Rates of self-reported postpartum depressive symptoms in the United States before and after the start of the COVID-19 pandemic

Background: This study aimed to determine the relationship between the start of the COVID-19 pandemic and changes in postpartum depressive symptoms (PDS) in individuals in the United States. Further analyses explored how these changes related to state-level measures of pandemic severity, economic hardship, and social isolation. Methods: Data were collected from users of the Flo mobile health application who completed a survey about their mood within 90 days of giving birth. Analyses assessed changes in national and state-level self-reported PDS from a pre-pandemic period (N = 159,478) to a pandemic period (N = 118,622). Linear regression determined which state-level pandemic severity or economic factors were associated with changes in PDS. Results: National rates of PDS increased from 6.5% (pre-pandemic) to 6.9% (pandemic). There was a significant increase in PDS over the course of the pandemic timeframe. Linear regressions revealed a negative association between percent change in PDS across states and COVID-19 deaths per 100 K residents as well as 2020 women's unemployment rate. There was no association between change in PDS and COVID-19 cases per 100 K residents, percent job loss, percent change in women's unemployment rate, or percentage of population staying at home. Conclusions: There was a national increase in PDS that worsened over the course of a year following the start of the COVID-19 pandemic. States with a greater increase in PDS tended to show overall fewer deaths from COVID19 and lower women's unemployment rates. Further work is needed to identify what individual-level factors may be driving these differences.