Psychological Distress in Childbearing Persons During the COVID-19 Pandemic: A Multi-Trajectory Study of Anger, Anxiety, and Depression

Abstract

Psychological distress can manifest as depression, anxiety, and anger in the perinatal period. These conditions are often comorbid yet studied in isolation. A full understanding of perinatal psychopathology requires the spectrum of common psychological distress to be studied concurrently to better understand interconnected symptoms. A transdiagnostic approach provides valuable insights into how symptoms interact and cumulatively affect mental health, which can inform more effective screening and treatment strategies. This, in turn, can improve outcomes for birthing parents experiencing psychological distress. We undertook group-based multi-trajectory modeling (GBMTM) to uncover the patterns of affective disorders (anger, anxiety, and depression) over three-time points (pregnancy, 3-, and 12-months postpartum (mPP)) in a large longitudinal cohort of persons who gave birth during the COVID-19 pandemic (n = 2145). We identified five trajectory groups: high-stable (11.3%), postpartum-increase (16.0%), postpartum-decrease (21.5%), low-stable (37.9%), and minimal stable (13.2%) symptoms of anger, anxiety, and depression. Multinomial regression revealed that lower levels of sleep disturbance, less financial hardship, and lower intolerance of uncertainty predicted postpartum decreases in psychological distress compared with the high stable group. Higher levels of sleep disturbance, greater financial hardship, lower level of social support, and greater intolerance of uncertainty predicted postpartum increases in psychological distress compared with the low-stable and minimal-stable groups. Screening for psychological distress symptoms (i.e., anger, anxiety, and depression), paired with access to evidence-based management for those who screen positive, is warranted during the first postpartum year to reduce the harmful effects of unmanaged distress on families.