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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 217-221

Psychological distress in pregnant women: A cross-sectional study


1 Department of Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
2 Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
3 Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India

Date of Submission26-Jul-2022
Date of Acceptance20-Sep-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Dr. K P Lakshmi
Department of Psychiatry, Amrita Institute of Medical Sciences and Research Centre, Kochi - 682 041, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_174_22

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  Abstract 


Background and Aim: The morbidity and mortality caused by COVID-19, the economic crisis brought about by the pandemic, and the health policies laid down for the containment of the virus, have a negative effect on the mental health of the people. Pregnant women represent a high-risk group, being particularly susceptible to stress and emotional instability. This study aims to estimate the prevalence of psychological distress in pregnant women during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional observational study done in a tertiary care center in Kerala between June and July 2021. All the pregnant women attending the obstetric department, after taking their informed consent were assessed with a pro forma to collect their sociodemographic details and Kessler Psychological Distress Scale was used to assess their psychological distress. The association between sociodemographic variables and distress was assessed using the Chi-square test. Results: A total of 66 pregnant women were studied. Fourteen (21.2%) were noted to have psychological distress. Three (4.5%) and 6 (9.1%) were in moderate and severe distress, respectively. None of these women were known to have any psychiatric illness. Psychological distress was more prevalent among homemakers compared to employed pregnant women (P = 0.134), more in primi, compared to second and third gravida (P = 0.825) and more in pregnant women in the second trimester compared to women in the first and third trimesters (P = 0.296). Conclusion: Psychological distress is highly prevalent in pregnant women during the COVID-19 pandemic. There is an urgent need for health policies to decrease its negative impact on the health of pregnant women, mothers, and children.

Keywords: COVID-19, Kerala, Kessler Psychological Distress Scale, pregnant women, psychological distress


How to cite this article:
Lakshmi K P, Chandra S, Menon B, Radhamany K, Rajana P, Suresh P. Psychological distress in pregnant women: A cross-sectional study. Arch Med Health Sci 2022;10:217-21

How to cite this URL:
Lakshmi K P, Chandra S, Menon B, Radhamany K, Rajana P, Suresh P. Psychological distress in pregnant women: A cross-sectional study. Arch Med Health Sci [serial online] 2022 [cited 2023 Feb 5];10:217-21. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/217/364955




  Introduction Top


Novel coronaviral infection that emerged in China in late 2019, the morbidity and mortality caused by COVID-19, the economic crisis brought about by the infection worldwide, and the subsequent health policies implemented by the governments and public health authorities for its containment, have a negative effect on the mental health of the population.[1],[2],[3],[4],[5],[6] When we consider the state of the common man, the anxiety of contracting the infection, fear of death, and the loneliness caused by the changes in the work environment, can be cause of distress. This complex global problem has a particularly detrimental effect on the more vulnerable groups of society. Adolescents are reported to have many psychological issues during the COVID-19 pandemic.[7] Pregnant women represent a high-risk group, as they are particularly susceptible to emotional instability and stress.[8] Considering the fact that there is a greater predisposition to mental health issues during pregnancy, the pandemic has increased their vulnerability.[9] Studies have shown that being pregnant could be an extra risk factor for the development of psychopathological symptoms during this pandemic.[10] The adverse conditions that prevail in relation to the pandemic can lead to physical and mental issues in newborns and can increase the risk of premature delivery and infant mortality.[11] Psychological evaluation of pregnant women in this current situation will represent a valuable input for the planning of health policies, which will help to reduce the negative effects on the mental health of pregnant women, mothers, and children. Research on the impact of the COVID-19 pandemic on pregnant women in this part of the country has not been done extensively. This study aims to estimate the prevalence of psychological distress in pregnant women during the COVID-19 pandemic and the factors associated with it. The findings will definitely help in improving perinatal care, which in turn will improve the quality of life of pregnant women and their children.


  Materials and Methods Top


This study was conducted between June and July 2021, in a tertiary care center in Kerala. This cross-sectional observational study was approved by the scientific research committee and the institutional ethics committee with reference number ECASM-AIMS-2021-290. A previous study by Khatri et al. published in the Journal of Marine Medical Society showed the prevalence of psychological distress in pregnant women to be 72.2% and the sample size was calculated using the formula 4pq/d2, where P is prevalence, q is 100-p, d the relative precision. Based on this with 20% allowable error and 95% confidence, the minimum sample size was calculated as 40.[12] Informed consent was taken from all the pregnant women attending the obstetric department in this hospital during the study period. Patients who withheld consent and those who needed emergency obstetric care were excluded from the study. After collecting their sociodemographic details using the pro forma, psychological distress was assessed using the Kessler's Psychological Distress Scale (K10).[13] K10 is a 10-item questionnaire, scores ranging from 10 to 50. People who score under 20 are likely to be well, scores 20–24 have mild distress, scores 25–29 have moderate distress, and those who score 30 and over have severe distress.[14] Studies have proved its validity in pregnant women.[15] Data were analyzed using SPSS International Business Machines Corporation (IBM), Armonk, New York. The percentage prevalence rate was computed with 95% confidence limit. To test the statistical significance of the association of categorical factors with distress, the Chi-square test was used.


