We’re all reeling from the pandemic and living with mixed messages about the future. Although a significant percentage of the U.S. population will soon be vaccinated, infection rates have increased among young adults. There are new strains. There is still a lot we don’t know. Living with this uncertainty, and the abrupt changes the pandemic has triggered, is taking a toll on people’s mental health, especially expectant parents and parents with newborns and young children. Ovia Health’s new research, featuring digital depression screener data, highlights how difficult mental health challenges have been for parents over the past year.
Recent results from our digital depression screeners tell us that the percent of parents reporting mild, moderate, and severe anxiety and depression symptoms has increased during the pandemic. The most significant increases in anxiety, depression, and suicidal ideation are among women aged 35-39, in the BIPOC community (especially Black mothers), and first-time mothers.
The entire community has a responsibility to help face this crisis. Employers, health insurance providers, and their strategic partners can take leadership roles in combating this alarming mental health crisis. Preserving employees’ health and well-being and holding onto top workers is not only pragmatic; it’s the right thing to do. Working mothers and their families deserve a higher standard of care. The U.S. is now in the middle of a mental health crisis from which it will be difficult to recover if we rely solely on conventional approaches to care.
Choosing between children or paychecks
While we are all unsteady because of the pandemic, why are families, and especially working mothers, in crisis?
According to the Bureau of Labor Statistics, nearly 2.4 million women have left or lost their jobs since February 2020, compared to less than 1.8 million men. The pandemic has forced many working mothers to make impossible choices between childcare and their income. Daycare was either not an option during a pandemic, or the risks associated with it were not something families were willing to take on. Many parents are also responsible for simultaneously taking care of their own aging parents. Because of the pandemic, many women have given up their hard-won careers to care for their families.
Mothers who continue to work are often under pressure to maintain the same level of productivity they delivered before the pandemic, or risk losing their jobs. Others have been under the additional stress of being on the ‘front lines’ exposed regularly to people who may or may not be masked or adhering to social distancing. Many working mothers have risked their lives and their families’ health and safety just by going to work.
Disruption of family life
Intimate partner violence (IPV) has increased by 8.1 percent over the past year, according to a report from the National Commission on Covid 19 and Criminal Justice. Many incidents of IPV go unreported, so it’s likely that the number of incidents is even higher than those cited in the study.
The disruption of family life – giving up a job and losing household income, overseeing Zoom schooling or being expected to help teach themselves, losing contact with friends and family, living under tight restrictions – has fueled the mental health crisis. The strain of living through this pandemic continues to threaten parents’ mental health, increasing families’ risks of stress, depression, anxiety, and suicidal ideation.
What the digital depression screener data are telling us
Lack of childcare, financial stress, IPV, remote work and schooling, are taking a toll on parents.
We’ve been screening expectant mothers and postpartum mothers using digital depression screener surveys like the EPDS and PHQ-9 for the last several years. The Edinburgh Postnatal Depression Scale (EPDS) is a validated instrument made up of 10 screening questions used to determine whether a patient has symptoms of depression during pregnancy and in the year following the birth of a child. Scores on the EPDS can range from 0 to 30. The Patient Health Questionnaire Module 9 (PHQ-9) is another validated tool, comprising nine questions, which clinicians use to screen for depression and monitor the severity of depression and response to treatment using the DSM-IV criteria, with scores ranging from 0 to 27. While many providers use these screening tools, not all women are screened and that has become increasingly true as access to care has worsened during the pandemic.
We analyzed data from a sample of nearly 18,000 postpartum women who took the EPDS in Ovia’s apps either pre-pandemic (January 1, 2019 – February 29, 2020) or during the pandemic (March 1, 2020 – March 1, 2021). The results were alarming, but not unexpected.
Findings indicate that EPDS scores, in general, are higher during the pandemic than before. We are seeing the greatest increases in scores and suicidal ideation among women aged 35-39, in the BIPOC community (especially Black mothers), and in first-time mothers. Since the start of the pandemic, digital depression screener data have reported:
- Many women are having a harder time with anxiety and depression.
- 8% increase in women (overall) reporting mild to moderate symptoms of anxiety and depression and 7.5% increase in those reporting moderate to severe symptoms.
- The mental toll is greater for women in their 30s.
- Compared to women aged 25-29 who reported an average reduction in severe symptoms compared to before the pandemic, women aged 30-34 had an 11% increase in reported moderate to severe symptoms
- Women aged 35-39 had a 22% increase in reported moderate to severe symptoms and the greatest increase in reports of suicidal ideation (24%)
- Changes in screening results are even more significant for BIPOC women, especially Black mothers
- White women had a 10% increase in the proportion of moderate symptoms reported, but generally stable proportions in all other categories, including suicidal ideation.
- In contrast, BIPOC mothers had a 10% increase in severe symptoms reported and a 26% increase in reports of suicidal ideation.
- These changes so far appear to be primarily driven by increasing scores in Black women, more so than Hispanic or multiracial women.
- The pandemic has also disproportionately affected first-time mothers
- First-time mothers had a 12% increase in reports of mild depression and anxiety, an 11% increase in moderate symptoms, and a 2% increase of reported severe symptoms.
- First-time mothers also had a 7% increase in reports of suicidal ideation, compared to a 13% decrease in non-first-time mothers.
It’s clear mothers are struggling. Their employers and health plans should be focusing on new programs and benefits that can help alleviate the pressures of parenting during a pandemic, and invest in long-term benefits that will ensure their workforce is adequately supported in the future.
Raising the standard of care. How employers and health plans can support working parents
For nearly ten years, Ovia Health has been the leader in using digital health to proactively identify, stratify, and escalate health risk factors among new and expectant parents. Our clinical team has delivered more than 10 million digital depression screeners. The screeners we use help us understand how mental health uniquely impacts women on their parenthood journey.
We can identify factors that affect a woman’s risk of developing perinatal depression and continue to expand the role digital depression screener tools can play to fill in mental health screening gaps. Throughout the pandemic, we’ve been working with many organizations, like the March of Dimes, to continuously publish new research on how the pandemic impacts care delivery for parents, pediatrics, prenatal care, racial disparities in family care, and the parent mental health crisis.
We’ve partnered with large employers and health insurance providers to address these findings, and provide long-term benefits coverage and support for families. Our clinical intervention programming not only helps improve early identification for depression, it’s helping families and women connect to care in their networks, and avoiding healthcare spend associated with undiagnosed mental health conditions, and other adverse maternity events.
Return to work programming, parenting support, and manager training is also helping women juggle their careers and parenting duties. Equipped with stronger, more inclusive and comprehensive parental support programs, employers who work with Ovia are seeing a return to work rate of 92% after parental leave, and a one-year retention rate of 88% vs the industry standard of 80%.
With so many parents, especially women, struggling with mental health, employers and health plans need to act to address this crisis and prevent long-term leadership draughts. They owe it not just to their employees and members, but to parents everywhere, to invest in benefits beyond the traditional. Benefits and programs that count where it matters most — close to home.