Psychiatric symptoms and couple satisfaction in parents of newborns before and during the COVID-19 pandemic—A comparison of two prospective studies

Abstract

Aims

To assess anxiety, depression, perceived stress, couple satisfaction and life satisfaction of parents of healthy newborns in two cohorts in 2015 and in 2020 during the COVID-19 pandemic.

Design

A prospective follow-up study.

Methods

We enrolled 60 parents of healthy newborns (n = 30 dyads) in 2015 and 60 parents (n = 30 dyads) in 2020. Both parents completed six valid and reliable questionnaires independently 1–2 days and 12 months after delivery: Beck Anxiety Inventory, Beck Depression Inventory-II, Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Couple Satisfaction Index and Life Satisfaction Scale-4.

Results

Anxiety was more common but couple satisfaction better in both parents during the COVID-19 pandemic than in 2015. Depressive symptoms and perceived stress were similarly low, and life satisfaction was similarly high in both cohorts, indicating ample parental resilience. There was a moderate positive association between previous mental health disorders and parental anxiety after delivery during the COVID-19 pandemic.

INTRODUCTION

The perinatal period is a sensitive time for the entire family. A newborn changes the dynamics in the family and requires continuous attention. Some relationships lack sufficient resources, which can lead to tension and conflicts between the parents. However, resilient relationships can even strengthen in the face of challenges, which can have a positive effect on life satisfaction (Isokääntä et al., 2019).

Parental life satisfaction varies depending on the time after birth. In general, both new parents are satisfied with life around the time of delivery, but life satisfaction often slightly decreases over the following months as the burdens of parenthood increase (Aasheim et al., 2014). Nonetheless, pregnancy and delivery include multiple biological, social and psychological changes that can substantially impact on the parental relationship.

Anxiety and depressive symptoms are common in the perinatal period. The prevalence of anxiety is 10%–17% in pregnant women and 13%–40% during the first weeks after delivery (Kendig et al., 2017; Leight et al., 2010). During pregnancy, the prevalence of maternal depression is 4%–16% (Dunkel Schetter & Tanner, 2012; Fairbrother et al., 2015, 2016; Kendig et al., 2017; Leight et al., 2010; Woody et al., 2017), and during postpartum period it is similar, being 14% (Davé et al., 2010). The prevalence of paternal anxiety during the 3rd trimester is 10%–14%, but contrary to mothers, it decreases in the postnatal period to 4%–10% (Philpott et al., 2019). The prevalence of paternal depression is similar to that in mothers, being 8%–10% during pregnancy and 13% at 3–6 months postpartum (Cameron et al., 2016).

Mental health problems in parents are associated with elevated stress, even though the delivery itself is a stressful situation. These factors are associated with adverse birth outcomes (Cuijlits et al., 2019; Dunkel Schetter & Tanner, 2012; Staneva et al., 2015). On the other hand, high couple satisfaction and positive dyadic coping can relieve these stressors and decrease the risk of anxiety and depression (Koivula et al., 2019; Razurel et al., 2017; Yu et al., 2020).

BACKGROUND

The ongoing coronavirus disease 2019 (COVID-19) pandemic has caused multiple changes in our everyday lives. The restrictions and fear of contracting the coronavirus have immensely changed our social life and behaviour. Furthermore, some people are at risk of severe COVID-19 disease (Finnish Institute for Health and Welfare, 2021), which can further increase the fear of the virus and cause psychiatric symptoms, such as anxiety, depression and sleep problems (Dragioti et al., 2022).

Strategies to minimize viral spread had a psychological impact on many of us during the COVID-19 pandemic, and families waiting for a baby may experience extra anxieties. In Finland, the Finnish Institute for Health and Welfare has reported that the risk of developing severe COVID-19 is higher in pregnant women with or without risk factors, such as obesity. Moreover, pregnant and postpartum women are more susceptible to venous thrombosis, and parturients with coronavirus disease have higher incidences of preterm births and other adverse pregnancy outcomes. A pregnant woman can transmit the coronavirus infection to the foetus via the transplacental route and a new mother to the newborn via respiratory droplets and contact (Finnish Institute for Health and Welfare, 2022). This type of information can be assumed to increase stress in vulnerable parents. Fear of unknown complications, concerns about infection and effects of social isolation in and out of the maternity hospital can cause psychiatric symptoms and are a challenge to parents and their dyadic relationship. Furthermore, fathers have garnered less attention in research, even though they play a crucial role in parenthood, family life and the well-being of the mother and the entire family. In order to develop strategies for best supporting both parents during stressful situations such as the COVID-19 pandemic, more information is needed about how these psychiatric symptoms evolve over time compared to the situation before the COVID-19 pandemic.

