Article Summary: COVID-19 and Maternal Mental Health

By Laura Madlinger Lewis

Mask up. 6 feet. Stay at home. Isolation. Essential workers. Wash hands. Quarantine. PPE. Unprecedented times. Transmission. 14 days. Contact tracing. Social distancing. Lock down. Community spread. Super spreader. New cases. Flatten the curve. Contactless.

The rapid spread of COVID-19 throughout the world has affected our lives drastically. Since the start of the pandemic, experts have predicted that the incidence of mental health problems would significantly increase, and that vulnerable populations will be disproportionately affected. Postpartum depression and anxiety affect approximately 1 in 7 mothers, though numbers are likely under-reported, and it is well established in the literature that having an infant in the NICU is a risk factor for perinatal mood disorders.

Researchers from the University of Alberta recently published a paper entitled Moms Are Not Ok: COVID-19 and Maternal Mental Health. Their study sought to evaluate the effects of the COVID-19 pandemic on mental health in pregnant women, and women who had delivered within the past year.

The study participants (n=900) completed an online survey which included questionnaires on self-reported levels of depression/depressive symptoms (Edinburgh Postnatal Depression Survey; EPDS), anxiety (State-Trait Anxiety Inventory), and physical activity. Participants reported current and pre-pandemic values for each. Results demonstrated 15% of participants had an EPDS score indicative of depression before the pandemic, and this number increased to 40.7% of participants currently. Additionally, moderate to high anxiety identified via the State-Trait Anxiety Inventory was present in 29% of participants pre-pandemic, and 72% of participants currently.

The study also found that mothers who engaged in at least 150 minutes of moderate physical activity per week during the pandemic had significantly lower anxiety and depression scores.

As the title of the article states, moms are not ok. Although this study was not specific to NICU moms, we as neonatal therapists recognize that NICU moms (and dads) are definitely not ok. Public health measures including social distancing and stay-at-home orders, while necessary to prevent the spread of COVID-19, may result in more limited access to the NICU for families. Limited access to their baby has negative impacts on the health of both parent and child. This study serves as an important tool to continue the conversation about maternal mental health in the NICU during the pandemic.

So, what can we as neonatal therapists do in the midst of isolation, social distancing, and unprecedented times to help mitigate a family’s risk for depression and anxiety?

An article that was recently published in the Journal of Perinatology calls for increasing support for families in the NICU during the pandemic by emphasizing basic well-being strategies to families, increasing on-site or virtual access to mental health professionals and virtual peer support, capitalizing on the role of fathers/partners in supporting mothers, considering assessment of baseline mental health in NICU families, and optimizing family-centered developmental care opportunities (Erdei & Liu, 2020).

As neonatal therapists we can focus on:

*Knowing the signs – does a mom (or dad) seem less engaged, nervous, present with flat affect, or report not eating or sleeping well? Are they irritable? Tearful? Expressing feelings of guilt?

*Making referrals – to your unit’s social worker or other mental health professional, to their OB/GYN provider, or to local resources.

*Striving for connection – assist families with interacting with their babies, use video chat or other forms of communication approved by your NICU regularly, and facilitate families meeting other families virtually. Some great resources for helping parents connect to others are listed below. Remember to ask them how they are doing. And then listen!

Additional Resources:

Hand to Hold – virtual support groups

Postpartum Support International – virtual support groups, connections to local resources

Davenport, M., Meyer, S., Meah, V., Strynadka, M., & Khurana, R. (2020). Moms are not ok: COVID-19 and maternal mental health. Frontiers in Global Women’s Health 19 June 2020. Click here for the full text article.

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