• Simone N Vigod, Hilary K Brown, Anjie Huang, Kinwah Fung, Lucy C Barker, Neesha Hussain-Shamsy, Elisabeth Wright, Cindy-Lee Dennis, Sophie Grigoriadis, Peter Gozdyra, Daniel Corsi, Mark Walker, and Rahim Moineddin.
• Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont. simone.vigod@wchospital.ca.
• CMAJ. 2021 Jun 7; 193 (23): E835-E843.

BackgroundIt is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns.MethodsIn this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March-November 2020 based on prepandemic data (January 2016-February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics.ResultsIn March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25-4.89) and an IRR of 1.08 (95% CI 1.03-1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14-12.6) and IRR (1.30, 95% CI 1.24-1.36) were higher; this level was generally sustained through November 2020. From April-November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0-90 days postpartum compared with 91-365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November.InterpretationIncreased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses.© 2021 CMA Joule Inc. or its licensors.

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