COVID-19 PANDEMİSİ POSTPARTUM DEPRESYON RİSKİNİ ARTIRDI MI?

Öz

Amaç: İstanbul’daki bir üçünçü basamak hastanede, pandemi öncesi ve sonrası Edinburgh Postpartum Depresyon Skalası (EPDS) skorlarını kıyaslayarak Coronavirus Disease 2019 (Covid-19) pandemisinin postpartum depresyon riskini artırıp artırmadığını araştırmak. Gereçler ve Yöntem: Doğumlarından 10-14 gün sonraki takip muayenelerine gelen ve EPDS formlarını tamamlayan tüm kadınlar çalışmaya dahil edildi. Formları pandeminin ilanından önce (14 Ocak 2020 - 11 Mart 2020) tamamlayan kadınlar pandemi-öncesi gruba, formları 12 Mart 2020 – 28 Haziran 2020 arası dolduran kadınlar pandemi-sonrası gruba dahil edildi. Hastaların bazal özellikleri kaydedildi. Pandemi öncesi ve sonrası EPDS skorları kıyaslandı. Bulgular: Yetmiş-üçü pandemi öncesi, 91’i pandemi sonrası olmak üzere toplam 164 kadın çalışmaya dahil edildi. Gravida ve paritenin pandemi sonrası dönemdeki hastalarda daha yüksek olması dışında, bazal özellikler iki grup arasında benzerdi. Medyan (25-75 persentil) EPDS skoru pandemi-öncesi grupta 7(4-11), pandemi sonrası grupta 6(3-10) hesaplandı ve aradaki fark istatistiksel olarak anlamlı bulunmadı (p=0.39). Skorları <9 ile ≥9; ve <13 ile ≥13 olan kadınların bazal özellikleri benzer bulundu. Sonuç: PPD riski stresli olaylar ve destek eksikliğinda artmaktadır. Covid-19 pandemisinin ve kısıtlamaların PPD riskine etkisini bildiren az sayıda çalışmanın sonuçları çelişkilidir. Çalışma popülasyonumuzda pandemi öncesi ve sonrası PPD riskini benzer bulduk. Farklı şehirlerde ve sosyoekonomik gruplarda yürütülecek çok-merkezli prospektif çalışmalar, riskli alt grupları bulmada rol oynayabilir.

Anahtar Kelimeler

• postpartum depresyon
• Covid-19
• pandemi
• Edinburgh postpartum depression skalası
• Türkiye

HAS THE COVID-19 PANDEMIC INCREASED POSTPARTUM DEPRESSION RISK?

Öz

Aim: To observe if Coronavirus Disease 2019 (Covid-19) pandemic had an impact on postpartum depression (PPD) risk in women who delivered in a tertiary hospital in Istanbul, Turkey, by comparing Edinburgh Postnatal Depression Scale (EDPS) scores before and after the pandemic was declared. Materials and Methods: All women who attended to the postpartum follow-up visit within 10-14 days of their delivery and completed the EPDS form were included. Women who completed forms before the declaration of pandemic (between January 14, 2020, and March 11, 2020) were labeled as the pre-pandemic group, whereas those between March 12, 2020 and June 28, 2020 were designated as the post-pandemic group. Baseline characteristics were recorded. Pre-pandemic and post-pandemic EPDS scores were compared. Results: A total of 164 women, 73 in the pre-pandemic and 91 in the post-pandemic period, were included in the study. Baseline characteristics were similar except for gravidity and parity, which were higher in the post-pandemic group. Median(25th-75th percentile) EPDS scores were similar at 7(4-11) and 6(3-10) in the in the pre- and post-pandemic periods, respectively (p=0.39). When we compared the characteristics of women with scores <9 and ≥9; and <13 and ≥13, all characteristics were similar. Conclusion: PPD risk increases with stressful events or lack of support. The handful of studies on the effect of Covid-19 pandemic and the restrictions related to it on PPD risk provide conflicting results. PPD risk was similar before and after pandemic in our population. Prospective, multi-centered studies from different cities and socioeconomic backgrounds may identify subgroups at risk.

Anahtar Kelimeler

• postpartum depression
• Covid-19
• pandemic
• Edinburgh postnatal depression scale
• Turkey

Kaynakça

1. 1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
2. 2. Mahase E. Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. Bmj. 2020;368:m1036.
3. 3. Ministry of Health TR. 2020 [Available from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html.
4. 4. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet. 2020;395(10228):931-4.
5. 5. Organization WH. Mental health and psychosocial considerations during the COVID-19 outbreak 2020 [updated 18 March 2020. Available from: https://apps.who.int/iris/bitstream/handle/10665/331490/WHO-2019-nCoV-MentalHealth-2020.1-eng.pdf.
6. 6. Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. Qjm. 2020;113(5):311-2.
7. 7. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. The lancet Psychiatry. 2020;7(4):300-2.
8. 8. Ford E, Ayers S. Stressful events and support during birth: the effect on anxiety, mood and perceived control. J Anxiety Disord. 2009;23(2):260-8.

