Lockdown is taking a toll on the mental health of pregnant women

According to a study published recently in the Social Psychiatry and Psychiatric Epidemiology journal, and conducted by a team of researchers at the Alan J Flisher Centre for Public Mental Health at the University of Cape Town (UCT), the COVID‑19 lockdown is taking a toll on the mental health of pregnant women living in low‑resource settings.

Pregnant women attending 14 healthcare facilities in Cape Town were enrolled in the study. Data on their socio‑demographic information, presence of common mental disorders (CMD), experiences of psychological distress, food insecurity and domestic violence were collected.

Of the 885 women enrolled in the Health System Strengthening in Sub Saharan Africa (ASSET) study, the team found that 12% of them had probable CMD and 43% were severely food insecure. Psychological distress increased significantly during the lockdown period, compared with before the pandemic. While they did not find an increase in women who felt suicidal, significantly more women reported feeling anxious and depressed.

“We found that the risk of CMD was almost three times greater in women who were severely food insecure.”

“We found that the risk of CMD was almost three times greater in women who were severely food insecure, or who experienced psychological or sexual abuse. Importantly, we found strong associations between certain risk factors (having more than four pregnancies or a previous miscarriage or stillbirth, experiencing increased crime in the community, decreased income or less food in the household, severe food insecurity, or any form of abuse) and psychological distress during the lockdown,” said the lead researcher, Dr Zulfa Abrahams.

“We found that the proportion of women experiencing psychological distress during the lockdown was higher than those who were distressed at their first clinic visit. While the lack of a control group makes it difficult to draw strong conclusions about the effect of the lockdown on symptoms of depression and anxiety, evidence from a longitudinal study in the same population indicates that symptoms of depression detected early in pregnancy tend to abate during the course of pregnancy and the first year of the baby’s life.”

However, Dr Abrahams added that their findings “indicate the opposite, namely an increase in [the] prevalence of psychological distress. As there were no other significant societal level events during this period that may have contributed to such an increase, we believe there is some support for the hypothesis that it was due to the lockdown.”

Increased risk

The study also found that being severely food insecure doubled the odds of CMDs during the lockdown, and that 80% of participants reported experiencing various levels of food insecurity.

During April and May 2020, when South Africa was at alert Level 4 and Level 5 of the lockdown, all non‑essential services were halted. This resulted in high levels of unemployment, affecting the most vulnerable workers, who were low‑skilled and less educated.

“In our already vulnerable group of perinatal women living in low‑resource settings, we found that more than 40% were severely food insecure.”

Six weeks into the lockdown, Statistics South Africa, using an online survey, found that 4.3% of respondents reported experiencing hunger during the month prior to the lockdown, while 7% experienced hunger during the lockdown.

Abrahams said this is likely being under‑reported as those living in poverty and experiencing hunger would be unlikely to have access to a web‑based survey.

“In our already vulnerable group of perinatal women living in low‑resource settings, we found that more than 40% were severely food insecure.

“This translates to 40% of perinatal women living in households where they were eating fewer meals than needed, lacked the resources to acquire more food, went to sleep hungry or went a whole day and night without eating,” she added.

They also found that the risk of CMDs was almost three times greater in women experiencing psychological or sexual abuse, even though the prevalence of domestic abuse was quite low.

“We found that 15% of participants reported experiencing psychological abuse, 14% reported experiencing physical abuse and less than 2% reported experiencing sexual abuse,” said Abrahams.

“Our findings highlight how a crisis such as the lockdown amplified the psycho‑social risk factors associated with CMDs in perinatal women.”