Article ; Online: Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated cross-sectional study.
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
2021 Volume 193, Issue 23, Page(s) E835–E843
Abstract: ... during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness ... In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario ... visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 ...
| Abstract | Background: It is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns. Methods: In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March-November 2020 based on prepandemic data (January 2016-February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics. Results: In March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25-4.89) and an IRR of 1.08 (95% CI 1.03-1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14-12.6) and IRR (1.30, 95% CI 1.24-1.36) were higher; this level was generally sustained through November 2020. From April-November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0-90 days postpartum compared with 91-365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November. Interpretation: Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses. |
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| MeSH term(s) | Adult ; COVID-19/epidemiology ; Comorbidity ; Cross-Sectional Studies ; Female ; Humans ; Mental Disorders/epidemiology ; Mental Disorders/psychology ; Mental Health ; Ontario/epidemiology ; Pandemics ; Population Surveillance ; Postpartum Period ; Retrospective Studies ; SARS-CoV-2 | |||||
| Language | English | |||||
| Publishing date | 2021-06-07 | |||||
| Publishing country | Canada | |||||
| Document type | Journal Article ; Multicenter Study | |||||
| ZDB-ID | 215506-0 | |||||
| ISSN | 1488-2329 ; 0008-4409 ; 0820-3946 | |||||
| ISSN (online) | 1488-2329 | |||||
| ISSN | 0008-4409 ; 0820-3946 | |||||
| DOI | 10.1503/cmaj.210151 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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