In this study, our aim was to evaluate mental health symptoms, life satisfaction and couple satisfaction in the parents of healthy, full-term newborns during the COVID-19 pandemic 1–2 days and 12 months after delivery, and to compare these with data collected 5 years earlier, before the COVID-19 pandemic. Our study hypothesis was that the COVID-19 pandemic would result in more psychiatric symptoms in both parents early after delivery, and that the symptoms would alleviate during the 12-month follow-up. The primary outcome was the prevalence of anxiety and depressive symptoms, as well as life satisfaction and couple satisfaction during the COVID-19 pandemic compared to that before the pandemic.

METHOD Design

This study was a prospective case-controlled 12-month follow-up study.

Study population and measures

This was a prospective study of two parent cohorts shortly after the birth of a child in a tertiary care maternity hospital in Eastern Finland. All participants were recruited 24 to 48 h after delivery in the labour ward of Kuopio University Hospital, Kuopio, Finland. The researchers provided oral and written information about the study and allowed the parents time to consider participation before obtaining written informed consent. The first cohort (2015 cohort, n = 60) was recruited in May 2015 and the second cohort (COVID-19 cohort, n = 60) after the outbreak of the COVID-19 pandemic between May–June 2020.

Eligible participants were an adult couple with a healthy full-term biological newborn. Four couples asked declined participation in 2015 and 12 couples in 2020. Couples who agreed to participate completed the first set of six questionnaires independently and concurrently before discharge from the labour ward and the second set of follow-up questionnaires at 12 months after delivery. The 12-month follow-up questionnaires were mailed to the parents and a prepaid envelope was provided to return them to the researchers. The questionnaires comprised questions about background information, anxiety, depression, perceived stress, couple satisfaction and life satisfaction. For background information, we collected data on previous deliveries, miscarriages, infertility treatments, economic (e.g. unemployment/low incomes/debts/distraints) and other burdens in the family (e.g. stress at work, lack of social support, moving to a new house, selling a house) and medical history of physical and mental illnesses.

We used self-report questionnaires to minimize interviewer bias. Anxiety of the participants was measured with the Beck Anxiety Inventory (BAI; Beck et al., 1988). The BAI has 21 items that are rated on a 4-point scale of increasing severity. The total score varies between 0–63 and can be categorized as no anxiety symptoms (BAI score 0–7), mild (8–15), moderate (16–25) and severe anxiety symptoms (26–63).

Depression was measured with two tools, the Beck Depression Inventory-II (BDI-II; Beck et al., 1996) and the Edinburgh Postnatal Depression Scale (EPDS; Cox et al., 1987). The BDI-II consists of 21 items that are rated on a 4-point scale of increasing depression. The total score can vary between 0–63 and can be categorized as no depressive symptoms (BDI-II score 0–13), mild (14–19), moderate (20–28) and severe depressive symptoms (29–63). The EPDS measures depressive symptoms after the birth of a child. It consists of 10 items that are rated on a 4-point scale of increasing severity. The total score varies between 0–30 and is categorized as no depression (EPDS score 0–9), possible depressive symptoms (10–13) and severe depressive symptoms (14–30).

General psychological stress was measured with the Perceived Stress Scale (PSS; Cohen et al., 1983). The PSS has 10 items that are rated on a 5-point scale of increasing severity. The total score can vary between 0–40 and can be categorized as low stress (PSS scores 0–13), moderate (14–26) or high perceived stress (27–40).

