Latent class analysis of health, social, and behavioral profiles associated with psychological distress among pregnant and postpartum women during the COVID‐19 pandemic in the United States

• Published in: Birth (Berkeley, Calif.) Vol. 50; no. 2; pp. 407 - 417
• Main Authors: Goldstein, Ellen, Brown, Roger L., Lennon, Robert P., Zgierska, Aleksandra E.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-06-2023; John Wiley and Sons Inc
• Subjects: Access; Anxiety; Anxiety - epidemiology; Anxiety - psychology; Child; Clinical outcomes; Computerized medical records; Coping; COVID-19; Cross-Sectional Studies; Depression - epidemiology; Depression - psychology; Early intervention; Female; Health behavior; Health care industry; Health records; Health status; Humans; Latent Class Analysis; Maternal & child health; Maternal characteristics; maternal mental health; Medical records; Mental depression; Mental health; Mental health services; Original; Pandemics; Perinatal; Polls & surveys; postpartum; Postpartum Period - psychology; Postpartum women; Pregnancy; Pregnant Women - psychology; Protective factors; Psychological Distress; Public health; Risk factors; Social behavior; Social networks; Social support; Stress; Stress, Psychological - epidemiology; United States - epidemiology; Women; United States; United States > US; COVID-19; postpartum; maternal mental health; psychological distress; pregnancy
• ISSN: 0730-7659; 1523-536X
• DOI: 10.1111/birt.12664

Background
There is a growing body of literature documenting negative mental health impacts from the COVID‐19 pandemic. The purpose of this study was to identify risk and protective factors associated with mental health and well‐being among pregnant and postpartum women during the pandemic.
Methods
This was a cross‐sectional, anonymous online survey study distributed to pregnant and postpartum (within 6 months) women identified through electronic health records from two large healthcare systems in the Northeastern and Midwestern United States. Survey questions explored perinatal and postpartum experiences related to the pandemic, including social support, coping, and health care needs and access. Latent class analysis was performed to identify classes among 13 distinct health, social, and behavioral variables. Outcomes of depression, anxiety, and stress were examined using propensity‐weighted regression modeling.
Results
Fit indices demonstrated a three‐class solution as the best fitting model. Respondents (N = 616) from both regions comprised three classes, which significantly differed on sleep‐ and exercise‐related health, social behaviors, and mental health: Higher Psychological Distress (31.8%), Moderate Psychological Distress (49.8%), and Lower Psychological Distress (18.4%). The largest discriminatory issue was support from one's social network. Significant differences in depression, anxiety, and stress severity scores were observed across these three classes. Reported need for mental health services was greater than reported access.
Conclusions
Mental health outcomes were largely predicted by the lack or presence of social support, which can inform public health decisions and measures to buffer the psychological impact of ongoing waves of the COVID‐19 pandemic on pregnant and postpartum women. Targeted early intervention among those in higher distress categories may help improve maternal and child health.