Abstract
Postnatal/postpartum depression (PND/PPD) had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother’s social network related to her experience of postnatal depressive symptoms during the first “lockdown” in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still “takes a village” to raise children in high-income populations and mothers are struggling in its absence.
Highlights
Postnatal or postpartum depression (PND/PPD) is the term given to a bout of Major Depressive Disorder which has onset during pregnancy or within 4 weeks of birth (APA, 2013), though in practice it is applied to depression occurring within the first year from birth (Stowe et al, 2005; Halbreich and Karkun, 2006; Skalkidou et al, 2012)
We explore: (Q1) Who did mothers keep in contact with during lockdown and how?; (Q2) Did characteristics of maternal social networks during lockdown vary by timing of birth in relation to lockdown?; (Q3) How did maternal social network characteristics and social communication during lockdown associate with self-reported depressive symptoms assessed via the Edinburgh Postnatal Depression Scale (EPDS; Cox et al, 1987)? We conduct a concurrent design mixed-method study (Leech and Onwuegbuzie, 2009) where quantitative and qualitative analyses were carried out at the same time
We address the questions: (Q1) Who did mothers keep in contact with during lockdown and how?; (Q2) Did characteristics of maternal social networks during lockdown vary by timing of birth in relation to lockdown?; and (Q3) How did maternal social network characteristics and social communication during lockdown associate with Edinburgh Postnatal Depression Scale scores?
Summary
Postnatal or postpartum depression (PND/PPD) is the term given to a bout of Major Depressive Disorder which has onset during pregnancy or within 4 weeks of birth (APA, 2013), though in practice it is applied to depression occurring within the first year from birth (Stowe et al, 2005; Halbreich and Karkun, 2006; Skalkidou et al, 2012). Ultimate function of depression is still under debate (Nettle, 2004; Hahn-Holbrook and Haselton, 2014; Myers et al, 2016, 2017; Hagen and Thornhill, 2017; Raison and Miller, 2017; Rantala et al, 2018), PND is associated with costs for both mothers and their children It inhibits a mother’s ability to care for herself and her infant (Downey and Coyne, 1990; Boath et al, 1998), and is associated with increased risks of a range of inflammation-related illnesses (Mykletun et al, 2009; Keicolt-Glaser and Glaser, 2002). As waves of COVID-19 continue to occur, it is crucial to understand how mothers are being impacted and what might mitigate their exposure to PND risk factors – here we take an evolutionarily informed focus on one such key risk factor, low social support (Beck, 2001; Yim et al, 2015; Doyle and Klein, 2020)
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