Stress, coping and silver linings: How depressed perinatal women experienced the COVID-19 pandemic

COVID-19 Public Health Restrictions and New Mothers' Mental Health: A Qualitative Scoping Review

Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.

Sleep and Mood Among Women With Histories of Depression When They Used a Responsive Infant Bassinet During the COVID-19 Pandemic

OBJECTIVE

To describe the experiences of women with histories of depression who used a responsive infant bassinet during the first 6 months after birth during the COVID-19 pandemic.

DESIGN

Secondary qualitative descriptive study with analytic expansion.

SETTING

United States.

PARTICIPANTS

Women (N = 139) who gave birth up to 6 months previously and had histories of depression.

METHODS

We used Kyngäs's method of inductive content analysis to analyze 109 open-ended responses that were collected between August 2020 to November 2021 as part of a previously conducted longitudinal study of women who used a responsive bassinet.

RESULTS

Most participants indicated that the responsive bassinet improved their infants' sleep, which, in turn, subjectively improved their sleep and mood. External stressors and challenges presented barriers to good sleep for the participants and their infants, and participants described how these challenges contributed to their symptoms related to mood. When participants reported that they used the responsive bassinet, they shared that their infants were swaddled in the supine sleep position. Participants who did not use the bassinet commonly reported unsafe sleep practices. We identified seven themes from the data: Improved Maternal Sleep Quality, Barriers to Good Maternal Sleep, Mood and Sleep Go Hand and Hand, External Stressors Impair Mood, Improved Infant Sleep Quality, Barriers to Good Infant Sleep, and Safe Sleep Positioning.

CONCLUSION

These findings can be used to inform clinicians on how a responsive bassinet may offer women at high risk for postpartum depression improved sleep and instrumental support. Future researchers should use validated measures to objectively evaluate rates of postpartum depression and sleep quality in high-risk women when using a responsive bassinet.

Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being

BACKGROUND

It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping.

METHODS

We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021.

RESULTS

The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%).

CONCLUSION(S)

Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.

Natural environments, psychosocial health, and health behaviors in a crisis - A scoping review of the literature in the COVID-19 context

The COVID-19 outbreak led to major restrictions globally, affecting people's psychosocial health and their health behaviors. Thus, the purpose of this scoping review was to summarize the available research regarding nature and health in the COVID-19 context. Keywords relating to natural environments and COVID-19 were combined to conduct a systematic online search in six major databases. Eligibility criteria were a) published since 2020 with data collected in the COVID-19 context b) peer-reviewed, c) original empirical data collected on human participants, d) investigated the association between natural environments and psychosocial health or health behaviors, and e) English, German, or Scandinavian languages. Out of 9126 articles being screened, we identified 188 relevant articles, representing 187 distinct studies. Most research focused on adults in the general population and was predominantly conducted in the USA, Europe, and China. Overall, the findings indicate that nature may mitigate the impact of COVID-19 on psychological health and physical activity. Through a systematic thematic analysis of the extracted data, three primary themes were identified: 1) type of nature assessed, 2) psychosocial health and health behaviors investigated, and 3) heterogeneity in the nature-health relationship. Research gaps in the COVID-19 context were identified regarding I) nature characteristics that promote psychosocial health and health behaviors, II) investigations of digital and virtual nature, III) psychological constructs relating to mental health promotion, IV) health-promoting behaviors other than physical activity, V) underlying mechanisms regarding heterogeneity in the nature-health relationship based on human, nature, and geographic characteristics, and VI) research focusing on vulnerable groups. Overall, natural environments demonstrate considerable potential in buffering the impact of stressful events on a population level on mental health. However, future research is warranted to fill the mentioned research gaps and to examine the long-term effects of nature exposure during COVID-19.

Scoping Review of Racial and Ethnic Representation of Participants in Mental Health Research Conducted in the Perinatal Period During the COVID-19 Pandemic

OBJECTIVE

To identify the racial and ethnic representation of participants in mental health research conducted in the perinatal period during the COVID-19 pandemic.

DATA SOURCES

MEDLINE, CINAHL, Cochrane Library, PsycINFO, Scopus, Web of Science.

STUDY SELECTION

We included peer-reviewed research articles in which researchers reported mental health outcomes of women during the perinatal period who were living in the United States or Canada during the COVID-19 pandemic. We included 25 articles in the final review.

