Study: COVID-19 stress is worsening depression, anxiety in pregnant and postnatal women

COVID-19 related grief and health worries have exacerbated the rates of depression, generalized anxiety and post-traumatic stress disorder (PTSD) symptoms in pregnant women and those who have recently given birth, according to new research by Brigham and Women's Hospital, which was published in the journal Psychiatry Review.

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

The findings in this US-based study echo the experience of many perinatal in the UAE, says Dr Rose Logan, clinical psychologist at The Lighthouse Arabia. “The pandemic has created some very specific challenges that might otherwise not be present for women,” says Dr Logan. “I think for some women this has precipitated or worsened mental health concerns.”

A sense of loss

The researchers launched the Perinatal Experiences and COVID-19 Effects Study (PEACE) to better understand the mental health and well-being of pregnant and postpartum individuals during the COVID-19 pandemic.

Among 1,123 of these women surveyed between May 21 and August 17, 2020, the researchers found that more than 1-in-3 (36.4 percent) reported clinically significant levels of depression. Before the pandemic, rates of perinatal depression (depression occurring during or soon after pregnancy) were generally considered to be 15-20 per cent. Furthermore, 1-in-5 (22.7 per cent) reported clinically significant levels of generalized anxiety, and 1-in-10 (10.3 per cent) reported symptoms above the clinical threshold for PTSD.

In particular, the researchers found that approximately 9 per cent of participants reported feeling a strong sense of grief, loss, or disappointment as a result of the pandemic. This group was roughly five times more likely to experience clinically significant measures of mental health symptoms. More respondents (18 percent) reported being "very worried" or "extremely worried" about COVID-19-related health risks. This group was up to over four times more likely to experience clinically significant psychiatric symptoms.

Perinatal women are having a similar experience in the UAE, according to Dr Rose Logan, clinical psychologist at The Lighthouse Arabia. She says: “I have actually been running an online support group for pregnant women and the main themes that are discussed are; loss (no family, not being able to celebrate and share their news as anticipated, loss of choices in their medical care such as if their husband cannot be present and water births not being allowed), adjustment (changing plans, having to be flexible to things not being as they planned), anxiety, isolation, and uncertainty. I would say loss is almost the overarching theme."

The importance of raising awareness

For Dubai-based pregnant mother-to-be Andrea*, the lack of social interaction that has come about as a result of the pandemic has been one of the most challenging aspects of expecting a baby during this period. “Being pregnant, especially for the first time, is a sensitive episode in anyone’s life, and not being able to socially engage yourself as much as you need, and not being able to get the support you need and want, can be a little bit challenging.”

She says that, although she has pregnant friends who had a more relaxed approach to socializing and seeing family who have gone on to have healthy pregnancies and babies, she and her husband do not want to expose themselves to any unnecessary risks.

It’s therefore never been more important to raise awareness of maternal mental health issues, so that partners can be aware if the mother may be in need of some help, and in order to highlight the tools and services that are available to support women. “Having a newborn can be anxiety-provoking anyway, as understanding and constantly providing for a baby's needs is often overwhelming,” says Pashmi Khare, MSc, PCOS and infertility support specialist at Thrive, which has a dedicated maternal mental health facility at its wellbeing centre in Dubai.

“One of the most important pillars of support for new mothers is the social support (or help from external agencies, especially for expats without extended families in Dubai),” adds Khare. “With the Covid-19 crisis, the precautionary social isolation and self-quarantine, new mothers are losing that support at the moment. This can trigger or strengthen self-doubt, guilt of not being able to do everything as planned or expected, or even resentment towards the partner. The uncertainty of how long it can go can make things much worse.”

Could you be suffering from perinatal anxiety or depression?

Symptoms of perinatal mood disorders such as anxiety or depression can include, “constantly worrying about the pregnancy or baby's wellbeing, feeling on-edge, having a sense of dread, difficulty concentrating or racing thoughts, or engaging in behaviours or rituals to try and reduce negative thoughts, such as constantly checking the baby’s breathing throughout the night,” says Siobhan Miller, founder of The Positive Birth Company. If you think you may be affected here are some strategies that may help…

Seek out an online community

If you don't feel comfortable meeting up in person then nvestigate dedicated post-natal groups and communities with people going through similar experiences. Out of the Blues is an active UAE-based Facebook group dedicated to those suffering from pre and postnatal depression (or any kind of depression and anxiety) and is full of advice, links to free resources and many UAE-based women in the same boat who are able to offer advice and support or just a listening ear at all hours of the day and night.

Swap WhatsApp for video chat

It sounds obvious, but it is always best to seek advice, comfort and support from friends and family, says Tanya Dharamshi of The Priory Wellbeing Centre in Dubai. “While physical contact is not currently an option for most, it’s vital that new parents find alternative ways and means to communicate,” – and WhatsApp texts alone don’t cut it. Research shows that video chatting fosters greater bonding and emotional benefits than either audio phone chats or instant messages like WhatsApp, in that order. Schedule regular video catch-ups with friends and loved ones.

Schedule Me-time

It’s easier said than done, but when your mental health is on line it’s really important to prioritise scheduling some regular time - no matter how limited - to focus on yourself and no-one else. “Whether it’s having a relaxing bath, reading a book, or doing some exercise in another room,” says Tanya Dhramshi of The Priory. “Just 15 mins of time away from everything and everyone can do wonders for your mental health.”

Make a Self-care NEST

A regular routine (as much as is permitted by infants if you have a newborn) with a focus on self-care based on NEST-S principles (Nutrition, Exercise, Sleep, Time for Self, Supports) is key, says Ryan Van Lieshout, Canada Research Chair in the Perinatal Programming of Mental Disorders, McMaster University. He says this can begin with taking a shower daily, changing out of Pjs into daytime clothes and opening all the blinds since these can really jump start the day, but also prioritise regular hydration (especially if breastfeeding), wholesome nutrition and sleep as much as possible (try sharing the nightfeeds with your partner if you can – there’s no medal to be had for doing it all yourself, rather it’s responsible and brave to ask for help rather than suffer in silence).

Set goals for small wins

“Pick one thing, doesn’t have to be a big task, but something that you can complete,” says The Priory’s Dharamshi. “This will provide a sense of accomplishment and purpose for the day.” Pashmi Khare from Thrive adds: “One of my clients mentioned to me how frustrated she feels for not having done anything in the last few weeks. So we started noting down what she did during this time and it turned out to be quite a list of accomplishments that made her feel happy or motivated in the moment, but remained hidden when she looked at her weeks in an overview. The reason was that she had many other things on her to do list that she was not able to finish. She expected too much from herself and the long (undone) to do list made the accomplishments look very small.” Whether it’s putting the washing on, eating a good breakfast or messaging a friend back, identify achievable goals that you can tick off.

Do breathing exercises

Relaxation techniques like box breathing, a breathing technique that helps manage stress, and progressive muscle relaxation can benefit mothers who are struggling with anxiety or are feeling overwhelmed.

Talk to your partner

“You’re meant to be a team, so share your worries and concerns as a couple and discuss how you can help and support each other to get through this challenging time,” says Tanya Dharamshi of The Priory Wellbeing Centre in Dubai.

Seek professional support

Many health professionals are providing virtual support and counselling, making help more available and reducing the barriers. Check out Thrive, The Priory, The LightHouse Arabia, Dubai Community Health Centre and The Psychiatry and Therapy Centre Dubai to find psychologists, counsellors and psychatrists based in the UAE who come recommended and are offering online services.