ABSTRACT
The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes.
ABSTRACT
The novel COVID pandemic has had a substantial impact on global mental health, including those populations that are inherently vulnerable such as pregnant and postpartum (perinatal) women. Anxiety disorders (ADs) are the most common mental health disorders during the perinatal period, affecting up to one in five women. However, since the onset of the pandemic, up to 60% of perinatal women are experiencing moderate to severe levels of anxiety. Given the substantial increase in perinatal anxiety during COVID, we sought to better understand its phenomenology by characterizing the collective worry content and impact of COVID using a content analysis. Eighty-four treatment-seeking pregnant (n = 35) and postpartum (n = 49) women with a principal AD, participated in this study between April and October 2020. In addition to completing questionnaire measures and a semistructured diagnostic interview, participants were asked to (1) describe their top excessive and uncontrollable worries, (2) describe additional COVID and non-COVID worries, and (3) describe how the pandemic had affected their lives. All responses were given verbally and transcribed verbatim by assessors. A content analysis led to the emergence of various COVID and non-COVID worry and impact themes. One third of participant's principal worries were specific to COVID, and 40% of COVID worries were specific to the perinatal context. Understanding the worry content and impact of COVID may improve symptom detection and inform the development of targeted treatment strategies to support the mental health needs of perinatal women with ADs throughout the pandemic and thereafter. Understanding pandemic-specific worries is important for perinatal symptom screening and may allow for the development of targeted treatment strategies to address COVID-specific worries and impact.