Couple relationship satisfaction was assessed with the Couples Satisfaction Index-4 (CSI-4; Funk & Rogge, 2007). The first question is rated on a 7-point scale and three questions on a 6-point scale of increasing couple satisfaction. The total score can vary between 0–21 and can be categorized as dissatisfied (CSI score 0–13) and satisfied with the relationship (14–21).

Life satisfaction was measured with the Life Satisfaction Scale-4 (LS-4) (Koivumaa-Honkanen et al., 2000), which assesses interest and happiness in life, ease of living and loneliness. The LS-4 is a 4-item measure and the items are rated on a 5-point Likert scale of decreasing satisfaction. The total score can vary between 4–20 and is categorized as satisfied with life (LS score 4–6), intermediate (7–11) and dissatisfied with life (12–20).

Ethics

The Research Ethics Committee of the Northern Savo Hospital District, Kuopio (No.88//2013; 7 January 2014) approved the study protocol and an amendment was submitted to the Ethics Committee and approved on 17 March 2020. The study had institutional approval (No. TJ_146/2015) and complied with the principles presented in the Declaration of Helsinki. This study is reported in line with the STROBE guidelines (Table S1).

Analysis

The data were entered and analysed with SPSS software (IBM SPSS Statistics 27, International Business Machines Corporation, Armonk, NY, USA). We used the Kolmogorov–Smirnov test to assess the normality of the data distribution and Levene's test to compare the variances in the two cohorts. The continuous variables were analysed with the Mann–Whitney U-test between cohort comparisons and the Wilcoxon matched pair signed-rank test within cohort comparisons. The binominal and categorical variables were analysed with the chi-square test or Fisher's exact test. Spearman's correlation coefficients were calculated to measure the correlation between previous mental health disorders and study parameters: absolute values less than 0.30 were considered weak, between 0.3 and less than 0.50 moderate, 0.5 to less than 0.90 strong and above 0.9 very strong. The data are presented as the number of cases and the median and [minimum, maximum] or [interquartile range], as appropriate. p-values <.05 were considered statistically significant.

We performed no formal sample size calculations, but we reasoned that the parents of 30 newborns, with 60 parents in each cohort and 120 in total, would provide a representative sample to test our hypothesis. For the very few cases of missing data in the questionnaires, we used the last observation carried forward approach (see e.g. Jakobsen et al., 2017).

RESULTS

The characteristics of the 120 parents and 60 dyads are listed in Table 1. For 17 couples in the 2015 cohort and for 19 in the Covid-19 cohort in 2020, the newborn was the first child in the family. In the 2015 cohort, eight parents (5 mothers and 3 fathers) had a medical history of depression, two mothers had anxiety, one father had panic disorder and one mother had sleep disturbance. In the COVID-19 cohort, eight parents (7 mothers and 1 father) had a medical history of depression, seven parents had anxiety (6 mothers and 1 father), two parents had panic disorder (one mother and one father), two mothers had burn-out and one mother had sleep disturbance.

TABLE 1 Sociodemographic characteristics of the 120 parents in the study (N = 60 dyads, N = 120 parents)

Variable	2015 cohort (N = 60)a		COVID-19 cohort (N = 60)a
Age (years)
Fathers	n = 30	31 [21–47]	n = 30	32 [24–44]
Mothers	n = 30	29 [20–38]	n = 30	29.5 [19–36]
Siblings	0 [0–6]		0 [0–7]
Miscarriages: yes/no	7/23		9/21
Infertility treatments: yes/no	3/27		5/25
Fathers employed: yes/no	28/2		29/1
Mothers employed: yes/no	24/6		23/7
Living together: yes/no	30/–		28/2
Physical illnesses: yes/no
Fathers	8/22		7/23
Mothers	6/24		6/24
Mental disorders: yes/no
Fathers	4/26		3/26
Mothers	7/23		10/20
Burden of workload: yes/no
Fathers	14/16		13/16
Mothers	12/18		13/16
Newborn: boy/girl	17/13		14/16

^aThe data are medians [minimum, maximum] or the number of cases.

The questionnaire scores in the two cohorts are presented in Table 2 and those of fathers and mothers in Table 3. The 12-month response rate was 70% in the 2015 cohort and 83% in the Covid-19 cohort. The flow chart of participants in Figure 1 illustrates the study design.