DATA EXTRACTION

We extracted the citation, publication date, design, aim, country of origin, participant characteristics, sampling method, method of measurement of race and ethnicity, and mental health outcome(s).

DATA SYNTHESIS

The combined racial and ethnic representation of the 16,841 participants in the included studies was White (76.5%), Black (9.8%), other/multiracial (6.2%), Asian (3.9%), Hispanic/Latina (2.6%), Indigenous or Ethnic Minority Canadian (0.9%), and Native American or Alaska Native (0.1%). Most studies were conducted in the United States, used a cross-sectional design, and incorporated social media platforms to recruit participants. Depression, anxiety, and stress were the most frequently assessed mental health outcomes.

CONCLUSION

Relatively few women of color who were pregnant or in the postpartum period during the pandemic participated in mental health research studies. Future studies should develop intentional recruitment strategies to increase participation of women of color. Researchers should use updated guidance on reporting race and ethnicity to accurately represent every participant, minimize misclassification of women of color, and report meaningful results.

Impact of COVID-19 Related Maternal Stress on Fetal Brain Development: A Multimodal MRI Study

BACKGROUND

Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined.

METHODS

Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using multivariate models.

RESULTS

Increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity).

CONCLUSIONS

We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Impact of COVID-19 related maternal stress on fetal brain development: A Multimodal MRI study

Background

Disruptions in perinatal care and support due to the COVID-19 pandemic was an unprecedented but significant stressor among pregnant women. Various neurostructural differences have been re-ported among fetuses and infants born during the pandemic compared to pre-pandemic counterparts. The relationship between maternal stress due to pandemic related disruptions and fetal brain is yet unexamined.

Methods

Pregnant participants with healthy pregnancies were prospectively recruited in 2020-2022 in the greater Los Angeles Area. Participants completed multiple self-report assessments for experiences of pandemic related disruptions, perceived stress, and coping behaviors and underwent fetal MRI. Maternal perceived stress exposures were correlated with quantitative multimodal MRI measures of fetal brain development using ltivariate models.

Results

Fetal brain stem volume increased with increased maternal perception of pandemic related stress positively correlated with normalized fetal brainstem volume (suggesting accelerated brainstem maturation). In contrast, increased maternal perception of pandemic related stress correlated with reduced global fetal brain temporal functional variance (suggesting reduced functional connectivity).

Conclusions

We report alterations in fetal brainstem structure and global functional fetal brain activity associated with increased maternal stress due to pandemic related disruptions, suggesting altered fetal programming. Long term follow-up studies are required to better understand the sequalae of these early multi-modal brain disruptions among infants born during the COVID-19 pandemic.

Parenting stress, maternal depression and child mental health in a Melbourne cohort before and during the COVID-19 pandemic

AIM

This paper aims to examine the maternal and child mental health and parenting outcomes in the context of COVID-19 pandemic conditions using a sample from Melbourne, Australia - a city exposed to one of the longest lockdowns world-wide in response to the pandemic.

METHODS

This study utilises observational data from a prospective, pregnancy cohort, Mercy Pregnancy Emotional Wellbeing Study and includes 468 women and their children followed up in Melbourne to 3-4 years postpartum pre-COVID pandemic and compared to those followed up during the COVID-19 pandemic.

RESULTS

When compared to mothers followed up at 3-4 years postpartum pre-pandemic, those followed up during the COVID-19 pandemic showed higher depressive symptoms with a steep incline in their symptom trajectory (EMM_difference  = 1.72, Bonferroni-corrected P < 0.01, d = 0.35) and had a three times higher risk of scoring 13 or above on the EPDS (aRR = 3.22, Bonferroni-corrected P < 0.01). Although this increase was not associated with the variation in the duration of exposure to pandemic conditions, the steep increase in depressive symptoms was more pronounced in those with pre-existing depressive disorders. There was no difference in parenting stress or adjusted childhood mental health symptoms or disorder.

CONCLUSIONS

Our findings highlight the vulnerability of those with pre-existing clinical mental health disorders and the need for adequate clinical care for this vulnerable group. Equally, our study indicates the possibility that  parenting and early childhood mental health outcomes, at least in the short term, may be resilient.

