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COVID-19: Postpartum mental health visits increased by 30 per cent during pandemic, study says

Study found people living in northern public health units had relatively low increases after July 2020, which they say could likely be explained by fewer public health restrictions in those areas during the summer

TORONTO — Heather Eldebs remembers sitting down with her young family to eat takeout from her favourite burger restaurant five years ago and feeling nothing — no anticipation for the meal, no desire to eat it.

As Eldebs struggled to explain her mental state eight months following the birth of her and her husband Eddy's first child, she Googled "postpartum depression." And after recognizing the symptoms, she reached out for professional help.

The bout of depression and anxiety Eldebs felt following son Joey's birth was her first experience with postpartum mental illness, but it returned three years later after daughter Ally was born.

While the London, Ont., mother had recovered from the worst of her illness by the time COVID-19 started circulating in Canada, she feels for those whose postpartum mental concerns were exacerbated by the pandemic. 

A study published Monday in the Canadian Medical Association Journal found mental health visits by new mothers in Ontario increased 30 per cent during the pandemic compared to previous years, with a noticeable bump occurring within the first three months after giving birth. 

Eldebs says the increase isn't surprising, as pandemic restrictions took away "so many things new mothers hold on to during those early periods" after childbirth.

"Mom groups, going to another mom's house for playdates, having someone come over and watch the baby for an hour so you can take a nap, that was gone," she says.

"So often we minimize (postpartum mental illness). We think, 'Oh, it's just a phase. You have a newborn, it's a rough patch.' But it is definitely more than that."

The CMAJ study looked at 137,609 postpartum mental health visits to both family physicians and psychiatrists in Ontario from March through November 2020, with researchers collecting data on age, number of children, neighbourhood income and ethnic diversity, and region of residence. 

They found people living in northern public health units had relatively low increases after July 2020, which they say could likely be explained by fewer public health restrictions in those areas during the summer.

Dr. Simone Vigod, chief of psychiatry at Toronto's Women's College Hospital and co-author of the study, says isolation from COVID-19 restrictions, financial insecurities from lost jobs and health concerns over a circulating virus all likely factored into the increase in mental health visits noted by her team.

Vigod says one of the biggest risk factors for developing postpartum mental illness is history with previous mental health issues, but the second is lack of social support and life stress.

The pandemic restrictions, Vigod says, "essentially reduced social support for new parents and gave them more life stress."

"Family, friends, peer support, public health nursing to come and help and to be around, those are the pieces that are really protective against postpartum mental illness," she adds.

Virtual options for care likely contributed to the rising number of visits by making them easier to access — at least for some, Vigod says.

The study found patients in the lowest-income neighbourhoods had the smallest increase in mental health visits, which Vigod says raises concerns about other potential barriers to accessing care. Those include technology and internet capabilities and privacy within patients' homes.

Vigod's team looked exclusively at Ontario data, but she expects similar trends across the country based on broader mental health survey results from the pandemic.

"Postpartum people were noting more psychological distress (in surveys), but it really wasn't clear whether this was natural feelings of anxiety that would just abate, or whether this was going to turn into an increased need for clinical care," she says, noting the survey results were part of the impetus to explore the data further.

Researchers say postpartum mental illness affects as many as one in five mothers and can have long-term effects on children and families if it becomes chronic.

While the term postpartum depression is what most are familiar with, Vigod says mental health concerns can manifest for new mothers in other ways, including anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. There's also a spectrum of severity, she says, adding that not all cases require medication or intensive psychiatric treatment.

Still, postpartum mental health concerns are "a major issue" that shouldn't be ignored.

"It has implications potentially for their kids and for generations," says Vigod, who treated Eldebs through both her postpartum periods. "So it really is upon us to make sure that while these people are struggling more during — and probably after — the pandemic, that we have the ability to meet their needs and get them well."

Eldebs says new parents experiencing mental health issues should know they're not alone. And while efforts have been made to destigmatize mental health in recent years, she feels that postpartum depression hasn't caught up to that trend. 

"It's so important for those people to be kind to themselves," she says. "The guilt they might feel, that shame of being ill and maybe losing hope and not wanting to be a parent during a time (that) is supposed to be so exciting and happy, it's not their fault they're feeling that way."

This report by The Canadian Press was first published June 7, 2021.

Melissa Couto Zuber, The Canadian Press