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Patterns of Postpartum Depression during the COVID-19 Pandemic, 2018-2021
Alyssa Kasmierski, Mathematics Department, alk1018@sru.edu
Introduction
Results
Discussion
Postpartum depression (PPD) is a serious mental health issue that can affect women who
have recently given birth. For that reason, a postpartum depression screening is typically
given within the first year of postpartum care. For this research, Edinburgh questionnaire
scores from Kids Plus Pediatrics sites in Western Pennsylvania, collected between the
years 2018 and 2021 inclusively, are used to determine if temporal pattern of PPD rates
were affected by the COVID-19 pandemic. Time series modelling is utilized to understand
overall trend and seasonal patterns of PPD. Preliminary results suggest that rates of PPD
were adversely affected by the pandemic.
A time series decomposition of proportion of mothers diagnosed with PPD also yields a
significant trend over time and suggests some seasonal effects. The blue line, representing
the beginning of the COVID-19 pandemic.
Within the Kid Plus Pediatrics patient pool, as shown in the decomposition and ARIMA,
the average PPD scores over time are increasing from 2018-2021, and the overall
proportion of women experiencing PPD is increasing as well. However, the mean EPDS
score for women undergoing effects of PPD first increases from 2018 through the end of
2019, and then decreases for the remainder of the time period. In addition, the mean EPDS
score for women experiencing symptoms of PPD has an obvious seasonal component.
Preliminary modeling suggests this seasonal component is correlated with hours of
daylight.
The blue line in the decompositions shows the beginning of the COVID-19 pandemic.
While the mean EPDS score does not appear to change in trajectory after the COVID-19
pandemic commences, the proportion of women diagnosed with PPD appears to increase
as a higher rate after the COVID-19 pandemic begins.
Materials & Methods
The data used in my research was provided by the Kids Pediatric sites located near
Pittsburgh. I used two different statistical software packages: SAS for descriptive statistics
and R for time series modeling.
Future Work
I will be looking into the reasoning behind the significance of daylight-saving time on the
increasing number of women experiencing PPD symptoms.
Results
Limitations
Summary statistics of PPD rates suggest an increase in 2020, with a slight decrease in
2021.
Figure 3: Time series decomposition of proportion of mothers diagnosed with PPD by month and year.. Source: 2022 SRU PPD
study database.
A time series decomposition of mean score on the EPDS for mothers diagnosed with PPD
shows a different story. This time series shows strong seasonal effects and a downward
slope starting in 2020. These results suggest that while diagnoses of PPD rose over time,
severity of PPD decreased on average starting in 2020.
Figure 1: Proportion of mothers presenting with PPD as diagnosed by a score of ten or greater on the Edinburgh Postnatal
Depression Scale. Source: 2022 SRU PPD study database.
A time series decomposition of mean score on the Edinburgh Postnatal Depression Score
yield a significant trend over time and suggests some seasonal effects. The blue line,
representing the beginning of the COVID-19 pandemic.
Figure 4: Time series decomposition of mean EPDS score for mothers diagnosed with PPD by month and year. Source: 2022 SRU
PPD study database.
Results of this study are representative of the study participants only, as a random sample
of individuals was not used. Further modeling to determine potential reasons for the
seasonality in the time series is required.
References
1.Andrews-Fike C. A Review of Postpartum Depression. National Center for
Biotechnology Information. February 1999.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/. Accessed July 26, 2021.
2. Shorey S, Chee C, Ng E, Chan Y, Tam W, Chong Y. Prevalence and incidence of
postpartum depression among healthy mothers: A systematic review and meta-analysis.
Journal of Psychiatric Research. 2018;104:235-248.
3. Anderson GR. Postpartum Depression: Prevalence, Risk Factors and Outcomes. Nova
Biomedical; 2017. Accessed January 23, 2021. http://search.ebscohost.com.proxysru.klnpa.org/login.aspx?direct=true&db=nlebk&AN=1453453&site=ehost-live
4. Shetty RA, Sadananda M. Brief Social Isolation in the Adolescent Wistar-Kyoto Rat
Model of Endogenous Depression Alters Corticosterone and Regional Monoamine
Concentrations. Neurochemical research. 2017;42(5):1470-1477. doi:10.1007/s11064-0172203-2.
