Increased maternal mental health burden in a representative longitudinal community cohort coinciding with COVID-19 lockdown

Figures & data

Table 1. Sociodemographic characteristics of 2020 review sample and inception cohort

	Inception cohort		Current review
Characteristics	N = 1,064		N = 346		p-value*
At current review
Days since lockdown on 24 March 2020, mean (SD)	-		42.42	(6.44)	-
Maternal age, mean (SD)	-		40.79	(4.33)	-
Child age, mean (SD)	-		7.95	(0.85)	-
Child female	-		167	(48)	-
At conception
Maternal age, mean (SD)	31.32	(4.79)	32.08	(4.30)	<0.001
Paternal age, mean (SD)	33.49	(5.87)	33.44	(5.29)	0.8
Maternal uni degree or above, n (%)	541	(51)	216	(62)	<0.001
Paternal uni degree or above, n (%)	360	(34)	141	(41)	0.01
Most socio-economically disadvantaged tertile postcode, n (%)	352	(33)	93	(27)	0.003
Regional/rural postcode, n (%)	282	(27)	90	(26)	0.8
Mother born in Australia, n (%)	957	(90)	315	(91)	0.4
Both parents born in Australia, n (%)	834	(78)	284	(82)	0.2
Number of older siblings in the same house, mean (SD)	0.88	(0.95)	0.77	(0.88)	0.01
Maternal history of asthma, n (%)	320	(30)	106	(31)	0.03

* p-values comparing current review to inception cohort using Pearson’ chi-squared test for categorical characteristics, and Student’s t-test for continuous characteristics

Table 2. Subgroup analyses of current EPDS scores by past depressive symptoms

	Subgroup
Outcome, % (95%CI),	EPDS <10 at 2 and 4 years		EPDS 10+ at 2 or 4 years		EPDS 10+ at 2 and 4 years
EPDS score 10+	23.4	(17.6–30.1)	44.2	(30.5–58.7)	82.6	(61.2–95.0)
EPDS score 13+	11.5	(7.3–16.8)	23.1	(12.5–36.8)	56.5	(34.5–76.8)
Thoughts of self-harm	2.6	(0.9–6.0)	11.5	(4.4–23.4)	30.4	(13.2–52.9)

Adjusted for characteristics at conception reported in Table 1

Table 3. Univariate associations between EPDS scores and household, family, community and employment characteristics

	EPDS score 10+			EPDS score 13+			Thoughts of self-harm
Characteristics	RR	95% CI	p	RR	95% CI	p	RR	95% CI	p
Days since lockdown started (24 March 2020)	0.98	0.96–1.01	0.2	0.98	0.94–1.02	0.3	0.99	0.93–1.05	0.7
Household characteristics
Number of adults in household	1.10	0.87–1.38	0.4	0.75	0.38–1.50	0.4	0.46	0.19–1.12	0.09
Number of children in household	1.09	0.89–1.33	0.4	1.13	0.80–1.58	0.5	1.63	0.93–2.85	0.08
Number of people in household (adults and children)	1.07	0.96–1.18	0.2	0.96	0.83–1.10	0.5	0.98	0.86–1.12	0.8
In a relationship	1.04	0.61–1.78	0.9	0.69	0.35–1.38	0.3	0.36	0.15–0.86	0.02
Lives with biological father of the child/ren	0.42	0.35–0.50	<0.001	0.59	0.33–1.05	0.07	0.45	0.18–1.10	0.08
Most socio-economically disadvantaged tertile	1.02	0.69–1.50	0.9	1.25	0.72–2.19	0.4	1.72	0.75–3.96	0.2
Lives in a regional area	0.89	0.65–1.24	0.5	0.90	0.54–1.50	0.7	0.71	0.29–1.72	0.4
Employment			0.2			0.5			0.5
Employed/job keeper, partner employed/job keeper	ref			ref			ref
Employed/job keeper, partner unemployed/no partner	3.07	0.50–18.85		1.38	0.21–9.29		1.07	0.16–7.15
Not working, partner employed/job keeper	1.42	0.20–9.82		0.56	0.06–5.08		-
Not working, partner unemployed/no partner	2.54	0.42–15.21		1.47	0.25–8.76		0.62	0.11–3.52
Pre-COVID-19 social support
See parents at least once per week	0.89	0.64–1.25	0.5	1.15	0.64–2.06	0.6	0.62	0.26–1.46	0.3
See inlaws at least once per week	1.51	1.11–2.06	0.008	1.60	0.98–2.60	0.06	1.41	0.63–3.15	0.4
See other family at least once per week	1.26	0.93–1.70	0.1	1.25	0.78–2.00	0.4	0.61	0.25–1.51	0.3
See friends at least once per week	1.22	0.85–1.77	0.3	0.95	0.56–1.61	0.8	0.67	0.29–1.52	0.3
Stress and substance abuse
Perceived stress scale score	1.11	1.06–1.15	<0.001	1.13	1.05–1.22	<0.001	1.17	1.01–1.36	0.04
Alcohol more than once per week	0.98	0.71–1.34	0.9	1.39	0.86–2.25	0.2	0.94	0.42–2.11	0.9
Binge drinking ever	0.95	0.69–1.30	0.8	1.25	0.75–2.08	0.4	0.70	0.31–1.60	0.4
Smoking (at 4 years)	0.49	0.14–1.67	0.3	-			-
Major life events in the past 12 months
Suffered a serious illness, injury, or assault	1.35	0.82–2.21	0.2	1.18	0.49–2.86	0.7	0.69	0.10–4.66	0.7
Close relative with illness, injury or assault	1.02	0.70–1.49	0.9	1.00	0.54–1.83	0.9	0.74	0.24–2.34	0.6
Parent, partner, or child died	2.83	1.18–6.78	0.02	1.39	0.30–6.39	0.7	2.77	0.62–12.44	0.2
Close family friend or relative died	1.43	1.04–1.96	0.03	1.61	0.96–2.70	0.07	0.89	0.28–2.82	0.8
Broke off a steady romantic relationship	1.39	0.79–2.44	0.3	2.51	1.37–4.60	0.003	3.69	1.36–10.05	0.01
Serious problem with a friend, neighbour, or relative	1.48	1.04–2.09	0.03	0.88	0.39–1.98	0.8	0.77	0.19–3.06	0.7
Seeking work unsuccessfully for more than a month	1.36	0.80–2.30	0.3	0.80	0.23–2.86	0.7	1.07	0.17–6.89	0.9
Major financial crisis	1.52	0.99–2.35	0.06	2.26	1.15–4.42	0.02	4.38	1.93–9.91	<0.001
Problems with police and court appearance	-			-			-
Something valuable lost or stolen	3.34	1.84–6.04	<0.001	-			31.45	5.34–185.26	<0.001
Someone in household had an alcohol problem	1.05	0.39–2.84	0.9	1.10	0.20–5.94	0.9	2.51	0.52–12.18	0.3
Someone in household had a drug problem	-			-			-
Serious disappointment in work or career	1.44	1.03–1.99	0.03	1.70	1.03–2.81	0.04	1.00	0.37–2.70	0.9
Thought would lose job soon	1.78	1.27–2.51	<0.001	2.23	1.34–3.68	0.002	5.25	2.26–12.19	<0.001
Lost job (not from choice)	1.29	0.87–1.90	0.2	2.10	1.25–3.53	0.005	3.39	1.54–7.45	0.002

