Our team is the only clinical translational research group focused on perinatal mood and anxiety disorders (PMADs) in Puerto Rico.  For our work, we define perinatal as pregnancy and the postpartum period (up to when the child is 24 months old). While there are no currently identified prevalence rates of PMADS in Puerto Rican mothers, clinical experience and the determinants of health that affect women in Puerto Rico place them at a higher risk of mental health disorders. In particular, for Puerto Rican mothers, the past years have been riddled with disaster related trauma. In addition to an economic recession and a Zika epidemic, Puerto Rico (PR) was devastated by two major hurricanes in 2017 and recently suffered from a sequence of earthquakes. Puerto Rican mothers are also disproportionately exposed to other risk factors for PMADs. For example, Puerto Rican mothers had higher rates of adverse obstetric outcomes with the cesarean section birth rate at 47% of births and premature birth rate at 11.5%. The maternal mortality rate in PR for 2016 was 31.9 deaths for each 1,000 live births. The rates of domestic violence in PR are also staggering with 6,725 cases reported in 2019. Puerto Rican women also have a higher probability of being the head of a household under poverty level. In addition, being a woman is a known risk factor for depression and anxiety disorders as can be seen by the differential rates of mental health disorders prevalence in PR (22.1% in women versus 15.1% in men). Isolation has also been documented as a risk factor for depression during the postpartum period. It is therefore, of extreme importance, to evaluate the effect that the COVID-19 epidemic has had on this very vulnerable population of women in the perinatal period.

The first case of COVID-19 was reported in Puerto Rico on March 13, 2020 and two days later on March 15, 2020, a shelter-in-place/lock-down order for Puerto Rico was established.

Suicide rates have been consistently decreasing in Puerto Rico, but a small spike was seen in the months after Hurricane Maria. We do know that there has been an increase in calls to the mental health hotline Linea Pas. During the first weeks of the pandemic, there was an average of 400 more calls than usual but in the week of April 27th to May 1st there was an average increase in calls of 540. This increased usage of the hotline seems to suggest that the COVID-19 pandemic has negatively affected the mental health of Puerto Ricans.