TABLE 2 Questionnaire scores in the two cohorts

Variable	Anxiety (BAIa), scale 0–63 median [IQR] number of cases	Depression (BDI-IIb), scale 0–63 median [IQR] number of cases	Depression (EPDSc), scale 0–30 median [IQR] number of cases	Perceived stress (PSS-10d), scale 0–40 median [IQR] number of cases	Couple satisfaction (CSI-4e), scale 0–21 median [IQR] number of cases	Life satisfaction (LS-4f), scale 4–20 median [IQR] number of cases
2015 cohort: shortly after delivery (n = 60)
Total score	5 [2, 8]	2 [1, 5]	3 [2, 5]	11 [8, 15]	19 [16, 20]	5 [5, 6]
Score groups	44/9/6/1	59/1/–/–	56/4/–	40/20/–	7/53	47/13/–
COVID-19 cohort: shortly after delivery (n = 60)
Total score	6 [3, 13]	3 [0, 7]	3 [0, 5]	10 [7, 15]	19 [18, 20]	5 [5, 6]
Score groups	34/13/11/1	53/6/–/–	52/3/4	41/16/2	5/54	46/11/2
p-value between cohorts at baseline	.042	.492	.365	.918	.288	.977
2015 cohort: at 12 months (n = 42)
Total score	3 [1, 5]	4 [1, 8.5]	3 [1, 7]	11 [8, 15]	16 [12, 18]	6.5 [5, 9]
Score groups	36/4/–/–	36/4/1/–	37/1/2	27/15/–	13/29	21/21/–
COVID-19 cohort: at 12 months (n = 50)
Total score	5 [2, 7]	5 [1, 9]	2.5 [1, 6]	11 [8, 15]	18 [15, 20]	5 [5, 8]
Score groups	38/8/4/–	44/3/2/1	45/2/3	33/17/–	10/37	32/13/4
p-value between cohorts at 12 months	.011	.773	.635	.888	.014	.190
Within cohorts comparisons
2015 cohort p-value between time points	.026	.003	.054	.554	<.001	.030
COVID-19 cohort p-value between time points	.042	.492	.365	.918	.288	.977

Abbreviation: IQR, interquartile range.

^aBeck Anxiety Inventory: 0–7/8–15/16–25/26–63.

^bBeck Depression Inventory-II: 0–13/14–19/20–28/29–63.

^cEdinburgh Postnatal Depression Scale: 0–9/10–13/14–30.

^dPerceived Stress Scale-10: 0–13/14–26/27–40.

^eCouple Satisfaction Index: 0–13/14–21.

^fLife Satisfaction Scale-4: 4–6/7–11/12–20.

TABLE 3 Classification of questionnaire scores in mothers and in fathers after the birth and at 12 months

Variable	2015 cohort shortly after delivery (N = 60)a	COVID-19 cohort shortly after delivery (N = 60)a	2015 cohort at 12 months (N = 42)a	COVID-19 cohort at 12 months (N = 50)a
Anxiety, Beck Anxiety Inventory, scale 0–63
Mothers	5.5 [3, 12]	11.5 [5, 19]	3 [0.5, 4]	4 [2, 7]
Fathers	3 [1, 6]	4 [1, 6.5]	3 [1, 6]	5 [2.5, 7.5]
Depression, Beck Depression Inventory-II, scale 0–63
Mothers	3 [2, 5]	6 [2, 8]	7 [2, 11]	6 [2, 12.5]
Fathers	1 [1, 4.5]	1 [0, 4.5]	2 [1, .5]	2 [0.5, 6]
Depression, Edinburgh Postnatal Depression Scale, scale 0–30
Mothers	4 [2, 6]	3 [1, 6]	5 [1, 8]	4 [1, 5.5]
Fathers	2.5 [2, 5]	2 [0, 5]	3 [1, 5]	2 [1, 6]
Perceived stress, Perceived Stress Scale-10, scale 0–40
Mothers	12 [7.5, 16.5]	11 [7, 16]	12 [7.5, 16.5]	11 [8, 16]
Fathers	10.5 [8, 14]	9 [7.5, 12.5]	11 [9, 15]	10 [9, 14]
Life satisfaction, Life Satisfaction Scale-4, scale 4–20
Mothers	5 [5, 6]	5 [5, 7]	7 [5, 10]	5 [5, 8.5]
Fathers	5 [5, 6]	5 [5, 6]	6 [5, 9]	6 [5, 8]
Couple satisfaction, Couple Satisfaction Index, scale 0–21
Mothers	19.5 [15, 20]	20 [17, 21]	20 [17, 21]	18 [15, 20]
Fathers	19 [16, 20]	19 [18, 20]	19 [18, 20]	18 [15, 20]

