A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health

Abstract

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries’ Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period—with an infant aged up to 6 months—who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Global prevalence of perinatal depression and anxiety during the COVID‐19 pandemic: An umbrella review and meta‐analytic synthesis

“…11 The different prevalence rates observed among continents might be attributed to several groups of factors: (a) COVID-19-related variables, like restrictions imposed by governments to limit the contagion, or the impact of COVID-19 infection in terms of mortality and contagion rates; (b) and cultural differences. 51 F I G U R E 5 Forest plot of the pooled prevalence (proportion) of postnatal anxiety.…”

Estimates of Sensitivity and Specificity of Serological Tests for SARS-CoV-2 Specific Antibodies Using a Bayesian Latent Class Model Approach

“…Differences in the provision of care between countries was evident. The best-case scenario estimation of mental healthcare for clinically significant comorbid symptoms of depression and anxiety was 21.6% in Brazil, a country with one of the highest containment and health index (i.e., composite measure based on governmental responses to COVID-19 pandemic indicators, for details see 44 ) among the countries in study 5 and with a high proportion of women reporting that mental healthcare is very important (66%, Supplementary Table 2), a key factor for seeking help. 17 These gaps in mental healthcare may be due to disruptions in antenatal or postnatal mental healthcare during the COVID-19 pandemic, 8 which may have led to either lack of systematic screening and/or referral and/or lack of access to treatment for women screened positive for perinatal mental health problems.…”

“…2,4 The estimates of clinically significant symptoms of anxiety (GAD-7 ≥ 10) reaches 30% during pregnancy and 20% in the postpartum in the pre-pandemic vs 36% during pregnancy and 42% in the postpartum in the COVID-19 pandemic in studies conducted in Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom. 2,5 The estimates of recent systematic reviews and of a study conducted in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom, indicated that clinically significant symptoms of depression and anxiety is around 6.3% during pregnancy and 5.7% postpartum, in the pre-pandemic period vs 15% during pregnancy and 20% in the postpartum in the COVID-19 pandemic. 2,6,7 Despite the high rates of perinatal mental health problems, especially in countries with lower inequality-adjusted human development index 5 during the COVID-19 pandemic, more than 60% of antenatal or postnatal mental healthcare services of 130 countries were disrupted.…”

“…2,5 The estimates of recent systematic reviews and of a study conducted in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom, indicated that clinically significant symptoms of depression and anxiety is around 6.3% during pregnancy and 5.7% postpartum, in the pre-pandemic period vs 15% during pregnancy and 20% in the postpartum in the COVID-19 pandemic. 2,6,7 Despite the high rates of perinatal mental health problems, especially in countries with lower inequality-adjusted human development index 5 during the COVID-19 pandemic, more than 60% of antenatal or postnatal mental healthcare services of 130 countries were disrupted. 8 During the pre-pandemic period, it was estimated that about 1 in 2 pregnant women with a major depressive episode received mental health treatment in the United States of America, 9 1 in 4 women with clinically significant symptoms of depression or anxiety in the postpartum period had consulted a health professional, and 37% had unmet needs in mental healthcare in Canada.…”

Social distancing and mental health among pregnant women during the coronavirus pandemic

“…Previous outbreaks and pandemics show the deleterious effects of social isolation [13,14], and such isolating behaviors have been intensely stressful for many people. However, evidence is contradictory: at least one study suggests that more stringent government containment measures were associated with better mental health among pregnant women [15], while others find higher COVID-19 restrictions to be associated with more stress and worse mental health [16]. In this study, we examined how various types of social distancing were associated with mental health and stress in a sample of pregnant women.…”