Background Postnatal depression (PND) is highly detrimental for both mother and baby, with a pre-COVID-19 estimated prevalence of up to 23% in Europe. Low social support is a key risk factor for developing PND. Social distancing measures designed to limit COVID-19 transmission likely created unprecedented barriers for mothers to access social support. We explore how social support networks existed during the UK’s first national lockdown amongst London mothers with infants, and their associations with postnatal depressive symptoms.
Methods Using self-reported social network data from 162 London-based mothers with infants aged ≤6 months collected in May-June 2020 (during the first lockdown), we conduct a concurrent design mixed-method study. We quantitatively describe communication within maternal support networks, using quasi-Poisson regression models to analyse associations with postnatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). In parallel, we thematically analyse open-text data to explore and understand the experiences of mothers with infants during England’s lockdown.
Results Quantitative findings: Levels of depressive symptoms were high in our sample, with 47.5% of participants meeting the >=11EPDS cut-off for potential postnatal depression.On average, women kept in contact with 10–11 people remotely (via WhatsApp, Zoom etc), and saw one family member other than their partner, suggesting high compliance with lockdown rules. The number of seen in person, and remote communication with a higher proportion of those not seen, negatively predicted depressive symptoms (RRR = 0.950 – 0.996 across models). However, a higher proportion of relatives seen in person was associated with increased depressive symptoms (RRR=1.003; 95% CI 1.001–1.006), suggesting family members may have broken lockdown rules to support mums in need. Qualitative findings: We identified four themes. Some mothers in our sample felt lockdown ‘protected’ family time which led to better bonding, often facilitated by high levels of support from the partner (theme 1). However, many experienced the ‘burden of constant mothering’ without anyone around to help (theme 2). Mothers felt remote contact was ‘not as good’ and led to reduced or inadequate support (theme 3). Mothers grieved for lost opportunities for them and their baby, and worried about the developmental impact on their baby (theme 4). Overall, these experiences coexisted with feelings of isolation, exhaustion, worry, inadequacy, guilt, and increased stress.
Conclusion Results suggest the strict lockdown in the UK may have increased the risk of postnatal depression, reflected in the high levels of PND symptoms and poor maternal experiences in our sample.
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