^aData are median [interquartile range].

Anxiety was more common in parents during the COVID-19 pandemic 1–2 days and 12 months after delivery compared to the parents in 2015. Moderate or severe anxiety symptoms were recorded in 12 parents (10 mothers and 2 fathers) during the COVID-19 pandemic compared to seven parents (6 mothers and 1 father) 5 years earlier. Anxiety decreased during the COVID-19 pandemic, and at 12 months after delivery, four parents (2 mothers and 2 fathers) had moderate, and none had severe anxiety symptoms. A similar decrease in anxiety symptoms was also seen in the 2015 cohort; none of the parents had moderate or severe anxiety symptoms at 12 months after delivery.

The total scores for depressive symptoms were similarly low during the COVID-19 pandemic compared to those 5 years earlier. Shortly after delivery, six parents (5 mothers and 1 father) in the COVID-19 cohort had mild depressive symptoms compared to one father in the 2015 cohort assessed with the BDI-II. Depressive symptoms increased during the follow-up in both cohorts; at 12 months, six parents (5 mothers and 1 father) in the COVID-19 cohort and five parents (4 mothers and 1 father) in the 2015 cohort had depressive symptoms. However, no such increase was detected in the EPDS scores. Shortly after delivery, seven parents (6 mothers and 1 father) in the COVID-19 cohort had EPDS score of 10 or higher compared to four parents (2 mothers and 2 fathers) in the 2015 cohort, and at 12 months, five parents (4 mothers and 1 father) in the COVID-19 cohort and four parents (2 mothers and 2 fathers) in the 2015 cohort had EPDS score 10 or higher.

The parents experienced similar amounts of low psychological stress in both cohorts: the median PSS scores were 10 or 11 out of 40 1–2 days and 12 months after delivery. One-third of the parents had moderate or high stress in both cohorts. In the 2015 cohorts shortly after delivery, 12 mothers and eight fathers, and at 12 months, nine mothers and six fathers had moderate psychological stress symptoms. In the COVID-19 cohort shortly after delivery, 10 mothers and six fathers had moderate and two mothers had high psychological stress symptoms, and at 12 months, eight mothers and nine fathers had moderate psychological stress symptoms respectively.

Both cohorts were similarly satisfied with their relationship: seven parents (4 mothers and 3 fathers) in the 2015 cohort and five parents (3 mothers and 2 fathers) in the COVID-19 cohort had a CSI score of 13 or less shortly after delivery, indicating a distressed relationship. Couple satisfaction decreased in both cohorts during the follow-up; at 12 months after delivery, 13 parents (8 mothers and 5 fathers) in the 2015 cohort and 10 parents (5 mothers and 5 fathers) in the COVID-19 cohort reported a distressed relationship.

Parents of both cohorts were similarly satisfied with their life according to the LS-4 1–2 days and 12 months after delivery; no parents in the 2015 cohort and two mothers in the COVID-19 cohort were dissatisfied with their life. The proportion of parents who were satisfied with their life decreased and that of parents reporting intermediate satisfaction increased in both cohorts, and at 12 months after delivery, four parents (3 mothers and 1 father) in the COVID-19 cohort were dissatisfied with their life.

Spearman's correlation coefficients between previous mental health disorders and study parameters are listed in Table 4. Shortly after delivery, there was a weak positive correlation between previous mental health disorders and anxiety in the 2015 cohort and a moderate correlation in the COVID-19 cohort, but at 12 months, no correlation was found between these parameters.

