On average, the Women’s Mental Health Program at the University of Arkansas for Medical Sciences treats two cases of postpartum psychosis in a year, but over the course of the pandemic, UAMS team members saw nine.
Postpartum psychosis is not to be confused with postpartum depression, which is comparatively common. Nationally, approximately 150 out of 1,000 new mothers will experience postpartum depression, while postpartum psychosis affects 1 out of 1,000 mothers. Postpartum psychosis can develop within four weeks of giving birth and can include feelings of paranoia or irritability, aggressive behaviors, hallucinations and hyperactivity.
“It is very recognizable when present,” says Dr. Jessica Coker, the medical director of the Psychiatric Research Institute’s women’s inpatient unit at UAMS. “The patients are typically very, very ill. Family members see it first usually. They’re not sleeping, paranoid and can be very irritable.”
When Coker and Erin Bider, M.D., a fourth-year resident in the UAMS College of Medicine’s Department of Psychiatry, recognized the dramatic increase in postpartum psychosis statistics between March 2020 and February 2021, they began to review five years of patient records in an effort to determine if such a spike in cases was out of the ordinary. Together they wrote a paper for the Archives of Women’s Mental Health medical journal about a possible correlation between the increase in postpartum psychosis cases and the pandemic.
Eight of the nine mothers exhibiting symptoms required inpatient psychiatric hospitalization due to their severity. Three of them tested positive for COVID-19 prior to the onset of psychosis, but all were asymptomatic.
“We can safely say that the pandemic was associated with a higher risk for postpartum psychosis,” Bider says. “We think that the stress of the pandemic, combined with being isolated from their families and friends, contributed to their psychosis.”
One of Coker’s patients began exhibiting postpartum psychosis symptoms shortly after giving birth and was admitted to the Psychiatric Research Institute’s women’s inpatient unit.
“She wasn’t sleeping, saying bizarre things to her family,” Coker says. “She was paranoid about anyone caring for her baby but herself. She was very disorganized and aggressive, which is typical of postpartum psychosis.”
The patient’s symptoms greatly improved after two weeks in the hospital, where Coker says the ability to sleep and rest made a huge difference. Stress related to childbirth, she adds, even in a non-pandemic setting, is something that should be taken seriously.
“It’s always something that you should be aware of, stress causes bad things to happen.”
Bider thinks this trend should be a wake-up call for women and their families about how much support new mothers need.
“We should always be asking these questions regardless of whether we’re having a pandemic or not,” Bider says. “We need to recognize a problem before it becomes full-blown psychosis.”