Cumulative effects of pre-pandemic vulnerabilities and pandemic-related hardship on psychological distress among pregnant individuals.

OBJECTIVE: Our primary objective was to determine whether pre-existing vulnerabilities and resilience factors combined with objective hardship resulted in cumulative (i.e., additive) effects on psychological distress in pregnant individuals during the COVID-19 pandemic. A secondary objective was to determine whether any of the effects of pandemic-related hardship were compounded (i.e., multiplicative) by pre-existing vulnerabilities. METHOD: Data are from a prospective pregnancy cohort study, the Pregnancy During the COVID-19 Pandemic study (PdP). This cross-sectional report is based upon the initial survey collected at recruitment between April 5, 2020 and April 30, 2021. Logistic regressions were used to evaluate our objectives. RESULTS: Pandemic-related hardship substantially increased the odds of scoring above the clinical cut-off on measures of anxiety and depression symptoms. Pre-existing vulnerabilities had cumulative (i.e., additive) effects on the odds of scoring above the clinical cut-off on measures of anxiety and depression symptoms. There was no evidence of compounding (i.e., multiplicative) effects. Social support had a protective effect on anxiety and depression symptoms, but government financial aid did not. CONCLUSION: Pre-pandemic vulnerability and pandemic-related hardship had cumulative effects on psychological distress during the COVID-19 pandemic. Adequate and equitable responses to pandemics and disasters may require more intensive supports for those with multiple vulnerabilities.

Fear of COVID-19, mental health, and pregnancy outcomes in the pregnancy during the COVID-19 pandemic study: Fear of COVID-19 and pregnancy outcomes.

BACKGROUND: Sustained fear during pregnancy has the potential to increase psychological distress and obstetric risk. This study aimed to (1) identify factors and characteristics associated with fear of COVID-19, (2) investigate the relationship between fear of COVID-19 and maternal anxiety and depression, and (3) determine the relationship between fear of COVID-19 and pregnancy outcomes. METHODS: 9251 pregnant Canadians were recruited between April - December 2020. Participants self-reported (scale of 0-100) the degree of threat they perceived from the SARS-CoV-2 virus in relation to themselves and their unborn baby. RESULTS: Mean fear scores indicated moderate to elevated concern. In multivariable linear regression, fear of COVID-19 was associated with food insecurity, ethnicity, geographic location, history of anxiety prior to pregnancy, having a chronic health condition, pre-pregnancy BMI, parity, and stage of pregnancy at study enrollment. Higher COVID-19 fear was associated with increased odds of depression, adjusted odds ratio (aOR) = 1.75, p < 0.001, 95% CI 1.66-1.85, and anxiety, aOR=2.04, p < 0.001, 95% CI 1.94-2.15). Furthermore, fear of COVID-19 was associated with a 192-gram reduction in infant birthweight, and a 6.1-day reduction in gestational age at birth. LIMITATIONS: The sample has higher education compared to the Canadian population and cannot test causal effects. CONCLUSION: This study suggests that sociodemographic, health, and obstetric factors may contribute to increased fear of COVID-19 and associated adverse psychological and pregnancy outcomes.

Surveying providers to identify gaps in perinatal mental health services during the COVID-19 pandemic

Objectives: In Canada, an estimated 20% of women experience perinatal mental illness. Rates are elevated during the COVID-19 pandemic. Poor mental health affects expectant and new parents’ overall emotional and physical well-being, and has consequences for children, families, and society. Services currently available to those experiencing perinatal mental illness in Canada are largely inadequate and issues are magnified during COVID-19. This presentation offers findings from the Canadian Perinatal Mental Health Collaborative survey, which examines gaps in perinatal mental health service delivery. Methods: We conducted a cross-sectional online survey of Canadian perinatal health care providers. Providers (N=405) were recruited via social media. Results: The majority of providers (87%) do not have mandated screening for perinatal mental illness at their workplace. When women are screened and have symptoms indicative of needing intervention, 61% of providers reported wait times of 1-12 months for services. Mental health services provided are disparate across health regions. Half (50%) reported that they have not received specialized training in perinatal mental illness. Providers identified significant barriers in service provision, with language and/or lack of culturally-appropriate counselling services being cited by 87%. Providers reported that COVID-19 has complicated access to care, including reduced in-person visits and overall services. Conclusions: The survey findings underscore a critical need for anational perinatal mental health strategy to address gaps in screening and treatment. Obstetricians and other perinatal care providers should integrate screening for mood disorders into routine practice while systemic changes are required to ensure accessible and culturally safe treatment of perinatal mental illness across Canada.