TABLE 4 Spearman's correlation coefficients between previous mental health disorders and the mental health outcome 1–2 days and at 12 months after delivery

Variable	Spearman's correlation coefficient
	2015 cohort		COVID-19 cohort (N = 60)
	1–2 days (n = 60)	12 months (n = 42)	1–2 days (n = 60)	12 months (n = 50)
Beck Anxiety Inventory	0.214 (p = .101)	0.003 (p = .986)	0.408 (p = .001)	0.062 (p = .664)
Beck Depression Inventory-II	0.384 (p = .002)	0.203 (p = .203)	0.376 (p = .003)	0.332 (p = .018)
Edinburgh Postnatal Depression Scale	0.104 (p = .428)	0.379 (p = .016)	0.339 (p = .009)	0.203 (p = .158)
Perceived Stress Scale-10	0.390 (p = .002)	0.425 (p = .005)	0.372 (p = .004)	0.255 (p = .073)
Couple Satisfaction Index	−0.219 (p = .092)	−0.421 (p = .006)	0.013 (p = .919)	−0.123 (p = .408)
Life Satisfaction Scale-4	0.194 (p = .139)	0.345 (p = .025)	0.229 (p = .082)	0.298 (p = .038)

A post hoc sensitivity analysis demonstrated that the BAI, BDI-II and CSI scores were similar in the parents lost to follow-up (n = 28) compared to the other parents shortly after delivery. The parents lost to follow-up had slightly more depressive symptoms measured with the EPDS and perceived stress, and slightly lower life satisfaction shortly after delivery compared to those who also completed the 12-month questionnaires.

DISCUSSION

To the best of our knowledge, this is one of the first follow-up studies evaluating the impact of the COVID-19 pandemic on the mental health of both parents of healthy newborns. In the present study, half of the new parents had some anxiety, and in one out of five the anxiety was moderate or severe early after giving birth during the COVID-19 pandemic in May–June 2020. A novel finding was a moderate positive association between a history of previous mental health disorders and perceived postpartum anxiety. The prevalence and association were higher in 2020 compared to 5 years earlier in spring 2015. Our data support the study hypothesis: anxiety was higher than before the COVID-19 pandemic throughout the follow-up, even though it decreased in both cohorts. No such difference was found in the depressive symptoms scores, and perceived stress was similarly low in both cohorts, while couple satisfaction and life satisfaction were similarly high in the two cohorts, indicating ample parental resilience.

Based on our current knowledge, higher anxiety was expected, as pregnant and postpartum women are at increased risk of severe illness and death from COVID-19 compared to non-pregnant women. For example, the risk of a venous thromboembolism is over 20-fold higher compared with healthy non-pregnant women during the first 6 weeks postpartum, and it is assumed that COVID-19 may further increase the risk of thrombotic complications (American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics, 2018). Pregnant women with COVID-19 are also at risk of adverse pregnancy outcomes, such as preterm birth (Lokken et al., 2021; Papapanou et al., 2021). In addition, during the COVID-19 pandemic, the fear of the virus, isolation, physical distancing and the national lockdowns have caused a perceived sense of lacking control and can have substantial perceived mental health impacts on the entire family. Higher anxiety symptoms during the COVID-19 pandemic in early summer 2020 in the present study are consistent with recent findings in pregnant and postpartum women (Effati-Daryani et al., 2020; Farewell et al., 2020; Guvenc et al., 2021; Hessami et al., 2020; Lebel et al., 2020; Wu et al., 2020). After the birth of a child, the importance of social support increases. During the COVID-19 restrictions, new parents might not have been able to receive much support from closed ones, and may therefore have been more prone to anxiety.

Consistently to a recent systematic review of studies in pregnant and postpartum women (Iyengar et al., 2021), despite the continuation of the COVID-19 pandemic, anxiety symptoms decreased during the 12-month follow-up, similar to the 2015 cohort, indicating sufficient parental resilience (Isokääntä et al., 2019). Possible reasons for this are that information about the novel virus increased and prevention and treatment guidelines, as well as vaccinations, were developed during the follow-up period. Furthermore, experiencing some symptoms measured with the BAI shortly after delivery could also be more connected to the delivery itself or the medications used rather than psychological anxiety.

