Researchers from Brigham and Women’s Hospital recently surveyed pregnant women and those who had recently given birth, finding concerning rates of depression, generalized anxiety, and post-traumatic stress disorder (PTSD) symptoms, which were found to be exacerbated by coronavirus disease 2019 (COVID-19)-related grief and health worries.

“We know the perinatal period is already a time in which women are particularly vulnerable to mental health concerns,” said corresponding study author Cindy Liu, PhD, of the Department of Pediatric Newborn Medicine and the Department of Psychiatry, in a press release. “We primarily wanted to see what factors related to the pandemic might be associated with mental health symptoms.”

The researchers launched the Perinatal Experiences and COVID-19 Effects Study to better understand the mental health and well-being of pregnant and postpartum individuals within the United States during the COVID-19 pandemic, according to the study authors.

Among 1123 women surveyed between May 21 and August 17, 2020, the researchers found that more than 1 in 3 reported clinically significant levels of depression. Before the pandemic, rates of perinatal depression were generally considered to be 15% to 20%. Further, 1 in 5 reported clinically significant levels of generalized anxiety, and 1 in 10 reported symptoms above the clinical threshold for PTSD.

The researchers discovered that approximately 9% of participants reported feeling a strong sense of grief, loss, or disappointment as a result of the pandemic. Additionally, the group was roughly 5 times more likely to experience clinically significant measures of mental health symptoms. More respondents reported being “very worried” or “extremely worried” about COVID-19-related health risks and were up to 4 times more likely to experience clinically significant psychiatric symptoms, according to the study authors.

Participants were recruited from the PEACE survey primarily via word-of-mouth, using posts on email lists and in social media groups. As a result, the sample population was fairly homogenous, with 89.9% being white, 92.1% at least college educated, and 98% living with their spouse or partner. The household income for 45% of the participants was more than $150,000.

“People who are working from home, who have maternity leave, or who simply have the time to do a survey like this are disproportionately white and well-off,” Liu said in a press release. “That is a limitation to this work. Through a survey, we can get in-depth information very quickly, but we are missing the perspectives of various important segments of the population.”

Using standardized measures for evaluating COVID-19-related health worries and experiences of grief, the researchers wanted to look for associations that informed what clinical providers can do to better support families during this time.

“We wanted to know what is being taken away when a new mother is not able to participate in the usual rituals around birth and welcoming a new family member,” said study co-author Carmina Erdei, MD, of the Department of Pediatric Newborn Medicine, in a press release. “The survey responses offer valuable insight into that and help guide what we as health care professionals can do better.”

The researchers were also able to examine how previous mental health diagnoses, as self-reported by the respondents, affected these rates. They found that those with pre-existing diagnoses were 1.6 to 3.7 times more likely to have clinically significant measures of the 3 conditions analyzed. However, elevated psychiatric distress was observed in participants regardless of their mental health histories.

The qualitative data gathered through the survey have also provided the team with striking insights into the perinatal experience, but these findings have not yet been analyzed systematically, according to the study authors. The researchers noted that the mental health experiences of those surveyed match what they observed clinically during the early months of the pandemic, when many of the usual perinatal supports, such as assistance from a partner, family member, or peer group, were limited due to fears surrounding COVID-19 infection risks and halting of support services.

“Obstetric practices weren’t able to screen for mental health symptoms as well, all while people’s mental health was under the most pressure,” said study co-author Leena Mittal, MD, of the Department of Psychiatry, in a press release. “Mental health supports have persisted and come back in new ways, and the amount of innovation surrounding delivering group and individual care, especially using virtual platforms, is phenomenal. On the psychiatry side of things, we have never been busier, and individuals and families who feel they need mental health care should seek it.”

REFERENCE
COVID-19 may deepen depression, anxiety, and PTSD among pregnant and postpartum women. Brigham and Women’s Hospital. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3743. Published December 1, 2020. Accessed December 2, 2020.