This study aims to determine the rates of clinically-significant anxiety and depressive symptoms during the immediate postpartum in a sample of women referred to a university maternity department, as well as the associated risk factors and the relations with the level of maternal bonding.
Patients and methods
During the third national lockdown for the COVID-19 pandemic (February-April 2021), on days 2–3 after delivery 127 mothers were administrated the Edinburgh postnatal depression scale (EPDS), the state-trait anxiety inventory (STAI-YA), the mother-to-infant bonding scale (MIBS) and questions issued from the coronavirus health impact survey questionnaire (CRISIS).
The rate of perinatal clinically-significant symptoms were 17% for depression (EPDS cut-off ≥ 12) and 15% for anxiety (STAI-YA cut-off ≥ 40). In the multivariate analysis, being a single mother, risk of being infected by the SARS-CoV2, risk that a close relative might be infected by the SARS-CoV2 and the length of stay in maternity were associated with an increased EPDS total score, while breastfeeding was associated with a lower EPDS total score. Six variables remained positively associated with the STAI-YA total score in the multivariate model: the maternal level of academic achievement, a hospitalization during the pregnancy, peripartum medical complications, risk of being infected by the SARS-CoV2, risk of a close relative being infected by the SARS-CoV2 and physical fatigue. Low but statistically significant correlations were found between the MIBS total score and the EPDS total score (rs = 0.26) and with the STAI-YA total score (rs = 0.26).
The observed rates of anxiety and depressive symptoms were in the same range as those reported in observational studies conducted in high-resource countries during the COVID-19 pandemic. Risk of being infected by the SARS-CoV2 was both an independent risk factor for anxiety and depressive symptoms. The relations between the measure of maternal bonding and the severity of maternal emotional symptoms call for a better consideration of the long-term consequences of the pandemic on children's socio-emotional development.
Cumulative evidence supports an increased risk of maternal peripartum psychological difficulties since the beginning of the COVID-19 pandemic , , , , , . The meta-analysis conducted by Zhang and Yu  found an average prevalence of 43% for anxiety and of 32% for depression among pregnant women exposed to the context of the pandemic. These figures conceal although significant disparity across countries, with in particular a more substantial increase of postpartum depressive symptoms in low-resource compared to high-resource countries . The capacity of the healthcare professionals providing adapted mental health interventions and care continuity during the pandemic appears a key moderator factor of maternal psychopathology risk , . In line with this, Chmielewska and Barratt  found that the estimated efficiency of the national health care system was a stronger predictor of the observed between-study heterogeneity for maternal health outcomes than factors-related to the stringency of mitigation measures for the COVID-19 epidemic (e.g. the duration of lockdown).
Alongside, several concerns have been raised that the application of social distancing measures in maternity wards led to lower social and professional support, ultimately contributing to increase the risk of maternal psychological difficulties , , . The application of social distancing measures in maternity led to a strict restriction of partner and family visits while pregnant women faced additional sources of stress related to COVID-19 pandemic . It has also been raised that a reduction of the length of stay in maternity and a constriction of paramedical team linked to the reorganization of workforce during the pandemic complicate the recognition of psychological needs of women during the perinatal period. An underestimation of maternal psychological difficulties could also be reinforced by a lower access to face-to-face supportive care (including social worker, psychologist and psychiatrist) and subsequently decreased opportunity to receive professional help .
The rates of clinically-significant depressive and anxiety symptoms in the immediate postpartum among women referred to a university hospital center was roughly comparable to the range observed in previous observational studies prior the context of the COVID-19 pandemic. This report stresses the possible contribution of maternal worries about SARS-CoV2 infection in maternal anxiety and depressive symptoms, as long as other well-recognized risk factors. In a modern hospital where digital technologies and telehealth interventions were available the effect of social distancing measures in the maternity care was not clear. The relationships reported between the severity of maternal emotional symptoms and maternal bonding in the days following childbirth are worth considering to discuss the possible long-term impact of the pandemic on children socioemotional development.