Since the outbreak of COVID-19, multiple studies have been published about COVID-19 and perinatal women, but less attention has been paid to perceived mental health impacts on fathers and couples as a dyad. We believe that the entire family should be taken into consideration, since fathers and siblings may have similar concerns to pregnant women and new mothers. Pregnancy and delivery during the COVID-19 pandemic are assumed to have had substantial psychological impacts on mental health, parenting, relationships, family and marital life (Stamu-O'Brien et al., 2020).

In the present study, there was a moderate positive association between previous mental health disorders and parental anxiety shortly after delivery during the COVID-19 pandemic. This is contradictory to findings reported by the general population. Some recent studies (Liu et al., 2021; Pan et al., 2021) have demonstrated that the COVID-19 pandemic may more profoundly influence people without previous mental health disorders, whereas individuals with a medical history of mental health issues may experience less exacerbation of their symptoms. Even though these findings should be confirmed in further studies throughout the COVID-19 pandemic, we believe that this highlights the need for additional support for parents and the entire family during the pandemic, especially those with previous mental health disorders.

Depressive symptoms were similar in our two study populations when evaluated with the BDI-II and EPDS questionnaires. However, depressive symptoms increased in both cohorts when measured with the BDI-II but not with the EPDS. One possible reason might be that the EPDS was developed to measure maternal depression and might not detect paternal symptoms as well (Cox et al., 1987). Further studies should focus on both parents before and after delivery, and larger study populations are recommended so that a proper comparison of paternal and maternal outcomes can be achieved.

Our study findings are consistent with some previous studies on depressive symptoms in pregnant and postpartum women during the COVID-19 pandemic (Effati-Daryani et al., 2020; Stojanov et al., 2021). However, we observed a lower prevalence of depressive symptoms compared to others (Ayaz et al., 2020; Baran et al., 2021; Lebel et al., 2020; Matsushima et al., 2021; Wu et al., 2020). Several factors may explain this discrepancy. First, systematic reviews that include women in the postnatal period often also include pregnant women. Moreover, our data were obtained from both parents. Second, one systematic review and meta-analysis (Shorey et al., 2021) concluded that depressive symptoms might be more common in the prenatal than the postnatal period, which might cause the prevalence to be higher in studies that include both pregnant women and new mothers. Third, a systematic review and meta-analysis by Hessami et al. (2020) concluded that the EPDS scores during the COVID-19 pandemic were similar compared to the non-pandemic scores. Both reviews and meta-analyses also acknowledged that there was high heterogeneity in the included studies. Nonetheless, our study group completed the first set of questionnaires shortly after delivery, which is often a time filled with great happiness over the newborn that might overturn negative feelings. Finally, depressive symptoms might be connected to the number of suspected infections, newly confirmed cases of COVID-19 and deaths per day (Wu et al., 2020), which in Finland were relatively low in 2020 and increased in 2021.

In this study, no difference existed between parents of healthy newborns in 2015 and 2020 in perceived stress and life satisfaction. Couple satisfaction and life satisfaction decreased during the follow-up in both cohorts, but median scores still indicated satisfaction with life. Social support from the spouse and active coping strategies, such as endorsing self-care, are major buffers from anxiety, stress and depression, which support life satisfaction (Effati-Daryani et al., 2020; Lebel et al., 2020; Werchan et al., 2022). Couple satisfaction and life satisfaction were similarly high in the two cohorts shortly after delivery, which is consistent with other research on the life satisfaction of parents in the perinatal period (Aasheim et al., 2014) and during the COVID-19 pandemic (Chaves et al., 2021).

