A total of 6,894 women from 64 countries took part in the anonymous online survey, which was led by researchers at Harvard T.H. Chan School of Public Health. Significant numbers of the women scored at or above the cutoffs in widely used psychological screening tools for elevated levels of anxiety and/or depression (31%), loneliness (53%), and post-traumatic stress in relation to COVID-19 (43%). This was despite the fact that only 117 women (2%) had been diagnosed with COVID-19. Just 510 (7%) had been in contact with someone who had been diagnosed with COVID-19.
A Closer Look at the Study
The study found that poorer mental health was linked to certain factors and behaviors. For instance, seeking information about the pandemic five or more times a day was associated with more than twice the odds of elevated post-traumatic stress in relation to COVID-19 and anxiety/depression. Other significant factors were worries about children and childcare and financial pressures. The majority of women reported taking COVID-19 prevention measures (for instance, 93.3% reported practicing hand hygiene and 84.5% reported wearing a face covering). However, these behaviors were not associated with anxiety or depression symptoms. Study author Archana Basu, PhD, research scientist of Harvard’s department of epidemiology, says the team expected to see a larger proportion of women reporting mental health symptoms, relative to the non-pandemic period. Basu explains, “This would be an expected reaction in the pandemic particularly for pregnant and postpartum women, who are likely to be worried or have questions about their babies’ health and development, in addition to their own or their family’s health." However, Basu points out that the proportion of women with significantly elevated symptoms of PTSD and depression/anxiety related to the pandemic was much larger than what had previously been published during the pandemic.
Uncertainty and Isolation
“Once COVID-19 hit, women were no longer able to share their pregnancies with their families and friends—what is usually a time of excitement and celebration became one of fear and isolation,” says reproductive and perinatal psychiatrist Carly Snyder, MD, who is director of women’s health for Family Health Associates. Because pregnant people had to self-quarantine and be extremely careful, given how potentially serious COVID-19 infection can be while pregnant, they weren’t able to enjoy the positive reinforcement often experienced during pregnancy. “For a period, women weren’t sure if they would have a partner or other source of support during labor and delivery, and this caused significant anxiety and unhappiness,” Snyder says. The postpartum period is difficult, and many new moms feel isolated during this time. But COVID-19 added another layer, Dr. Snyder says, due to the inability to have grandparents, friends, and other sources of support around to help with the newborn. “Women were extremely hesitant about going outside with a new baby and ended up stuck indoors much of the time, which can be very stressful and can feel stifling,” she explains.
A Disproportionate Burden of Stress on Women
Board-certified psychiatrist and neurologist Elisabeth Netherton, MD, who specializes in women’s mental health issues and the psychiatric treatment of women and men before, during and after the birth of a baby, isn’t surprised by the findings. “We know that women have carried, and are carrying, a disproportionate burden of stressors during COVID-19,” she says. “In the United States, women are overrepresented in essential jobs, overrepresented in job loss/reduced income during the worst months of the pandemic, have struggled with homeschooling children while working from home themselves, and continue to be more likely to carry a higher burden of childcare and housework for their households.” Additionally, women are navigating these stressors with more social isolation and less household assistance. And for women who are carrying pregnancies during this time, all of these stressors coexist with fear that they, the baby, or their family might contract COVID-19, and reduced family support in medical appointments and delivery. “Overall, women are facing much more stress with less access to means to cope with that stress,” Netherton says. “We are hearing about these difficulties from our patients and it’s really quite heartbreaking.”
The Far-Reaching Impact of Perinatal Stress
It’s well-known that high levels of stress during pregnancy have the potential to impact the baby. “While we really can’t pinpoint specific outcomes for specific pregnancies (where we see an outcome in a particular baby and we know it’s because that baby’s mother was under stress), we do know that across the larger population stress in pregnancy is associated with a host of negative pregnancy outcomes, including preterm birth, lower birth weight babies, and complications with delivery,” Netherton explains. She adds that stress during pregnancy is also likely associated with negative neurodevelopmental outcomes for the child, such as ADHD and mood and anxiety disorders. “Clinically significant postpartum mood symptoms reduce the rate of breastfeeding, may negatively impact bonding and attachment, often hinder maternal self-care, and may make it difficult for mom to care for her baby,” says Snyder. “Furthermore, suicide is a leading cause of death postpartum, so it is imperative that maternal mood disorders are identified and treated.”
Change Is Needed
“In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as 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,” Basu says. She adds that public health campaigns and medical care systems need to explicitly address the impact of COVID-19 related stressors on mental health in perinatal women. “Prevention of viral exposure itself does not mitigate the pandemic’s mental health impact,” she says. Netherton highlights the fact that mothers often have a very difficult time accessing mental health care, especially during the pregnancy and postpartum period. It can also be hard for women (and their OB providers) to locate mental health providers who are comfortable treating pregnant or breastfeeding women, or who have experience in the challenges these women face. “If women are able to access mental health care at all, they are often left to find new providers during pregnancy,” Netherton reveals. “Aside from the waiting lists to see these providers, a downside of this system is that women are left seeking care from providers with whom they don’t have a prior relationship or as much time to build trust. These providers might be far away and in many cases might not be able to follow them after the immediate postpartum period," says Netherton. For these reasons, part of improving mental health care for mothers should include improving provider education about treating pregnant and postpartum women and to develop accessible lines of care that are wellness rather than illness-focused to treat women across their lifespan, from young adulthood through menopause, she adds. The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
