A multi-center survey on the postpartum mental health of mothers and attachment to their neonates during COVID-19 in Hubei Province of China

Abstract

Background: There is an emerging literature on the mental health of both pre- and post-partum mothers during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: As of April 1, 2020, 23 mothers confirmed with COVID-19, 15 mothers suspected with COVID-19 but with negative polymerase chain reaction tests, and 33 mothers without COVID-19 (Control Group) were recruited for a study from Hubei Province in China. The Maternal Postnatal Attachment Scale (MPAS), the Zung Self-rating Anxiety Scale, and the Zung Self-rating Depression Scale were applied to investigate the attachment of mothers to their neonates and the postpartum mental health of mothers within the first 3 months after delivery (between 20 to 89 days).

Results: The period of mother-child separation among the confirmed group (33.9±20.9 days) was significantly longer than that of suspected group (16.7±12.2 days) and control group (10.7±8.4 days). The total score of the MPAS in mothers confirmed with COVID-19 (45.5±4.2) was significantly lower (indicating less mother-child attachment) than that in the suspected (50.5±4.7) and control (48.8±4.6) groups. A negative correlation was noted between the mother-child separation time and the MPAS scores, including the subscale scores of attachment (MPAS acore: Spearman's ρ =-0.33, 95% CI: -0.095 to -0.538, P=0.005; Subscale score of attachment: Spearman's ρ =-0.40, 95% CI: -0.163 to -0.592, P=0.001). The incidence of postpartum anxiety in the confirmed, suspected and control groups was 4.3%, 6.7% and 12.1%, respectively; and the incidence of postpartum depression was 39.1%, 33.3% and 30.3%, respectively. No significant difference was found with regards to maternal postpartum anxiety and depression among the three groups.

Conclusions: Decreased mother-child attachment found among mothers confirmed with COVID-19, indicates that further intervention is needed to ensure mother-child interaction to appropriately develop attachment. Mother-child attachment experienced disruption due to prolonged mother-child separation necessitated by the COVID-19 management protocol, which needs to be revised to reduce prolonged mother-child separation. Additionally, mothers with and without COVID-19 suffered a high incidence of depression, which warrants further mental health investment for pregnant mothers during the COVID-19 pandemic.

Keywords: COVID-19; attachment; mental health; postnatal.

Figure 1

Research protocol and process of this study. The participants were enrolled between February 10–April 1, 2020, and the follow-up data were collected by May 15, 2020.

Figure 2

The MPAS scores as well as its subscale scores between the mothers with or without anxiety and depression. (A-C): The scatter plots showed that there was no statistical difference of the MPAS total scores (A) and the subscale scores of parenting anxiety (B) between mothers with or without postpartum anxiety. However, the subscale scores of attachment among mothers with postpartum anxiety were significantly lower than mothers without anxiety (C). (D,E,F): The scatter plots showed that there was no statistical difference of the MPAS total scores between mothers with or without postpartum depression (D). However, the subscale scores of parenting anxiety were significantly higher (E) while the subscale scores of attachment were significantly lower among mothers with postpartum depression (F). The black lines in the middle of scatter plots indicate the mean and the standard deviation. **P<0.01.