  Results Top


A total of 66 pregnant women were part of the study. [Table 1] shows the sociodemographic profile of the participants. None of the participants were known to have a previous psychiatric illness. [Figure 1] shows the prevalence of psychological distress in the study population. Six (9.1%) and 3 (4.5%) among them had severe distress and moderate distress, respectively. [Figure 2] represents the percentage distribution of psychological distress with the occupational status of pregnant women. Nine (32%) among the 28 homemakers had psychological distress and 5 (13%) among the 38 employed pregnant women had distress. There was no distress noted in all four patients educated up to the 10th standard, but some of the pregnant women with higher education were noted to be distressed (P = 0.769). Psychological distress was more prevalent among homemakers compared to employed pregnant women (P = 0.134). The mean score among homemakers and employed women was 17.07 ± 9.1 and 15.24 ± 6.56, respectively. [Table 2] and [Figure 3] represent the distribution of psychological distress among pregnant women in different trimesters. Psychological distress was more in pregnant women in the second trimester compared to women in the first and third trimesters (P = 0.296). The mean score among women in the first trimester and third trimester was 20.2 ± 10.08 and 14.42 ± 4.77, respectively. The distress was more in primi, compared to the second and third gravida (P = 0.825). The mean score among primi gravida was 16.49 ± 8.33, whereas it was 15.67 ± 7.66 among the third gravida. Severe distress was more prevalent in pregnant women with physical comorbidities (P = 0.421).
Figure 1: Prevalence of psychological distress in the study population

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Figure 2: Percentage distribution of psychological distress with the occupational status of pregnant women (P = 0.134)

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Figure 3: The distribution of psychological distress among pregnant women in different trimesters (P = 0.296)

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Table 1: Sociodemographic details of study participants (n=66)

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Table 2: The distribution of psychological distress among pregnant women in different trimesters (P=0.296)

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  Discussion Top


Sixty-six pregnant women were part of the study. Among them, 21.2% had psychological distress. None of these women had any known psychiatric illness previously; even then, 4.5% and 9.1% of them were in moderate and severe distress, respectively. This is similar to the findings of a study done in Spain by Lubián López et al., which reported that 21.3% of participants reported depressive symptoms during the COVID-19 pandemic.[16] A study by Berthelot et al. has reported that compared to the prepandemic period, pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms mainly anxiety and depressive symptoms.[17] Considering the fact that prenatal distress in mothers can negatively impact the growth and well-being of the child, this is an important area which needs immediate attention from health-care providers and health policymakers.[18],[19],[20],[21] The stress of being infected with the virus, factors such as isolation/quarantine, loss of loved ones, and disruption of social and economic life, maybe some of the factors contributing to psychological distress in pregnant women. A study by Parra-Saavedra et al. among pregnant women in Columbia has reported that their knowledge about the SARS-CoV-2 virus is far from reality and this may be associated with concern and psychological stress among them.[22] In our study, psychological distress was prevalent in pregnant women irrespective of their educational status (P = 0.769). Employed pregnant women had less distress compared to homemakers (P = 0.134). This could be explained by the fact that employment may provide more financial support to them to tide over the crisis brought about by the pandemic. In our study, compared to first and third-trimester pregnant women, those in the second trimester had more distress (P = 0.296). Women in the second trimester may be worried about the anomalies that can happen to their babies, which may decrease as the baby achieves more maturity. However, this is in contrast to the study by Nanjundaswamy et al., where the majority of pregnant women who contacted obstetricians for COVID-19-related anxiety were in their third trimester.[23] In our study, primi pregnant women had more distress compared to those who already have children (P = 0.825). Uncertainties and concerns about something they have never experienced before may be the reason for their distress. Severe psychological distress was more prevalent in pregnant women with physical comorbidities (P = 0.421). The concern regarding their physical health and well-being of the child may contribute to their distress in them. Although the association between the various sociodemographic variables and psychological distress in our study was not statistically significant, the findings may help to focus on pregnant women who are more likely to be distressed.

Pregnant women in distress should be provided with necessary help to overcome their difficulties. Literature reports that there are various smartphone applications and Internet cognitive-behavioral therapy that can be offered without the risk of the spread of infection during the pandemic. Internet cognitive-behavioral therapy may be a cost-effective way to address psychiatric symptoms such as insomnia in these women.[24],[25] Smartphone applications may represent a novel way to address the gaps in antenatal and postnatal services providing psychoeducation.[26]

Limitations

Although our study assessed the prevalence of psychological distress in pregnant women during the COVID-19 pandemic, the reasons for their distress were not studied. Being a cross-sectional study, the definite causative factors for distress was not identified. The scale used is a screening tool to assess predominantly depressive and anxiety symptoms, but a detailed psychiatric assessment is needed to identify the psychiatric illness in these women. Certain COVID-19 factors that may affect the mental health of pregnant women were not discussed in the study. For example, they may find it difficult to use the face mask and this may have an impact on their mental health.[27] Variables such as vaccination status, whether participants/family members/friends had already contacted COVID, and complications of COVID infection in participants/family members/relatives were not assessed which might have had a correlation with psychological distress. The impact of lockdown on these women was also not assessed in this study.[28] A small sample size can also be mentioned as a limitation.


  Conclusion Top


Psychological distress is highly prevalent in pregnant women during the COVID 19 pandemic. There is an urgent need for health policies to decrease its negative impact on the health of pregnant women, mothers, and children.

Acknowledgment

We would like to thank all participants who gave informed consent to be a part of this study. We would like to thank Dr. Dinesan, Professor and Former HOD, Department of Psychiatry, for his support for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

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