Objective
To compare postpartum depression screening rates during the COVID-19 pandemic with matched controls and determine if delivery during the pandemic is associated with increased postpartum (PP) Edinburgh Postnatal Depression Scale (EPDS) scores.
Study Design
At a tertiary care center directly affected by the COVID-19 pandemic, we conducted a retrospective cohort study of EPDS use and results for all women delivering in April 2019 and 2020. Women with incomplete prenatal care or delivery records were excluded. Outcomes were the proportion of women screened, median PP EPDS scores, and rates of screen positivity (score ≥ 10). Student t, Fisher exact, and Chi-squared tests were used for bivariate analyses as appropriate. Logistic regression models predicting PP visit attendance and study timepoint were created for significant factors.
Results
Patient demographics did not differ pre- vs peri-pandemic (Table 1), though black women were less likely to have PP visits overall (P<0.01). Patients delivering pre-pandemic were more likely to have diagnoses of anxiety/ depression (P<0.01), to have NICU admissions (P=0.03), and to have more prenatal visits (9.52 v 8.62, P<0.01). During the pandemic, patients were less likely to have PP visits (P<0.01) or to have PP EDPS scores from visits (P<0.01), especially virtual visits. However, there was no significant difference in EPDS scores or screen positive rates across timepoints (Table 2). In our model of pre-/post- pandemic care timing, not having an EPDS PP (P<0.01), not needing NICU care (P<0.01), having fewer prenatal visits (P<0.01), and not having anxiety/ depression (P=0.01) were significant independent predictors of having received care in the peri-pandemic period. Black race (P<0.01) and receiving care during COVID predicted not having a PP visit.
Conclusion
The COVID-19 pandemic has adversely affected depression screening, possibly due to new logistic barriers that may exacerbate pre-existing health disparities. Quality improvement efforts should work to optimize the screening process as care models continue to shift.
