Mental health disorders are common during pregnancy and the postnatal period, and canhave serious adverse effects on the well-being of woman and child. Every tenth woman hasdepressive symptoms and 5% suffer major depression during pregnancy. The consequences forglobal mental health due to the novel coronavirus disease, COVID-19, are likely to besignificant and may have long-term impact on the global burden of disease. Pregnant womenmay be particularly vulnerable due to partial immune suppression. Besides physicalvulnerability, the women could be at increased risk of mental health problems, such asanxiety, depression, and post-traumatic stress disorder (PTSD), due to social distancingleading to less support from the family and friends, and in some cases, partners notbeing allowed to be present during prenatal visits, labor and delivery. Furthermore, manypregnant women may feel insecure and worried about the effect of COVID-19 on their unbornchild, if the women get infected during pregnancy. Today, young urban women are used toutilizing internet services frequently and efficiently. Therefore, providing mentalhealth support to pregnant women via web-based support may be effective in amelioratingtheir anxiety/depression and reduce the risk of serious mental health disorders leadingto improved maternal and perinatal outcomes.
Pregnancy is a period of transition and great change, which may make some women more
vulnerable to mental health problems. It is known that depressive symptoms during
pregnancy may influence birth outcomes. Perinatal mental health disorders may become more
prevalent during a time of acute crisis, and the prevalence of maternal anxiety,
distress, and perinatal depression can be expected to increase globally, as a result of
the COVID-19 pandemic. However, there might be cross-national differences in the risk
factors and impact of pandemic on the prevalence of perinatal mental health disorders.
Some pregnant women might be predisposed to posttraumatic stress disorder (PTSD) during a
crisis situation, such as the COVID-19 pandemic. Mothers who developed PTSD in response
to the 9/11 terrorist attacks had lower morning and evening salivary cortisol levels,
compared to mothers who did not develop PTSD. Beyond effects on the mother alone,
perinatal mental health issues can have long-term effects on child´s mental and physical
health, as well as the participants behavior and cognition. Distress in pregnant women
may affect the fetus and is known to induce epigenetic changes in the placental genes.
Increased risk of psychopathology is observed in children exposed to maternal prenatal
distress. Elevated maternal cortisol and epigenetic regulation of placental
glucocorticoid-pathway genes are potential mechanisms for these observations. Women often
express feelings of inadequacy in the new mothering role, which can furthermore
negatively impact the participants mental health and the relationship to the infant.
Effective treatments are needed to address high global rates of postpartum depression
(PPD) with onset typically within 4 weeks after delivery and maternal depression up to
two years after delivery. Programs aimed at reducing PPD could achieve the most
cost-efficient results by focusing efforts in the critical time periods around
childbirth. Web-based psychosocial support provided by trained public health nurses is an
effective treatment method for PPD. Limited public health resources are challenges to the
accessibility of mental health services, which is why the use of web-based psychosocial
support could be a good alternative. Women perceive the risk for themselves or their
infants to be above average during global crises, which increases the levels of
uncertainty. However, face-to-face consultations during a pandemic are likely to increase
the risk of disease transmission. Therefore, easily accessible eHealth support could
provide fast and resource-effective care during the COVID-19 pandemic.
The study will generate evidence on whether web-based early intervention programs could
be efficient in ameliorating the risk and severity of perinatal mental health disorders,
and inform best clinical practice for women affected by the consequences of the COVID-19
pandemic.
Behavioral: Web-based psychosocial peer-to-peer support
The evidence-based eHealth peer-to-peer psychosocial intervention "Thinking Healthy",
will be tested in this RCT. In line with the World Health Organization's mhGAP
Intervention Guide (mhGAP-IG), "Thinking Healthy" is used to identify and manage
perinatal mental health conditions (distress, symptoms of depression, and anxiety) in
non-specialized psychosocial support setting.
Inclusion Criteria:
- Pregnant women between 12 and 18 weeks of gestation
- Viable intrauterine pregnancy.
Exclusion Criteria:
- History of severe psychiatric
- Substance abuse disorder
- Requiring medical treatment
- Presence of fetal chromosomal/structural abnormality
Shanghai Women's and Children's Health Center
Shanghai, Shanghai, China
Chinese University Hong Kong
Hong Kong, Hong Kong
Simone E Schwank, PhD
+41796137255
simone.schwank@ki.se
Ganesh Acharya, MD PhD
+46 70-099 63 35
ganesh.acharya@ki.se