5. Ceulemans M., Hompes T., Foulon V. Mental Health Status of pregnant and
breastfeeding women during the COVID-19 pandemic: A call for Action. Journal of
Gynecology & Obstetrics, Vol. 151(1); July 3, 2020. Accessed January 31, 2021.
6. Zanardo V, Tortora D, Guerrini P, et al. Infant feeding initiation practices in the context
of COVID-19 lockdown. Early Hum.
Dev. 2021;152:105286. doi:10.1016/j.earlhumdev.2020.105286
7. Zauderer C. (2009). Postpartum depression: how childbirth educators can help break the
silence. The Journal of perinatal education, 18(2), 23–31.
https://doi.org/10.1624/105812409X426305
8. Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S.,
Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs:
Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 69(19), 575–581.
https://doi-org.proxy-sru.klnpa.org/10.15585/mmwr.mm6919a2
An ARIMA model was run on the PPD indictor, the EPDS, and the EPDS scores above 9.
Figure 2: Time series decomposition of mean EPDS score across all mothers by month and year.. Source: 2022 SRU PPD study
database.
Sigma^2
Log likelihood
PPD
ARIMA(0,1,1)
0.0002664
99.68
EPDS
ARIMA(0,1,1)
0.04907
3.25
EPDS ABOVE 9
ARIMA(0,0,0)(0,0,1)
0.2994
-31.09
AIC
BIC
-195.36
-192.14
-2.5
0.72
68.17
73.09
Table 1: ARIMA models. Source: 2022 SRU PPD study database.
Acknowledgements
1.
2.
3.
Kids Plus Pediatrics
Dr. Jana Asher
Dr. Breanne Westendorf and Dr. Natalie Brahm
Alyssa Kasmierski, Mathematics Department, alk1018@sru.edu
Introduction
Results
Discussion
Postpartum depression (PPD) is a serious mental health issue that can affect women who
have recently given birth. For that reason, a postpartum depression screening is typically
given within the first year of postpartum care. For this research, Edinburgh questionnaire
scores from Kids Plus Pediatrics sites in Western Pennsylvania, collected between the
years 2018 and 2021 inclusively, are used to determine if temporal pattern of PPD rates
were affected by the COVID-19 pandemic. Time series modelling is utilized to understand
overall trend and seasonal patterns of PPD. Preliminary results suggest that rates of PPD
were adversely affected by the pandemic.
A time series decomposition of proportion of mothers diagnosed with PPD also yields a
significant trend over time and suggests some seasonal effects. The blue line, representing
the beginning of the COVID-19 pandemic.
Within the Kid Plus Pediatrics patient pool, as shown in the decomposition and ARIMA,
the average PPD scores over time are increasing from 2018-2021, and the overall
proportion of women experiencing PPD is increasing as well. However, the mean EPDS
score for women undergoing effects of PPD first increases from 2018 through the end of
2019, and then decreases for the remainder of the time period. In addition, the mean EPDS
score for women experiencing symptoms of PPD has an obvious seasonal component.
Preliminary modeling suggests this seasonal component is correlated with hours of
daylight.
The blue line in the decompositions shows the beginning of the COVID-19 pandemic.
While the mean EPDS score does not appear to change in trajectory after the COVID-19
pandemic commences, the proportion of women diagnosed with PPD appears to increase
as a higher rate after the COVID-19 pandemic begins.
Materials & Methods
The data used in my research was provided by the Kids Pediatric sites located near
Pittsburgh. I used two different statistical software packages: SAS for descriptive statistics
and R for time series modeling.
Future Work
I will be looking into the reasoning behind the significance of daylight-saving time on the
increasing number of women experiencing PPD symptoms.
