A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic

Abstract

Background Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021; Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress. Methods As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms. Results Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes. Conclusions This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.

A propensity score matching study: The prevalence of mental health problems among pregnant women at first antenatal care increased in Chongqing during the first wave of the COVID-19 pandemic

“…For instance, a multicenter network study reported that 32% of Chinese pregnant women had depression (PHQ-9 ≥ 10) or anxiety (GAD-7 ≥ 5) during the COVID-19 pandemic (39). Jones et al reported that anxiety and depression might have affected more than half of perinatal women during the first national lockdown in England (40). A multi-country network cross-sectional study in Europe reported that 15 and 11% of pregnant women had moderateto-severe depressive symptoms (Edinburgh Depression Scale ≥ 13) and generalized anxiety symptoms (GAD ≥ 10) (26).…”

Nutrition-Related Experiences of Women With Perinatal Depression During the COVID-19 Pandemic: A Qualitative Study

“…In other studies, mothers were not able to rely on family because of distance, 52 and this separation caused distress. 53…”

Addressing inequalities in the identification and management of perinatal mental health difficulties: The perspectives of minoritised women, healthcare practitioners and the voluntary sector

“…Being trauma-informed emphasises the importance of psychological safety, choice and control ( 31 ). Perinatal research conducted in the pandemic illustrates that the pandemic has been a time where people's psychological safety, choice and control have been diminished ( 34 ).…”