Analyses are adjusted for 2 year or 4 year EPDS score 10+

Table 4. Major life events that increased in prevalence at 7 year review

	Prevalence, n (%)					Due to COVID-19	Population attributable fraction, % (95% CI)
	Year 4		Year 7			N (%)	EPDS score 10+		EPDS score 13+		Thoughts ofself-harm
Major life event	N = 323		N = 346		p		%	95% CI	%	95% CI	%	95% CI
Parent, partner, or child died	12	(4)	5	(1)	0.02	1 (<1)	2.53	−0.95,5.89	0.58	−2.61,3.66	3.14	−4.24,9.99
Close family friend or relative died	79	(25)	64	(18)	0.06	2 (<1)	6.82	−0.20,13.34	9.39	−3.03,20.31	−1.89	−21.07,14.25
Broke off a steady romantic relationship	5	(2)	9	(3)	0.6	0 (0)	1.06	−1.06,3.14	4.05	0.12,7.83	7.62	−2.57,16.80
Serious problem with a friend, neighbour, or relative	22	(7)	32	(9)	0.2	1 (<1)	4.83	−0.18,9.59	−1.30	−9.57,6.35	−2.72	−16.55,9.47
Major financial crisis	17	(5)	17	(5)	0.9	7 (2)	1.80	−0.46,4.01	4.20	−0.80,8.95	10.39	−0.08,19.77
Something valuable lost or stolen	7	(2)	8	(2)	0.8	0 (0)	5.51	0.84,9.95	22.91	21.86,23.95	47.99	−34.26,79.85
Serious disappointment in work or career	34	(11)	53	(15)	0.07	19 (5)	7.17	−0.20,14.00	11.23	−1.78,22.58	−0.05	−21.54,17.64
Thought would lose job soon	17	(5)	44	(13)	0.006	32 (9)	10.10	3.07,16.62	15.29	2.95,26.06	40.35	11.14,59.96
Lost job (not from choice)	12	(4)	35	(10)	0.001	28 (8)	2.74	−2.01,7.26	9.79	0.61,18.12	19.30	−0.06,34.91

Population attributable fraction (PAF) estimates are provided for factors associated with outcomes in Table 3 and indicate how much, in the current wave, these outcomes could potentially be attributed to factors associated with these life events, if the significant associations shown in Table 3 were causal in nature. Adjusted for past depression history.

Figure 1. Proportion of responses indicating (a) Thoughts of self-harm, (b) EPDS score 10+, (c) EPDS score 13+, (d) EPDS score 13+and thoughts of self-harm (unadjusted analyses)