Although pregnancy and delivery cause multiple stressors for couples, it appears that the birth of a child has a generally positive effect on overall parental life satisfaction. The first year with a child can be challenging, and those parents with low resilience might have difficulties in maintaining couple satisfaction and life satisfaction. Nevertheless, most parents appear to have ample resilience and receive social support from each other (Yu et al., 2020). Active coping strategies, such as high levels of self-care and social support, can ease distress and help in dealing with anxiety and depression, especially during the pandemic (Werchan et al., 2022). Even though people are generally resilient, supporting those with a lower adjustment capacity can help the well-being of the entire family (Davis et al., 2021; Kinser et al., 2021; Werchan et al., 2022).

Limitations

The main limitation of our study is the relatively small sample size: there were 60 parents and 30 couples in each cohort. However, these two cohorts had similar background characteristics, and they were collected at the same time of the year and 5 years apart. Thus, other major societal changes than the outbreak of the COVID-19 pandemic were unlikely. We, therefore, assume that our data are soundly based. Second, the COVID-19 pandemic in Finland was under better control in 2020 compared to 2021 and was less severe than in some other countries. Thus, these findings should be generalized with caution to other countries experiencing a more widespread epidemic. Third, we used self-reported questionnaires and individuals could understand the questions differently. Nevertheless, the questionnaires used are validated screening tools, and the translations have been properly approved, which improves the overall validity of the questionnaire scores. Moreover, self-administered questionnaires are less prone to interviewer bias in studies of this kind where sensitive issues are evaluated. Couples were asked to complete the questionnaires independently and concurrently. However, using the data of each individual within a couple may break the statistical independence rule required for some of the hypothesis testing hence results may not be robust.

CONCLUSIONS

Our data indicate that new parents had higher anxiety shortly after delivery during the COVID-19 pandemic in 2020 compared to a similar sample from 2015. Parenteral anxiety decreased during the 12-month follow-up in both cohorts but was still higher during the COVID-19 pandemic than earlier. No such difference existed between the two cohorts in depressive symptoms, perceived stress, couple satisfaction or life satisfaction shortly after delivery, which may indicate sufficient resilience in parents, even during the COVID-19 pandemic. The first year with a child might pose challenges to some, even without the global pandemic, as we observed depressive symptoms to increase and couple satisfaction and life satisfaction to slightly decrease during the 12-month follow-up. Healthcare professionals should identify families at risk of persistent psychiatric symptoms and those with mental health disorders to support resilience and the well-being of the entire family.

RELEVANCE TO CLINICAL PRACTICE

The COVID-19 pandemic is an ongoing source of psychiatric symptoms for some new parents. Healthcare providers should systemically screen for psychiatric symptoms in both parents during and after the perinatal period, especially during stressful global situations such as the COVID-19 pandemic. Acknowledging the variation in psychiatric symptoms across countries and phases of the pandemic is essential in providing families with appropriate counselling, support and follow-up.

WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?

• During the COVID-19 pandemic, some parents with a newborn have suffered from increased psychiatric symptoms compared to pre-pandemic levels. Health care providers should screen for these symptoms in both parents and the entire family in pregnancy follow-up visits, perinatal care and child health clinics.
• Contrary to the general population, previous mental health disorders were associated with higher anxiety symptoms in new parents. Healthcare providers should detect families at risk of persistent symptoms and provide additional support for parents and the entire family during the COVID-19 pandemic and similar threats.
• The COVID-19 pandemic has decreased social support and made it less available for some families. Healthcare providers can seek online social connection groups for families and enable them to connect with other families in a similar situation.

AUTHOR CONTRIBUTIONS

IT, KK, HK and MK developed the study concept and design. KK, HK and MK applied for the official approvals, and MK is the principal investigator and supervisor to the project. SI, IT, SP, KT, HK and MK collated the data. Data were entered, analysed and interpreted by SI, IT, SP, KT, KK, HK and MK. SI primarily composed the manuscript, and others provided critical revisions. All authors approved the final version of the manuscript.

FUNDING INFORMATION

This work was supported by Olvi Säätiö, Iisalmi, Finland (grant number 201720396); Hengityssairauksien tutkimussäätiö, Helsinki, Finland under Grant in 2021; Finnish Cultural Foundation, North Savo Regional fund, Helsinki, Finland under Grant in 2021; Oskar Öflunds Stiftelse sr, Helsinki, Finland under Grant in 2021 to SI.

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.