The current coronavirus disease 2019 (COVID-19) pandemic has caused severe disruptions in social and economic interactions, affecting health services and other important aspects of human life. Until the start of the Omicron wave (B.1.1.529), COVID-19 had already had a staggering impact on the world, with over 40% of the world’s population already infected once by mid-November 2021. COVID-19 has wreaked havoc on mental health, with cases of anxiety and depression increasing by more than 25% globally, according to the WHO. Additionally, statistical evidence shows that COVID-19 has had a more severe effect on women’s mental health than men’s, according to data from the Global Burden of Disease.
Write in the journal reproductive health, two researchers examine the unexpected impact of the virus on maternal mental health. Factors contributing to such stresses include the implementation of non-pharmaceutical interventions (NPIs) such as lockdowns and social distancing, which have deprived many important means of interaction with other people; loss of family or loved ones with resulting mental, emotional and often financial hardship; the infection itself with the resulting loss of physical and mental health; and job loss. Coupled with the continuing lack of clarity about what the future would look like, it’s not hard to see why this pandemic has resulted in symptoms of poor mental health for many people.
Study: Uncovering the collateral impacts of COVID-19 on maternal mental health. Image Credit: fizkes/Shutterstock
The perinatal period is already known to be a period of high risk for depression, anxiety and psychosis or reactivation of mental disorders. In fact, new mothers are 22 times more likely to be admitted for a psychiatric illness than the same cohort before pregnancy. In addition, mental illness increases the risk of preterm birth, poor mother-infant bonding, and delayed cognitive development in infants.
Self-injurious tendencies are also common at this time among depressed women, affecting at least one in five. In total, perinatal mental illness is the most common disorder of the peripartum period, affecting mothers and babies in up to one-fifth of pregnancies. This figure has probably doubled, at least, according to recent research conducted in Asian and Western countries.
It appears that certain NPIs have been the cause of a significant number of mental illnesses, particularly among those at risk. While people already living on the edge experienced limitations in movement, loss of jobs, and a reduced ability to seek support from family or friends, financial stress played an additive role to the fear already present. to get infected and get sick or die.
Add to that the stress of bereavement and loneliness, and burnout in many people-facing professions, and you have a recipe for anxiety and depression. Domestic violence occurred when many families spent all their time together under conditions of uncertainty and stress. At the same time, mental health services were less available than before, while stressed people could not seek relief through the usual means such as going out to spend time with family, friends or neighbours.
Virtual interactions have multiplied but have not been able to compensate for all these deprivations. Many scientists have pointed out that pregnant women at risk and those already suffering from mental stress and poor health suffer from the lack of mental health services, while online consultations have not always had healthy results. In addition, pregnant women are often reluctant to take antidepressants, even on prescription.
The stigma of mental illness is another powerful factor that interferes with the accessibility of care. Meanwhile, reproductive services have been severely restricted during the pandemic, leading to increased stress for infertile women. Women of low socioeconomic status, including the poor, uneducated, unemployed and single, have been hardest hit.
Notably, in low- and middle-income countries (LMICs), 85% of people in need of mental health services, including those with substance abuse, mental illness or neurological illness, have been cut off from needed care due to lack of mental care. health workers, whose deficit is estimated at nearly 1.2 million. In many of these countries, there is less than one worker per 100,000 people.
The study authors stress the need for governments to work closely with voluntary organizations, communities and health care organizations to improve mental health care for pregnant women. Given that mental health care receives only about 2% of an already meager health budget, greater investment is needed.
More workers in this area need to be recruited and trained, especially in the LMICs. Virtual consultations can help reduce the shortage of workers in the meantime, although a hybrid model may work best. Better laws and programs are needed to raise the ranking of mental health care among other needs in times of health crisis, such as the Comprehensive Mental Health Action Plan 2013-2030.
Efforts to reduce the stigma of mental illness should leverage the acceptability and reach of social media, as has been pioneered for example by Facemums, a Facebook service run by midwives, to support women pregnant at the start of the UK lockdown.
International efforts are being made by WHO, other non-governmental organizations and voluntary agencies such as the Red Cross or Red Crescent, to integrate mental health support into mainstream health responses to COVID -19. Again, the Maternal Mental Health Alliance (MMHA) in the UK comprises over 100 organizations that have come together to provide good mental health care on a reliable basis to many women during the peripartum period.
Pregnant healthcare workers need extra support, as burnout is a common problem in this field and can lead to suicidal thoughts. These staff may need to be reassigned to less traumatic roles, and remote work may be the best solution in such cases. They should also have priority access to professionals who can support their mental health.
“Social vulnerabilities in society are intimately linked to the social determinants of health. Practical measures that promote equity, social justice and a shift in the balance of power and resources could improve the abysmal state of maternal mental health around the world.”
In conclusion, urgent action is needed to address the significant decline in maternal mental health observed since the start of the COVID-19 pandemic. It is essential to increase mental health funding, reduce social vulnerabilities and promote a greater presence of community organizations in order to combat this formidable threat.