Increase in Postpartum Physician Visits During COVID-19 Pandemic

Simone N. Vigod, MD, MSc

As the COVID-19 pandemic continued, physician visits for individuals with postpartum mental illnesses were significantly higher than what was expected based on prepandemic data.

A team, led by Simone N. Vigod, MD, MSc, Women’s College Research Institute, compared physician visit rates for postpartum mental illness in Ontario during the pandemic with rates that were expected based on prepandemic patterns.

It is not yet known whether or not the clinical burden of postpartum mental illness has increased during the course of the COVID-19 pandemic, but there have been reports throughout the pandemic on concerns about postpartum infections and difficulty accessing the extended postpartum social support networks and key community programs such as home visits from public health nurses, breastfeeding clinics, and support groups.

There was also Canadian surveys that show about 50% of pregnant individuals reported psychological distress in the spring of 2020.

Pandemic Data vs Prepandemic Data

In the population-based, repeated cross-sectional study, the investigators used linked health administrative databases in Ontario to compare visit rates to expected visit rates for each month of the pandemic period.

The investigators used negative binomial regression models for expected visit rates per 1000 postpartum individuals between March-November 2020 based on prepandemic data between January 2016 and February 2020.

The researchers sought primary outcomes of a visit to a primary care physician or a psychiatrist for any mental disorder and stratified the analyses by maternal sociodemographic characteristics.

Increased Visit Rates

The visit rate was 43.6 per 1000 individuals in March 2020, with a rate different of 3.11 per 1000 (95% CI, 1.25-4.89) and an incidence rate ratio (IRR) of 1.08 (95% CI, 1.03-1.13) compared to the expected rate.

For April, the rate difference was 10.9 per 1000 patients (95% CI, 9.14-12.6), while the IRR was 1.30 (95% CI, 1.24-1.36).

The higher levels were generally sustained throughout the duration of the pandemic study period.

In addition, the researchers observed elevated visit rates across provider types and for the diagnosis of anxiety, depressive and alcohol or substance disorders from April-November.

Subgroup Analysis

There was also a greater proportion of individuals 0-90 postpartum who increased expected visit rates compared to patients 91-365 days postpartum. However, the increases were small among individuals living in low-income neighborhoods and public health units in the northern areas of the providence did not see sustained elevations in visit rates after July, while southern health units had elevated rates through November.

“Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses,” the authors wrote. “Higher visit rates were seen in both primary and specialist care, most prominently for anxiety disorders, depressive disorders, and alcohol and substance use disorders, and early in the postpartum period.”

Postpartum mental illness can affect about 20% of mothers, resulting in maternal suffering and diminished functioning, which can result in poor social, cognitive, and behavioral outcomes in children across their lifespan.

The study, “Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated cross-sectional study,” was published online in CMAJ.