The global epidemic crisis is having a profound effect on all aspects of our life. In Poland, as well as in other European countries self-isolation and severe restriction in everyday routine were introduced in early March 2020. A study carried out in Poland 10 days after introducing restrictions [1] showed that the level of anxiety in Polish society was quite high. 75% respondents were worried that some people would not follow government’s instructions and the virus would spread too quickly. 73% were afraid of hospital overcrowding and healthcare system failure, 72% - losing loved ones, 71% - financial crisis and market collapse, and 70% - panic and irrational behaviour of other people. 26% Poles estimated that their anxiety reached the level of panic attack. Moreover, the study [1] revealed that women felt greater fear than men at the beginning of the epidemic crisis.
According to international studies [2, 3], especially vulnerable to stress and mental health problems are front-line health and social care staff, those with pre-existing health issues, young people (aged ≤ 18 years), and older adults (aged ≥ 65 years). However, beyond direct influence, psychological and social effects of the covid-19 epidemic are increasingly seen as pervasive factors which may affect mental health now and in the future [2]. On the basis of the studies concerning the early phase of the severe acute respiratory syndrome (SARS) outbreak, a range of psychiatric morbidities may be suspected including persistent depression, anxiety, panic attacks, psychomotor excitement, psychotic symptoms, delirium, and even suicidality [4–6]. Moreover, we believe that the epidemic crisis and high level of anxiety which was observed in the early stage of the covid-19 outbreak [1] could contribute to the intensification (or be a trigger) of mental health problems among those people who were at high-risk under normal (non-epidemic) conditions [7, 8]. We assumed that such factors as anxiety about the possibility of infection during pregnancy and / or after delivery, restrictions on delivery and hospital stay (limited contact with relatives and friends), limited access to specialist and control treatment (often restricted only to emergency situations), social isolation and loss of social support due to voluntary quarantine and lockdown, confusion and panic (often increased by fake news) – all may affect the well-being and mental health of mothers in the postpartum. It is worth emphasizing that lack of social support is listed as one of major risk factors for postpartum depression along with high life stress, current or past abuse, prenatal depression, and marital or partner dissatisfaction [8].
In the time of epidemic crisis, women after childbirth are exposed to several of the above-mentioned consequences (social isolation, higher life stress), which may worsen their mental health, and the existing psychosocial resources may not be sufficient to cope with the process of transition to motherhood, which can result in the development / intensification of depressive symptoms. Previous studies [9, 10] described the effects of the covid-19 epidemic on the depression and anxiety levels of pregnant women. Recent assessment of depression symptoms with the Edinburgh Postnatal Depression Scale revealed significantly higher rates of depressive symptoms among pregnant women assessed after the declaration of covid-19 epidemic in comparison to women assessed in pre-epidemic period [10]. However, there are no reports on the occurrence of severe depressive symptoms among women in the postpartum period during epidemic crisis.
Postpartum depression (PPD) is a common and serious mental health problem that affects about 13–20% of new mothers [11, 12]. In many cases PPD resolves spontaneously e.g. Whiteford et al. [13] reported the remission rate of 53% in adult samples experiencing depression within one year and O'hara et al. [14] indicated that the symptoms last seven months on average when left untreated. Yet still, about one in three women feel worse even more than a year after delivery, and research [15, 16] indicate that there are about 40% cases of relapses. Researchers [17–19] indicate that suicide accounts for one in five of deaths and is the second leading cause of mortality in the first year postpartum. Therefore, screening procedures (in order to detect PPD symptoms) are widely implemented in many countries. Of course, screening test precedes the extended clinical examination, but helps to quickly detect cases that may require fast professional help [20].
The severity of PPD symptoms is associated with many biological and non-biological factors e.g. Wisner et al. [19] indicates that the particular risk refers to those women with a personal or family history of depression, physical or sexual abuse, unplanned pregnancy, and pregnancy complications. On the other hand, social support is an important protective factor [21]. However now, during COVID-19 pandemic, new mothers are deprived of their social network. According to the British Academy of Medical Science, major adverse consequences of the epidemic crisis are increased social isolation and loneliness [22], which are strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan [23, 24]. The aggravated depressive symptoms during global epidemic crisis can thus be caused directly - by concerns about exposure to COVID-19 (an additional strong and widespread stressor) but also indirectly: negative mental state can get worse along with restrictions introduced by many countries e.g. reduced ability to stay in direct contact with family and friends after birth, recommendations for physical distance - all limits the accessibility to sources of social support – grandparents, friends as well as institutions providing support for mothers and their children: e.g. lactation consultations, postpartum home visits of midwives, consultations with pediatricians etc. Many families are also encountering several changes in financial well-being and economic stability. Moreover, prolonged direct contact with other children (daily care and home education during pandemic) can intensify daily fatigue, stress, trigger conflicts and interfere with adapting to life with a new baby. So, epidemic crisis can limit a great part of a psychological resources that builds woman’s health in the postpartum period.