel. Ana Mesquita is supported from the Portuguese Foundation for Science and Technology (FCT) and from EU through the European Social Fund and from the Human Potential Operational Program -IF/00750/2015. Ana Osorio received financial support from CAPES/Proex no. 0653/2018 and CAPES/PrInt grant no. 88887.310343/2018-00.The funders of the study had no role in the study design or the writing the protocol. The corresponding author had final responsibility for the decision to submit for publication.WOS:0006210843000022-s2.0-85101674301PubMed: 3359688

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis

Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis

Background: To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis. Aims: To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression. Method: PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125). Results: A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Exercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low. Conclusions: Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions

The impact of COVID-19 on breastfeeding rates: An international cross-sectional study

Breastfeeding promotes children's health and is associated with positive effects to maternal physical and mental health. Uncertainties regarding SARS-CoV-2 transmission led to worries experienced by women and health professionals which impacted breastfeeding plans. We aimed to investigate the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic

The impact of COVID-19 on breastfeeding rates: An international cross-sectional study

Background: Breastfeeding promotes children’s health and is associated with positive effects to maternal physical and mental health. Uncertainties regarding SARS-CoV-2 transmission led to worries experienced by women and health professionals which impacted breastfeeding plans. We aimed to investigate the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic. Methods: This study is part of a broader international prospective cohort study about the impact of the COVID-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19). We analysed data from 5612 women, across 12 countries. Potential covariates of breastfeeding (sociodemographic, perinatal, physical/mental health, professional perinatal care, changes in healthcare due to the pandemic, COVID-19 related, breastfeeding support, governmental containment measures and countries’ inequality levels) were studied by Generalized Linear Mixed-Effects Models. Results: A model encompassing all covariates of interest explained 24% of the variance of breastfeeding rates across countries (first six months postpartum). Overall, first child (β = -0.27), age of the child (β = -0.29), preterm birth (β = -0.52), admission to the neonatal/pediatric care (β = -0.44), lack of breastfeeding support (β = -0.18), current psychiatric treatment (β = -0.69) and inequality (β = -0.71) were negatively associated with breastfeeding (p < .001). Access to postnatal support groups was positively associated with breastfeeding (β = 0.59; p < .001). In countries with low-inequality, governmental measures to contain virus transmission had a deleterious effect on breastfeeding (β = -0.16; p < .05) while access to maternity leave protected breastfeeding (β = 0.50; p < .001). Discussion: This study shows that mother’s COVID-19 diagnosis and changes in healthcare and birth/postnatal plans did not influence breastfeeding rates. Virtual support groups help women manage breastfeeding, particularly when their experiencing a first child and for those under psychiatric treatment. The complex associations between covariates and breastfeeding vary across countries, suggesting the need to define context-specific measures to support breastfeeding