Results
Limitations
Summary statistics of PPD rates suggest an increase in 2020, with a slight decrease in
2021.
Figure 3: Time series decomposition of proportion of mothers diagnosed with PPD by month and year.. Source: 2022 SRU PPD
study database.
A time series decomposition of mean score on the EPDS for mothers diagnosed with PPD
shows a different story. This time series shows strong seasonal effects and a downward
slope starting in 2020. These results suggest that while diagnoses of PPD rose over time,
severity of PPD decreased on average starting in 2020.
Figure 1: Proportion of mothers presenting with PPD as diagnosed by a score of ten or greater on the Edinburgh Postnatal
Depression Scale. Source: 2022 SRU PPD study database.
A time series decomposition of mean score on the Edinburgh Postnatal Depression Score
yield a significant trend over time and suggests some seasonal effects. The blue line,
representing the beginning of the COVID-19 pandemic.
Figure 4: Time series decomposition of mean EPDS score for mothers diagnosed with PPD by month and year. Source: 2022 SRU
PPD study database.
Results of this study are representative of the study participants only, as a random sample
of individuals was not used. Further modeling to determine potential reasons for the
seasonality in the time series is required.
References
1.Andrews-Fike C. A Review of Postpartum Depression. National Center for
Biotechnology Information. February 1999.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181045/. Accessed July 26, 2021.
2. Shorey S, Chee C, Ng E, Chan Y, Tam W, Chong Y. Prevalence and incidence of
postpartum depression among healthy mothers: A systematic review and meta-analysis.
Journal of Psychiatric Research. 2018;104:235-248.
3. Anderson GR. Postpartum Depression: Prevalence, Risk Factors and Outcomes. Nova
Biomedical; 2017. Accessed January 23, 2021. http://search.ebscohost.com.proxysru.klnpa.org/login.aspx?direct=true&db=nlebk&AN=1453453&site=ehost-live
4. Shetty RA, Sadananda M. Brief Social Isolation in the Adolescent Wistar-Kyoto Rat
Model of Endogenous Depression Alters Corticosterone and Regional Monoamine
Concentrations. Neurochemical research. 2017;42(5):1470-1477. doi:10.1007/s11064-0172203-2.
5. Ceulemans M., Hompes T., Foulon V. Mental Health Status of pregnant and
breastfeeding women during the COVID-19 pandemic: A call for Action. Journal of
Gynecology & Obstetrics, Vol. 151(1); July 3, 2020. Accessed January 31, 2021.
6. Zanardo V, Tortora D, Guerrini P, et al. Infant feeding initiation practices in the context
of COVID-19 lockdown. Early Hum.
Dev. 2021;152:105286. doi:10.1016/j.earlhumdev.2020.105286
7. Zauderer C. (2009). Postpartum depression: how childbirth educators can help break the
silence. The Journal of perinatal education, 18(2), 23–31.
https://doi.org/10.1624/105812409X426305
8. Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo Mph, D. V., Warner, L., Folger, S.,
Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital Signs:
Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 69(19), 575–581.
https://doi-org.proxy-sru.klnpa.org/10.15585/mmwr.mm6919a2
An ARIMA model was run on the PPD indictor, the EPDS, and the EPDS scores above 9.
Figure 2: Time series decomposition of mean EPDS score across all mothers by month and year.. Source: 2022 SRU PPD study
database.
Sigma^2
Log likelihood
PPD
ARIMA(0,1,1)
0.0002664
99.68
EPDS
ARIMA(0,1,1)
0.04907
3.25
EPDS ABOVE 9
ARIMA(0,0,0)(0,0,1)
0.2994
-31.09
AIC
BIC
-195.36
-192.14
-2.5
0.72
68.17
73.09
Table 1: ARIMA models. Source: 2022 SRU PPD study database.
Acknowledgements
1.
2.
3.
Kids Plus Pediatrics
Dr. Jana Asher
Dr. Breanne Westendorf and Dr. Natalie Brahm