A Review Study on the Trends of Psychological Challenges, Coping Ways, and Public Support During the COVID-19 Pandemic in the Vulnerable Populations in the United States

Background

The COVID-19 pandemic resulted in significant mortality and morbidity in the United States. The mental health impact during the pandemic was huge and affected all age groups and population types. We reviewed the existing literature to understand the present trends of psychological challenges and different coping strategies documented across different vulnerable sections of the United States population. This rapid review was carried out to investigate the trends in psychological impacts, coping ways, and public support during the COVID-19 pandemic crisis in the United States.

Materials and Methods

We undertook a rapid review of the literature following the COVID-19 pandemic in the United States. We searched PubMed as it is a widely available database for observational and experimental studies that reported the psychological effects, coping ways, and public support on different age groups and healthcare workers (HCWs) during the COVID-19 pandemic.

Results

We included thirty-five studies in our review and reported data predominantly from the vulnerable United States population. Our review findings indicate that COVID-19 has a considerable impact on the psychological wellbeing of various age groups differently, especially in the elderly population and HCWs. Review findings suggest that factors like children, elderly population, female gender, overconcern about family, fear of getting an infection, personality, low spirituality, and lower resilience levels were at a higher risk of adverse mental health outcomes during this pandemic. Systemic support, higher resilience levels, and adequate knowledge were identified as protecting and preventing factors. There is a paucity of similar studies among the general population, and we restricted our review specifically to vulnerable subgroups of the population. All the included studies in our review investigated and surveyed the psychological impacts, coping skills, and public support system during the COVID-19 pandemic.

Conclusion

The evidence to date suggests that female gender, child and elderly population, and racial factors have been affected by a lack of support for psychological wellbeing. Further, research using our hypothesized framework might help any population group to deal with a pandemic-associated mental health crisis, and in that regard, analysis of wider societal structural factors is recommended.

Preliminary Effectiveness of mHealth App-Based Pelvic Floor Muscle Training among Pregnant Women to Improve Their Exercise Adherence: A Pilot Randomised Control Trial

This pilot randomised control trial (RCT) aimed to evaluate the feasibility and preliminary effectiveness of conducting a full-powered trial for a newly developed pelvic floor muscle training (PFMT) app among pregnant women with urinary incontinence (UI) in Malaysia. This was a prospective, single-centre, single-blind, parallel, randomised controlled, pilot feasibility study—the Kegel Exercise Pregnancy Training app (KEPT app) trial. In total, 26 pregnant women with urinary incontinence from an urban healthcare clinic were recruited and randomly assigned to either intervention or waitlist control group. The intervention group received the KEPT app, while the control group received usual antenatal care (waitlist control). Of the 26 pregnant women, 16 (61.5%) completed the two-month follow-up. The recruitment rate was 54.2%, and the retention rate was 62.5% in the intervention group and 60% in the control group. There was a significant difference between intervention and control groups’ baseline measurement in the severity of UI (p = 0.031). The app improved their knowledge (p = 0.011) and self-efficacy (p = 0.038) after the first month and attitude (p = 0.034) after two months of intervention, compared with the control group. This study supports the feasibility of our future cluster RCT. The KEPT app demonstrates a promising effect in improving PFMT attitude and self-efficacy and potentially enhancing exercise adherence among pregnant women with UI. Trial registration: This study was prospectively registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433).

Experiences of Perinatal Mental Health Care among Minority Ethnic Women during the COVID-19 Pandemic in London: A Qualitative Study

(1) Background: Approximately one in five women will experience mental health difficulties in the perinatal period. Women from ethnic minority backgrounds face a variety of barriers that can prevent or delay access to appropriate perinatal mental health care. COVID-19 pandemic restrictions created additional obstacles for this group of women. This study aims to explore minority ethnic women's experiences of perinatal mental health services during COVID-19 in London. (2) Methods: Eighteen women from ethnic minority backgrounds were interviewed, and data were subject to a thematic analysis. (3) Results: Three main themes were identified, each with two subthemes: 'Difficulties and Disruptions to Access' (Access to Appointments; Pandemic Restrictions and Disruption), 'Experiences of Remote Delivery' (Preference for Face-to-Face Contact; Advantages of Remote Support); and 'Psychosocial Experiences' linked to COVID-19 (Heightened Anxiety; Social Isolation). (4) Conclusions: Women from ethnic minority backgrounds experienced disrupted perinatal mental health care and COVID-19 restrictions compounding their mental health difficulties. Services should take women's circumstances into account and provide flexibility regarding remote delivery of care.