Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic

Raquel Costa; Ana Mesquita; Emma Motrico; Sara Domínguez-Salas; Pelin Dikmen-Yildiz; Sandra Saldivia; Eleni Vousoura; Ana Osorio; Claire A. Wilson; Rena Bina; Drorit Levy; Andri Christoforou; Maria Fernanda González; Camelia Hancheva; Ethel Felice; Tiago Miguel Pinto

doi:10.1111/acps.13664

Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic

Raquel Costa, Ana Mesquita, Emma Motrico, Sara Domínguez-Salas, Pelin Dikmen-Yildiz, Sandra Saldivia, Eleni Vousoura, Ana Osorio, Claire A. Wilson, Rena Bina, Drorit Levy, Andri Christoforou, Maria Fernanda González, Camelia Hancheva, Ethel Felice, Tiago Miguel Pinto

School of Social Work

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Objective/Background: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. Aim: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Method: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Results: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. Conclusion: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

Original language	English
Pages (from-to)	474-491
Number of pages	18
Journal	Acta Psychiatrica Scandinavica
Volume	150
Issue number	5
Early online date	11 Feb 2024
DOIs	https://doi.org/10.1111/acps.13664
State	Published - Nov 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.

Funding

This study was supported by the Portuguese fundings through FCT—Fundação para a Ciência e a Tecnologia, IP, in the scope of the projects EPIUnit—UIDB/04750/2020, https://doi.org/10.54499/UIDB/04750/2020 , ITR—LA/P/0064/2020, https://doi.org/10.54499/LA/P/0064/2020 . and HEI‐Lab—UIDB/05380/2020, https://doi.org/10.54499/UIDB/05380/2020 , respectively; and by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). Ana Osório received financial support from CAPES/Proex no. 0426/2021 and CAPES/PrInt Grant No. 88887.310343/2018‐00. CAW is funded by the UK's National Institute for Health and Care Research (NIHR) as an Academic Clinical Lecturer. This publication is based upon work from COST Action Research Innovation and Sustainable Pan‐European Network in Peripartum Depression Disorder (Riseup‐PPD), CA18138, supported by COST (European Cooperation in Science and Technology). The work developed by ProChild CoLAB was supported by (i) NORTE‐06‐3559‐FSE‐000044, integrated in the invitation NORTE59‐2018‐41, aiming to hire Highly Qualifed Human Resources, cofinanced by the Regional Operational Programme of the North 2020, thematic area of Competitiveness and Employment, through the European Social Fund (ESF) and (ii) Mission Interface Program from the Resilience and Recuperation Plan, notice no. 01/C05‐i02 /2022, aiming to guarantee public core funding to strengthen the network of interface institutions, as defined in the legal regime in force, approved by Decree Law no. 63/2019, of May 16th, as well as in its 1st review on “Technology and Innovation Centres—CTI” and “Collaborative Laboratories—CoLABs,” approved by Decree‐Law no. 126‐B/2021, of December 31st. The Psychology Research Centre—CIPsi (PSI/01662), School of Psychology, University of Minho, was supported by the Foundation for Science and Technology (FCT) through the Portuguese State Budget (Ref.: UIDB/PSI/01662/2020)

Funders	Funder number
Fundação para a Ciência e a Tecnologia

Keywords

EPDS
anxiety
depression
postpartum
pregnancy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/acps.13664

Cite this

Costa, R., Mesquita, A., Motrico, E., Domínguez-Salas, S., Dikmen-Yildiz, P., Saldivia, S., Vousoura, E., Osorio, A., Wilson, C. A., Bina, R., Levy, D., Christoforou, A., González, M. F., Hancheva, C., Felice, E., & Pinto, T. M. (2024). Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic. Acta Psychiatrica Scandinavica, 150(5), 474-491. https://doi.org/10.1111/acps.13664

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title = "Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic",

abstract = "Objective/Background: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. Aim: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Method: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Results: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. Conclusion: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.",

keywords = "EPDS, anxiety, depression, postpartum, pregnancy",

author = "Raquel Costa and Ana Mesquita and Emma Motrico and Sara Dom{\'i}nguez-Salas and Pelin Dikmen-Yildiz and Sandra Saldivia and Eleni Vousoura and Ana Osorio and Wilson, {Claire A.} and Rena Bina and Drorit Levy and Andri Christoforou and Gonz{\'a}lez, {Maria Fernanda} and Camelia Hancheva and Ethel Felice and Pinto, {Tiago Miguel}",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.",

year = "2024",

month = nov,

doi = "10.1111/acps.13664",

language = "אנגלית",

volume = "150",

pages = "474--491",

journal = "Acta Psychiatrica Scandinavica",

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Costa, R, Mesquita, A, Motrico, E, Domínguez-Salas, S, Dikmen-Yildiz, P, Saldivia, S, Vousoura, E, Osorio, A, Wilson, CA, Bina, R , Levy, D, Christoforou, A, González, MF, Hancheva, C, Felice, E & Pinto, TM 2024, 'Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic', Acta Psychiatrica Scandinavica, vol. 150, no. 5, pp. 474-491. https://doi.org/10.1111/acps.13664

TY - JOUR

T1 - Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic

AU - Costa, Raquel

AU - Mesquita, Ana

AU - Motrico, Emma

AU - Domínguez-Salas, Sara

AU - Dikmen-Yildiz, Pelin

AU - Saldivia, Sandra

AU - Vousoura, Eleni

AU - Osorio, Ana

AU - Wilson, Claire A.

AU - Bina, Rena

AU - Levy, Drorit

AU - Christoforou, Andri

AU - González, Maria Fernanda

AU - Hancheva, Camelia

AU - Felice, Ethel

AU - Pinto, Tiago Miguel

PY - 2024/11

Y1 - 2024/11

N2 - Objective/Background: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. Aim: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Method: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Results: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. Conclusion: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

AB - Objective/Background: Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. Aim: The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. Method: Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. Results: Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. Conclusion: There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.

KW - EPDS

KW - anxiety

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KW - postpartum

KW - pregnancy

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Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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