Healthcare utilization before and during the COVID-19 pandemic among mothers and birthing parents with elevated levels of postpartum depression symptoms

ABSTRACT

Little is known about the healthcare utilization of mothers and birthing parents experiencing elevated levels of symptoms of postpartum depression (PPD), particularly during the COVID-19 pandemic. This study examined how healthcare utilization changed in these individuals during COVID-19. Individuals living in Ontario, Canada, with Edinburgh Postnatal Depression Scale Scores ≥ 10 were recruited into two separate randomized controlled trials of a 1-day intervention for PPD before (pre-COVID-19, n = 441) and during the pandemic (COVID-19, n = 287). Participants in both samples completed the same health resource use questionnaire, self-reporting the number of virtual and/or in-person visits to specific healthcare services over the three months preceding their treatment intervention. Use of medications, mental health care, primary care, hospital-based care, allied health care, and overall healthcare utilization were compared between the pre-COVID-19 and COVID-19 groups. While participants had higher levels of PPD symptoms during COVID-19, differences were not seen in the use of specific categories of care (e.g. mental health and primary care). However, before and after statistically adjusting for covariates, overall healthcare utilization decreased from an average of 9.5 visits prior to COVID-19 to 6.9 during COVID-19 (p < .001), a change that was at least partly contributed to by reductions in visits to allied health professionals (e.g. dentists and physiotherapists). Overall healthcare utilization decreased by 27 % in mothers and birthing parents seeking treatment for elevated levels of PPD symptoms during the COVID-19 pandemic in Ontario, Canada – despite higher levels of PPD symptoms – highlighting the need to support and address barriers to postpartum care.

KEYWORDS:

• COVID-19
• healthcare utilization
• maternal health
• postpartum depression
• postpartum women
• public health

Acknowledgments

The authors would like to acknowledge the study participants and their families for participating in their respective RCT.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

V.L.: Conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing of the original draft, and reviewing and editing the manuscript. H.L.: Conceptualization, data curation, methodology, resources, software, reviewing, and editing the manuscript. C.S.: Data curation, formal analysis, resources, software, validation, and reviewing and editing the manuscript. K.H.: Data curation, resources, and reviewing and editing the manuscript. R.V.L: Conceptualization, funding acquisition, methodology, project administration, resources, supervision, and reviewing and editing the manuscript

All authors have read and approved the final article.

Data availability statement

The data that support the findings of this study are available from the corresponding author, V.L., upon reasonable request.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/03630242.2024.2308516.

Additional information

Funding

The Canada Research Chairs program supported the study of in-person, 1-day CBT-based workshops for PPD. The online CBT-based workshops for PPD RCT was supported by a Canadian Institutes of Health Research grant [COVID-19 Op Gr: COVID-19 MH/SU Developing Innovative Adaptations of Services/Delivery funding opportunity; CRC number: CRC-2021-00290; CIHR number: #450207.].