Two-years mothering into the pandemic: Impact of the three COVID-19 waves in the Argentinian postpartum women's mental health

Abstract

The COVID-19 pandemic disproportionately affects certain vulnerable groups, including postpartum women. Thus, this work aimed to analyze the mental health evolution in Argentinian postpartum women during the first three waves of COVID-19 and its determinants. In this repeated cross-sectional study, data were collected during the three waves of COVID-19: May-July/2020 (n = 319), April-August/2021 (n = 340), and December/2021- March/2022 (n = 341). Postpartum depression, insomnia, and perceived stress symptoms were assessed using valid instruments. Statistical analyses included multivariate logistic regression, analysis of variance, and structural equation modeling to test for temporal trends in mental health indicators during the pandemic and to identify their determinants. The prevalence rates of postpartum depression and insomnia rose from 37% to 60% and 46% to 62%, respectively. In contrast, pandemic-related stress decreased. The following negative factors for maternal mental health were identified: unemployment status, lack of medical support, reduced family size, remote working, advanced maternal age, late postpartum, multiparity, and living in the least developed region of Argentina. Structural equation modeling confirmed a process of pandemic-stress adaptation, although there is a persistent increment of postpartum depression and consequent increased insomnia. Postpartum women's mental health worsened during the COVID-19 pandemic. Although women have become more able to cope and perceive less pandemic-related stress, its social and economic impact still persists and puts them at higher psychological risk. Thus, health systems must seek protection of women of reproductive age against negative factors in order to cope with pandemic-related events.

Fig 1. Social, economic, political and health characteristics during the first three waves of COVID-19 in Argentina.

* Estimates of the epidemiological week with the most cases during the wave are presented, according to the report of the Ministry of Health of Argentina. Socio-economic statistics were taken from the national Institute of Statistics and Census of Argentina.

Fig 2. Logistic regression plot of adjusted odds ratios (OR) and 95% confidence intervals (CI) for postpartum depression, insomnia and stress across the three first waves of COVID-19 pandemic in Argentina (n

 = 1,000).

Fig 3. Association between postpartum mental health and the duration of the COVID-19 pandemic in Argentina and comparisons between waves (n

 = 1,000). Note: results derived from multivariate regressions (a) and analyses of variance (b). Radar charts (c) displaying mean scores of symptoms included in the instruments. *  p < 0.05; ** p < 0.01; *** p < 0.001.

Fig 4. Structural equation model of potential predictors of maternal mental health of postpartum women during the COVID-19 pandemic in Argentina.

Standardized paths coefficients are displayed. Ellipses are used to denote latent constructs, and rectangles are used to denote the observed variables. Red arrows indicate positive direct effects, blue arrows indicate negative direct effects, and gray arrows indicate non-significant relationships. χ²/df = chi-square value relative to the degrees of freedom; CFI=comparative fit index; TLI=Tucker Lewis index; SRMR=standardized root mean square residual; RMSEA=root mean square error of approximation; CIs = confidence interval.