The impact of COVID-19 on identifying and managing perinatal anxiety
Silverwood and colleagues1 provide valuable insight into health professionals’ perspectives on managing perinatal anxiety. As medical students remotely undertaking our placement in perinatal mental health, here we suggest how these factors may be influenced by the COVID-19 pandemic.
After 8 weeks of lockdown in the UK, we must prepare for an increase in prevalence of mental health illness.2 The quarantine has disrupted daily routines, loved ones are separated from one another and basic liberties have been limited. At the same time, alarming headlines and statistics revalidate fears of infection, adding to the public’s anxiety.3
Maternal mental health may be disproportionately affected by the pandemic.4 Unanticipated changes in birth-plan, fewer face-to-face appointments and concern for their own health and the wellbeing of their child exacerbate anxiety in an already predisposed subgroup.5 The reduction in availability of peer-support networks, which have been shown to have a beneficial impact on perinatal mental health, could also contribute to increased anxiety.6
Clinicians are not immune to the pandemic’s impact on mental health7. The stress experienced by health professionals could distort their perception of what is ‘normal’ perinatal anxiety. Moreover, the definition of ‘pathological’ anxiety as “affecting a woman’s everyday functioning” may require re-evaluation in the context of the current pandemic.8
The rise in remote consultations offers new opportunities to monitor women’s mental health under current social-distancing guidelines. Yet, although convenient, phone calls can be especially challenging when significant anxiety or low mood hampers a patient’s ability to talk.9 Patients and healthcare professionals recognise the visual component of video consultations as beneficial over phone calls in facilitating non-verbal communication of distress and reassurance.10 However, common technical problems can disrupt sensitive conversations or prevent video calls being initiated.
In trying to find the silver lining, we wonder if COVID-19 has any positive impact on our ways of working. Perhaps the necessitated use of video conferencing has solved the problem health professionals felt rose from “working in separate premises”. Our experience has been that perinatal mental health teams work closely with health visitors, midwives, social workers and specialist services in the voluntary sector to deliver integrated, holistic care.
References
1. Silverwood V, Nash A, Chew-Graham CA, et al. Healthcare professionals’ perspectives on identifying and managing perinatal anxiety: A qualitative study. Br J Gen Pract 2019; 69: E768–E776.
2. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395: 912–920.
3. Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure. Health Psychol 2020; 39: 355–357.
4. Thapa SB, Mainali A, Schwank SE, et al. Maternal mental health in the time of the COVID-19 pandemic. Acta Obstet Gynecol Scand 2020; 1–3.
5. Matvienko-Sikar K, Meedya S RC. Perinatal Mental Health during the COVID-19 Pandemic. Women and Birth.
6. Jones CCG, Jomeen J, Hayter M. The impact of peer support in the context of perinatal mental illness: A meta-ethnography. Midwifery 2014; 30: 491–498.
7. Gold JA. Covid-19: adverse mental health outcomes for healthcare workers. BMJ 2020; 369: m1815.
8. Corbett GA, Milne SJ, Hehir MP, et al. Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 2019–2020.
9. Ball SL, Newbould J, Corbett J, et al. Qualitative study of patient views on a ‘telephone-first’ approach in general practice in England: Speaking to the GP by telephone before making face-to-face appointments. BMJ Open 2018; 8: 1–9.
10. Donaghy E, Atherton H, Hammersley V, et al. Acceptability, benefits, and challenges of video consulting: A qualitative study in primary care. Br J Gen Pract 2019; 69: E586–E594.
Competing Interests: None declared.