Psychology, Psychology in the world, Research in the School

Prenatal mental health during COVID-19; the importance of social support, thinking style, and countering loneliness

Dr Gini Harrison discusses her new research on how COVID-19 impacts on pregnant women, and the steps they can take to counter some of the negative effects.

There is no doubt that COVID-19 has placed a significant strain on people’s mental health. And this may be amplified for pregnant women (who are classed as a ‘vulnerable group’ in the UK), who are likely to be worried about the potential consequences of contracting the virus on the foetus (which still remain unknown), as well as general concerns about access to healthcare and support. On top of that, lockdown restrictions mean that women are more likely to be less supported during the pandemic. Restrictions on movement led some hospitals to prevent partners from attending antenatal check-ups – and limit the amount of time they could spend with them during labour/childbirth; and peer-support groups and antenatal classes are significantly reduced – which is particularly problematic, as a lack of social support has been identified as a common source of distress during pregnancy and beyond. 

We have just published a paperthat explores the link between perceived social support and psychological wellbeing of perinatal women during lockdown. In line with other research that is beginning to emerge in this area, we found very high levels of psychological distress in pregnant women during COVID. Of the 205 women in our study, almost half (49%) screened positive for clinically significant anxiety, and 45% had probable depression – much higher than the rates usually reported in this group. We also found that depression and anxiety symptoms were significantly related to a lack of social support during the pandemic, illustrating the importance of social support to wellbeing for pregnant women.

Our study also aimed to understand the relationship between social support and wellbeing, by identifying some of the possible psychological factors through which a lack of support may result in poor mental health. In particular, we wanted to understand the way in which potentially modifiable factors may mediate the relationship between social support and psychological symptoms, as this can help us to identify potential targets for intervention that may help us to better support women’s wellbeing during pregnancy at this time.

We examined two important factors in this relationship. The first was loneliness – defined as “a distressing feeling that accompanies the perception that one’s social needs are not being met by the quantity or especially the quality of one’s social relationships” (Hawkley & Cacioppo, 2010). Our results suggest that those with lower perceived social support may have an increased level of loneliness. While loneliness is distressing in of itself, we investigated whether loneliness may lead to negative cognitive biases which, in turn, may reinforce and foster negative feelings and behaviours associated with depression and anxiety. The particular maladaptive cognitive process that we were interested in was repetitive negative thinking (RNT) – which refers to persistent negative thinking that is unwanted and difficult to control, and includes rumination (repetitive thinking about the past) and worry (repetitive thinking about the future). 

RNT has been found to be an important predictor of both depression and anxiety, and we thought it may be particularly problematic during lockdown, as it tends to occur more in times of uncertainty or when people feel they lack control (Nolen-Hoeksema, 2000). Additionally, ruminative thinking has been found to occur when there is a discrepancy between an idealised or desired state and one’s actual experience (Martin & Tesser, 1996). Given the significant uncertainty and practical disruption the pandemic has caused for pregnant women, it seems likely that there is a significant mismatch between what women may have expected pregnancy and birth to be like, and the current reality of their situation. (As someone who is currently 7 months pregnant, I can certainly see validity in that idea!!) Indeed, we found levels of rumination to be high, and found evidence of their role in the relationship between loneliness and mental health outcomes. Specifically, we found that low social support led to increased loneliness, which in turn led to higher levels of RNT, resulting in depression and/or anxiety. 

Overall, our findings suggest that interventions to promote prenatal wellbeing may benefit from incorporating strategies to bolster social support and reduce loneliness (e.g., promoting practical social behaviours such as scheduling times to contact friends and family, or focusing on peer support models, which have an element of social support built into them). Furthermore, our study found that some technology usage behaviours designed to promote social contact may be more effective in terms of protecting against symptoms of depression and anxiety whilst in lockdown. Specifically, using technology to make voice or video calls, or to send texts and video-call groups may be particularly helpful in this regard, while general social media, forum or internet use may not. Our findings also suggest that specifically targeting RNT (for example, using CBT-type strategies that aim to challenge and reduce problematic thinking styles) can help to promote wellbeing during pregnancy. 

The good news is, these are things that women can put into practice straight away… for example, making the time to regularly call or text family and friends is likely to help reduce feelings of loneliness during pregnancy. I have also produced some resources that are designed to tackle unhelpful thinking styles (such as RNT) during pregnancy, which can be accessed here:

Virginia Harrison, Michelle L. Mould and Katie Jones (2021) Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic Women and Birth

Read more about Gini Harrison’s research here

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