Changes in the identification and management of mental health and domestic abuse among pregnant women during the COVID-19 lockdown: regression discontinuity study

[摘要] Background Domestic violence and abuse (DVA) and mental illness duringpregnancy have long-lasting and potentially seriousconsequences, which may have been exacerbated during theCOVID-19 pandemic.AimsTo investigate how the UK COVID-19 lockdown policy influencedthe identification of DVA and depressive symptoms duringpregnancy in health services in South-East London in Spring2020, using eLIXIR (Early-Life Data Cross-Linkage in Research)maternity and mental routine healthcare data.MethodWe used a regression discontinuity approach, with a quasiexperimental study design, to analyse the effect of the transitioninto and out of the COVID-19 lockdown on the rates of positivedepression screens, DVA recorded in maternity and secondarymental health services, and contact with secondary mentalhealth services during pregnancy.ResultsWe analysed 26 447 pregnancies from 1 October 2018 to 29August 2020. The rate of DVA recorded in maternity services waslow throughout the period (<0.5%). Within secondary mentalhealth services, rates of DVA dropped by 78% (adjusted oddsratio 0.219, P = 0.012) during lockdown, remaining low afterlockdown. The rate of women screening positive for depressionincreased by 40% (adjusted odds ratio 1.40, P = 0.023), butreturned to baseline after lockdown lifted.ConclusionsRates of DVA identification in secondary mental health servicesdropped during and after lockdown, whereas overall rates ofDVA identified in maternity services were concerningly low.Healthcare services must adopt guidance to facilitate safeenquiry, particularly in remote consultations. Further research isvital to address the longer-term impact on women’s mentalhealth caused by the increase in depression during thelockdown.

[学科分类] 计算机科学（综合）

[关键词] Perinatal psychiatry;epidemiology;depressive disorders;out-patient treatment;statistical methodology