9. 9. Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. Jama. 2016;315(4):380-7.
10. 10. Woody CA, Ferrari AJ, Siskind DJ, Whiteford HA, Harris MG. A systematic review and meta-regression of the prevalence and incidence of perinatal depression. J Affect Disord. 2017;219:86-92.
11. 11. Kokanalı D, Ayhan S, Devran A, Kokanalı MK, Taşçı Y. Sezaryen doğumun postpartum depresyona ve maternal bağlanmaya etkisi. Journal of Contemporary Medicine. 2018.
12. 12. Özcan NK, Boyacıoğlu NE, Dinç H. Postpartum Depression Prevalence and Risk Factors in Turkey: A Systematic Review and Meta-Analysis. Arch Psychiatr Nurs. 2017;31(4):420-8.
13. 13. Oztora S, Arslan A, Caylan A, Dagdeviren HN. Postpartum depression and affecting factors in primary care. Niger J Clin Pract. 2019;22(1):85-91.
14. 14. Liang P, Wang Y, Shi S, Liu Y, Xiong R. Prevalence and factors associated with postpartum depression during the COVID-19 pandemic among women in Guangzhou, China: a cross-sectional study. BMC Psychiatry. 2020;20(1):557.
15. 15. Surkan PJ, Ettinger AK, Ahmed S, Minkovitz CS, Strobino D. Impact of maternal depressive symptoms on growth of preschool- and school-aged children. Pediatrics. 2012;130(4):e847-55.
16. 16. Hessami K, Romanelli C, Chiurazzi M, Cozzolino M. COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020:1-8.
17. 17. Yan H, Ding Y, Guo W. Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Psychol. 2020;11:617001.
18. 18. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-6.
19. 19. ACOG Committee Opinion No. 757: Screening for Perinatal Depression. Obstetrics & Gynecology. 2018;132(5):e208-e12.
20. 20. Aydin N, Inandi T, Yigit A, Hodoglugil NN. Validation of the Turkish version of the Edinburgh Postnatal Depression Scale among women within their first postpartum year. Soc Psychiatry Psychiatr Epidemiol. 2004;39(6):483-6.
21. 21. Guerin O. Coronavirus: How Turkey took control of Covid-19 emergency 2020 [Available from: https://www.bbc.com/news/world-europe-52831017.
22. 22. Silverman ME, Burgos L, Rodriguez ZI, Afzal O, Kalishman A, Callipari F, et al. Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Sci Rep. 2020;10(1):22380.
23. 23. Spinola O, Liotti M, Speranza AM, Tambelli R. Effects of COVID-19 Epidemic Lockdown on Postpartum Depressive Symptoms in a Sample of Italian Mothers. Front Psychiatry. 2020;11:589916.
24. 24. Mariño-Narvaez C, Puertas-Gonzalez JA, Romero-Gonzalez B, Peralta-Ramirez MI. Giving birth during the COVID-19 pandemic: The impact on birth satisfaction and postpartum depression. Int J Gynaecol Obstet. 2020.
25. 25. Stepowicz A, Wencka B, Bieńkiewicz J, Horzelski W, Grzesiak M. Stress and Anxiety Levels in Pregnant and Post-Partum Women during the COVID-19 Pandemic. Int J Environ Res Public Health. 2020;17(24).
26. 26. Pariente G, Wissotzky Broder O, Sheiner E, Lanxner Battat T, Mazor E, Yaniv Salem S, et al. Risk for probable post-partum depression among women during the COVID-19 pandemic. Arch Womens Ment Health. 2020:1-7.
27. 27. Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med. 2020:1-7.
28. 28. Guvenc G, Yesilcinar İ, Ozkececi F, Öksüz E, Ozkececi CF, Konukbay D, et al. Anxiety, depression, and knowledge level in postpartum women during the COVID-19 pandemic. Perspect Psychiatr Care. 2020.
29. 29. Oskovi-Kaplan ZA, Buyuk GN, Ozgu-Erdinc AS, Keskin HL, Ozbas A, Moraloglu Tekin O. The Effect of COVID-19 Pandemic and Social Restrictions on Depression Rates and Maternal Attachment in Immediate Postpartum Women: a Preliminary Study. Psychiatr Q. 2020:1-8.