1. Clinical visits for postpartum mental health illness increased in the first 9 months of the COVID-19 pandemic comparatively to pre-pandemic rates, peaking between 0 and 90 days after birth.
2. In Ontario, Canada, postpartum people living in low income neighbourhoods had less significant visit increases compared to higher income neighbourhoods.
Evidence Rating Level: 2 (Good)
Postpartum mental illness affects approximately 1 in 5 mothers, and can present as anxiety, depression, bipolar disorder, psychotic disorders, alcohol and or substance abuse. This emotional burden on mothers also represents a clinical burden on the health care system with increasing rates due to the COVID-19 pandemic. This study aimed to better understand the extent of this exasperation by comparing pre and current pandemic data. In this population-based, repeated cross-sectional study, patient records (n=137 609) were extracted from health care data from Ontario, Canada to assess rate changes of postpartum mental illness visits before and after the start of the COVID-19 pandemic. This data was combined, and a negative binomial regression was employed to contrast expected visit rates per 1000 postpartum people from March–November 2020 compared to pre-pandemic data, January 2016–February 2020. The study outcome measured was a mental health visit to a primary care physician or a psychiatrist. Incidence ratio was calculated and a stratified analysis, using sociodemographic characteristics such as ethnicity groups (specifically Chinese and South Asian individuals based on surnames), was completed. Elevated rate differences in postpartum mental health visits peaked between 0-90 days after birth, with the highest rate difference being in April 2020 [(RD = 11.7; 95% CI 10.0–13.5) (IRR = 1.30; 95% CI 1.24–1.36)]. Postpartum people living in lower income neighbourhoods had less significant increases in visit rates. However, individuals who did not seek out postpartum mental health support did not necessarily indicate a lack of mental illness. Furthermore, visit rates of postpartum people with Chinese surnames increased in April, whereas rates for those with South Asian surnames became elevated later into the pandemic, peaking in June. South Asian and Chinese postpartum people do not fully represent Ontarian postpartum people and therefore cannot be generalizable to the entire Canadian population. Overall, this study revealed the impacts of the COVID-19 pandemic on postpartum mental health, and highlighted the need for further support. Accessibility to resources such as support groups, breastfeeding clinics, mental health check-ins from health care professionals are imperative to meet the constantly evolving needs of postpartum people.
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