Pregnant and postpartum women report elevated depression, anxiety, and post-traumatic stress during COVID-19 pandemic

For immediate release: Wednesday, April 21, 2021

Boston, MA – In a worldwide survey, pregnant and postpartum women reported high levels of depression, anxiety, loneliness, and post-traumatic stress during the COVID-19 pandemic, according to researchers at Harvard T.H. Chan School of Public Health. Such high levels of distress may have potential implications for women and for fetal and child health and development, according to the study.

The study was published online in PLOS One on April 21, 2021.

“We expected to see an increase in the proportion of pregnant and postpartum women reporting mental health distress, as they are likely to be worried or have questions about their babies’ health and development, in addition to their own or their family’s health,” said study senior author Karestan Koenen, professor of psychiatric epidemiology at Harvard Chan School. “However, the number of women who had significantly elevated symptoms was much larger than what had previously been published during the pandemic.”

Koenen and her co-authors were interested in pregnant and postpartum women because prior research suggests that perinatal mental health problems can adversely impact not only women’s own health but also infant outcomes, mother-infant bonding, and children’s health over time. To gauge the mental health of pregnant and postpartum women during the pandemic, the researchers conducted an anonymous, online, cross-sectional survey of women in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in 12 languages, was hosted on the Pregistry platform for COVID-19 studies.

Of the 6,894 participants, substantial proportions of women scored at or above the cutoffs in widely-used psychological screening tools for elevated levels of anxiety/depression (31%), loneliness (53%), and post-traumatic stress in relation to COVID-19 (43%), despite the fact that only 117 women (2%) had been diagnosed with COVID-19 and 510 (7%) had been in contact with someone with COVID-19. The levels of psychiatric distress were significantly higher than previously published data on such distress in the general population during the pandemic and among pregnant and postpartum women before the pandemic.

Certain factors were linked with worse mental health among the women surveyed. Seeking information about the pandemic five or more times a day from any source (e.g., social media, news, or word-of-mouth) was associated with more than twice the odds of elevated post-traumatic stress in relation to COVID-19 and anxiety/depression. Worries about children and childcare and economic worries were also important factors in women’s mental health.

The majority of participants reported engaging in COVID-19 prevention behaviors (e.g., 93.3% reported practicing hand hygiene and 84.5% reported wearing a face mask) but these behaviors were not associated with anxiety or depression symptoms.

First author Archana Basu, research scientist in the Department of Epidemiology, said that the study’s results indicate that public health campaigns and medical care systems should explicitly address the impact of COVID-19–related stressors on mental health in pregnant and postpartum women.

“In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness, such as online support groups, should be part of intervention efforts for perinatal women,” Basu said.

Other Harvard Chan School researchers who contributed to the study include Hannah Hayoung Kim, Rebecca Basaldua, Nora Kelsall, and Sonia Hernández-DÍaz.

“A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic,” Archana Basu, Hannah Hayoung Kim, Rebecca Basaldua, Karmel W. Choi, Lily Charron, Nora Kelsall, Sonia Hernández-Díaz, Diego F. Wyszynski, and Karestan C. Koenen, PLOS One, online April 21, 2021, doi: 10.1371/journal.pone.0249780

Photo: iStock/ArtistGNDphotography

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Nicole Rura


Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.