A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic

Abstract

Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic. An anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies (https://corona.pregistry.com) and advertised in social media channels and online parenting forums. Participants completed measures on demographics, COVID-19 exposure and worries, information seeking, COVID-19 prevention behaviors, and mental health symptoms including posttraumatic stress via the IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions of women scored at or above the cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source (e.g., social media, news, talking to others) five or more times per day was associated with more than twice the odds of elevated posttraumatic stress and anxiety/depression, in adjusted models. A majority of women (86%) reported being somewhat or very worried about COVID-19. The most commonly reported worries were related to pregnancy and delivery, including family being unable to visit after delivery (59%), the baby contracting COVID-19 (59%), lack of a support person during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries related to children (i.e., inadequate childcare, their infection risk) and missing medical appointments were associated with significantly higher odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to mental health symptoms or loneliness. Elevated posttraumatic stress, anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum women across 64 countries during the COVID-19 pandemic. Excessive information seeking and worries related to children and medical care are associated with elevated symptoms, whereas engaging in hygiene-related preventive measures were not. In addition to screening and monitoring mental health symptoms, addressing excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness (e.g., online support groups) should be part of intervention efforts for perinatal women. Public health campaigns and medical care systems need to explicitly address the impact of COVID-19 related stressors on mental health in perinatal women, as prevention of viral exposure itself does not mitigate the pandemic’s mental health impact.

Psychological Impact of the COVID-19 Pandemic on Pregnant Women: A Scoping Review

“…A survey of pregnant women and postpartum women during the pandemic, showed that 40% of participants suffered from post-traumatic stress disorder and around 70% suffered from depression and/or anxiety following the onset of the new virus [ 62 ]. It is also in line with the results found in a systematic review that summarized the increase of mental disorders in pregnant women caused by this pandemic [ 63 ]. In contrast, previous studies have shown a prevalence of depression lower than 60% [ 43 , 45 , 55 ].…”

Association Between Serious Psychological Distress and Loneliness During the COVID-19 Pandemic: A Cross-Sectional Study with Pregnant Japanese Women

“…A recent large-scale international survey of pregnant women revealed that about half of the women reported increased feelings of loneliness during the COVID-19 pandemic. 12 In a study of the Spanish population during the initial stage of the COVID-19 pandemic, loneliness was correlated with depression, anxiety, and post-traumatic stress disorder. 13 Social support has been identified as a major protective factor against negative mental health outcomes resulting from natural disasters and pandemics, 14 , 15 and recent evidence suggests that it is also associated with lower mental health symptoms in pregnant women during the COVID-19 pandemic.…”

Loneliness and Depressive Symptoms among Pregnant Black Women during the COVID-19 Pandemic

“…Women who reported higher levels of loneliness also reported higher levels of perceived stress and depressive symptoms. Similarly, loneliness was related to stress and depressive symptoms during the COVID-19 pandemic among pregnant women (Basu et al, 2021;Perzow et al, 2021). Health care providers should recommend pregnant women to talk with family and friends (e.g., phone calls, FaceTime, Zoom), maintain a healthy lifestyle (e.g., walking outside while maintaining social distance, getting quality sleep, healthy diet), and participate in virtual support groups for pregnant women.…”

“…Research about loneliness during the pandemic is limited among pregnant women. In a sample of 6,894 pregnant and postpartum women from 64 countries who completed an online survey in May-June 2020 (18% from North America, 8% Black, no data on how many pregnant Black women from the United States), 54% of women had high levels of loneliness (Basu et al, 2021). In a study with 135 pregnant women from Colorado (n = 15 Black), higher levels of loneliness were associated with increased depressive symptoms during the COVID-19 pandemic (data collection April-May 2020) (Perzow et al, 2021).…”