Postpartum mental health visits up during pandemic, study finds

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New mothers sought mental health treatment more often during the coronavirus pandemic, a study found, with higher rates observed within three months after childbirth.

Findings published in CMAJ (Canadian Medical Association Journal) on Monday stemmed from data on more than 137,000 postpartum mothers in Ontario, Canada. Patients under study were about 31 years old on average.

Researchers affiliated with the Toronto-based Women's College Research Institute compared clinical visit rates from 2016-2020, pre-pandemic baseline rates, to data from March-November 2020 to determine any increase.

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Postpartum mental illness is said to affect up to 1 in 5 mothers, with detriments in mom-baby interactions potentially resulting in long-term social, cognitive and behavioral consequences for children, as well as suffering for the mother, study authors wrote.

Nine months into the pandemic, researchers found an approximate 30% uptick in visits; by November observed visits exceeded expected rates at 51.5 per 1000, compared to 40.9 per 1,000, or a 25.9% increase. 

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The elevated visits were seen in primary and psychiatrist care for anxiety, depressive and substance use disorders, persisting through November 2020.

"Increases in visit rates were more marked for individuals 0–90 days postpartum, especially from April through July 2020, than for those 91–365 days postpartum," study authors wrote.

"Over the first 9 months of the COVID-19 pandemic, clinical visits for postpartum mental illness were significantly more frequent than would have been expected from pre-pandemic patterns," the study reads. "Increased visit rates began in March 2020, although the state of emergency was declared only midway through the month, suggesting that distress related to the pandemic translated into an increased need for care very quickly. Whether the sustained elevation in service use is because of a true increase in mental health burden cannot be ascertained from these data."

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Researchers suggested expanded access to virtual care may explain the trends, potentially easing complex schedules owing to infant feedings, child care, travel to appointments and stigma.

Further, researchers expected the greatest uptick in visit rates among low-income patients, given the disproportionate impact felt among this group during the pandemic, but results indicated the smallest increases instead, compared to other income groups.

"This raises some concern about the potential for unmet need because low-income patients may have greater barriers to accessing care, including difficulty affording the required technology or finding private space to attend virtual appointments (e.g., crowded homes), or less opportunity to attend ‘live’ appointments because of employment in front-line jobs."

"Health systems should focus proactively on patients from high-risk groups, monitor waiting lists for care, and explore creative solutions to expand system capacity, with special attention to postpartum patients who may be experiencing barriers to care," study authors advised.