Pregnant Women Report More Depression, Anxiety Symptoms During COVID-19 Pandemic
A recently published study found that pregnant women reported more distress and psychiatric symptoms during the COVID-19 pandemic than pregnant women did before the pandemic, mainly depression and anxiety symptoms.
"The present findings would call for the rapid implementation of clinical and public health strategies targeting particularly pregnant women with a history of psychiatric disorder and a modest income," researchers wrote in the study.
Below, researcher and author Nicolas Berthelot, PhD, describes the study, possible clinical applications, and future research on the topic.
What led you and your colleagues to conduct this research?
We are currently conducting a study on the impacts of early life adversity on pregnancy and offspring development. At the beginning of the pandemic, we quickly realized that the indicators of psychological distress we were measuring in our ongoing cohort of pregnant women would be momentarily inflated by the stress caused by the pandemic and associated public health measures to limit the propagation of the virus. As researchers in maternal mental health and developmental psychopathology, we were well aware that such an increase in psychological distress may be harmful to the mother, the fetus and eventually the child, since anxiety and depression during pregnancy have been associated with negative outcomes such as offspring psychopathology, alterations in brain development, and poorer socioemotional and cognitive development. However, mental health was not considered as a priority at the beginning of the pandemic, and pregnant women were not considered a particularly vulnerable population. We thus decided to recruit, promptly, a new cohort of pregnant women during the pandemic, using the same instruments we were using in our pre-COVID cohort, to evaluate the extent to which the pandemic affected pregnant women’s mental health.
Please briefly describe your study and its findings.
We contrasted two large cohorts of pregnant women from the general population, one assessed before and the other during the COVID-19 pandemic, by using the same measurements. We observed important differences in the levels of depressive and anxiety symptoms between the 2 cohorts, as well as a modest increase of trauma-related symptoms, such as dissociative symptoms and post-traumatic stress symptoms, during the pandemic. Women who were pregnant during the pandemic were almost twice as likely as women who were pregnant prior to the pandemic to report depressive and anxiety symptoms that were so severe that a diagnosis of depression or anxiety disorder would have probably be confirmed by a psychiatrist. The uptrend of psychological distress and psychiatric symptoms was not better explained by confounding factors such as age, gestational age, household income, education, and lifetime psychiatric disorders.
Were any of the outcomes particularly surprising?
We were expecting such outcomes. What is surprising, considering the known repercussions of prenatal distress on mothers and offspring, is the fact that pregnant women’s mental health is not prioritized worldwide during the pandemic. We conducted the study to highlight the importance of intervening promptly with this population.
What are the possible near-term applications of these findings in clinical practice?
Physicians and clinicians should inquire about symptoms of depression and anxiety in their patients, and particularly in pregnant women. They should do their best to answer their questions and inquire about specific worries they might have regarding the effect of COVID-19 on pregnancy and fetal development.
Since most women are already informed that psychological distress may have negative impacts on pregnancy and fetal development, clinicians should intervene in a way that will contribute to diminishing self-blame (for instance, in reflecting that it is normal to be anxious in such circumstances), and orient toward positive strategies that could contribute to mitigating psychological distress (such as relaxation, or focusing on things they can control).
Different forms of telehealth assistance to women with elevated psychological distress, such as toll-free helplines to answer pregnant women’s questions and online psychological support, should be implemented.
Are you conducting any other studies on this topic?
We developed a prenatal program for pregnant women exposed to childhood trauma aiming to promote the physical and mental health of the participants, promote the psychosocial development of their child, and intercept the intergenerational trajectories of childhood trauma. We will offer this program online during the pandemic to mitigate psychological distress in pregnant women who experienced difficult life events prior to the pandemic.
We are also conducting new sets of analyses on the same cohorts of women to evaluate risk and protective factors that would offer targets for intervention.
In the next weeks, the participants will complete again the same measures to evaluate whether psychological distress was normalized by the attenuement of social distancing measures and the diminution observed in the propagation of the virus in Canada.
Nicolas Berthelot, PhD, is a clinical psychologist and professor in the department of nursing sciences at the University du Québec à Trois-Rivières in Canada. He is a regular researcher at the Center for Interdisciplinary Studies on Child and Family Development, the CERVO Brain Research Centre, the Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse, and the Research and Intervention Group on Vulnerable and Neglected Children. He is co-leading a longitudinal research program, STEP: Supporting the Transition to and Engagement in Parenthood, aiming to understand the mechanisms of risk and resilience involved in the intergenerational trajectories of childhood traumas. With his team, he developed one of the first prenatal accompaniment programs specifically intended for expectant parents with a history of trauma.