The Impact of Covid 19 on Perinatal Depression
Kassandra R. Pulido
Department of Psychology, York University
PSYC 2030: Introduction to Research Methods
Dr. Jorida Cila
October 17, 2022
1. Introduction
Firstly, perinatal depression is a type of mood disorder that can have an affect on women
during their pregnancy, as well as after childbirth; however for the sake of this study, only new
mothers will be surveyed. Often confused with more common terms, such as, postpartum and
prenatal depression. “Perinatal” fully encompasses the period of time before and after childbirth.
As discussed by Dagher et al., (2021) mothers who experience perinatal depression often
undergo typical symptoms of depression (sadness, anxiety, fatigue, mood swings, etc.) but to a
more extreme extent. Additionally, Baran et al., (2021) too said that those with perinatal
depression find completing what were once daily and mundane tasks to be very taxing and
difficult. Coping with perinatal depression and the responsibility of taking care of a newborn
with a proper care from one’s support system is hard in itself. Its evident that perinatal
depression bears a heavy weight on those affected, however, according to Woody et al., (2017)
there is a margarine of uncertainty due to an insufficient systematic literary review to produce a
global estimate of perinatal depression prevalence and incidence. Despite this precariousness, in
the words of Milgrom et al., (2014), perinatal depression is a pervasive and under-diagnosed, not
only that but it can have serious long-term effects on the welfare of women, their partners and
children. Due to a lacking of effective measures to identify and educate women on perinatal
depression, majority will not know they’re suffering with a legitimate illness and won’t seek nor
receive the help they need. With this understanding on the singular topic of perinatal depression
comes the impact of the viral outbreak, Covid-19, on many unsuspecting mothers and others
globally. As Lebel et al., (2020) eloquently put it, the pandemic is a unique stressor with
imaginably broad-ranging repercussions for pregnancy and beyond. One of these being that as
the virus spreads, the lack of sufficient means of treatment and the frequent emergence of new
symptoms and complications have led to a fluctuation of restrictions, for instance the ban on
hospital visits, (Baran et al., 2021). While these restrictions due aim to reduce the spread of the
virus, they further enforce social isolation and stress on new mothers. Furthermore, during the
period, new mothers may be left dependent on the aid of just the attending medical staff, who,
having an influx of mothers and babies in their care, are not able to provide the aid to the extent
that mothers may need. As alluded previously, despite the commonality of perinatal depression
there are many gaps in our understanding and treatment of it and with the arrival of Covid-19,
this gal had become even greater. To rectify this lacking in knowledge, more research must be
administered to enhance our understanding of perinatal depression, as a whole, but also in
tandem with the possible affects of Covid-19, (Woody et al., 2017). Combine that with social
isolation and uncertain climate brought on by Covid-19 is an unimaginable battle. Is it through
this research paper that I seek to study the degree to which the pandemic impacted mothers with
perinatal depression. Covid-19 has had many adverse affects on the world, that is not unknown
to us. This purpose of this research paper is to highlight the particular vulnerability that new
mothers are to perinatal depression during the pandemic and emphasize the importance of
perinatal health policies directed at the prevention, detection (when applicable) and treatment of
perinatal depression, in reference to the written work of King et al., (2021). An example of this
would be, implementing a non-intrusive process to screen for perinatal depression in new
mothers, conducted by their obstetrician and the child’s paediatrician, as proposed by Stuart Parrigon et al., (2014); while simultaneously making the resources and knowledge a more
incorporated part of the health care provided by health-care workers (midwife, nurses, and
family doctors) and institutions, (Gaynes et al., 2005). In doing so, some light will be shed on a
susceptible and marginalized group of people who are not only victims to the affects of perinatal
depression and anxiety but now also to the isolation and unfortunate consequences of the
pandemic. The purpose of this study is also its importance, the hypothesize is that new mothers
with (potentially) perinatal depression are vulnerable to higher levels of depression and anxiety
(lower quality mental health) during and due to Covid-19.
2. Methods
2.1 Study Design
The data collected was produced from a longitudinal study, due, in part, that it is the only
suitable design that could produce comprehensive results, capable of answering the research
question: What impact does Covid-19 have on perinatal depression?; and potentially proving the
hypothesis: with the arrival of Covid-19, new mothers with perinatal depression (potentially) are
to show higher levels of depression and anxiety. In addition, this would allow proper study of the
affects Covid-19 on perinatal depression throughout the course of the pandemic.
2.2 Independent and dependent variables
Due to the nature of a longitudinal study, sometimes it's a bit unclear what are the
independent and dependant variables are, considering there is no manipulation of the
independent variable in this study. However, in this particular case the ‘varying variable’ will be
the sociodemographic features, as well as, the social support, and physical activity per the
participant; this will be discussed in further detail below. These features will differ between
participants and therefore, influence the effects of the dependent variable; the degree of
depression symptoms and anxiety.
2.3 Participants
A total of 200 participants, from across Canada, have participated in this study. The data
was collected over the course of a a little over year, starting from April 2020 until May 2021.
The participants are made up, equally, with new moms (100) and non-pregnant (100) of whom
act as the control group. With respect to the sensitive nature of the topic, the study produce
primarily qualitative based on the format of the questions. The raw data collected from the
participants would come in the form a rating scale. However there will be some amount of
quantitative data since there is an open-ended question, at the end of the survey, for participants
to freely write any additional comments or anecdotes that they felt wasn’t represented in the
questions or feelings/ experiences that they want to divulge.
2.3 Sociodemographic Features
In part of the recruitment period, after giving their consent to participate in the study,
participants were to then fill out a short and close-ended question survey that would disclose
some personal but relevant information to the findings of the study. The questions set out to
explore the participants age, geographical region, education level, number of children, degree of
isolation, employment status, social class, economic affectation and if they’re currently receiving
psychotherapy.
2.4 Covid-19
A portion of the questions was dedicated towards questions regarding participants
specific health concerns and any changes in life as a result of Covid-19. Such questions were as
follows: “To what extent do I feel that my life is in danger due to Covid-19?”, “Since the start of
the pandemic, have I felt more alone/ isolated than normal?”, “Am I receiving the support and
care me and my child need?”, “I’m deeply concerned for the health and well-being of my child in
the face of Covid-19.” In the rating scale fashion, participants then answered on a scale of 0 to 5.
0 (in relation to the question) being not at all and 5 being greatly so.
2.5 Outside Support
To assess the degree and effectiveness of the social support the participants receive from
their friends, family, and partners, a section of the questionnaire is based on the interpersonal
support evaluation list (Cohen and Hoberman, 1983).
2.6 Physical Activity
The questions regarding the participants activity, simply gaged how often the participant
partook in any form of physical exercise, the difficulty level and the estimated duration.
2.7 Levels of Anxiety and Depression symptoms
To measure for anxiety, Spielberger et al. (1999)’s state-anxiety factor, which is the
Spanish version of the State-Trait Anxiety Inventory (STAI; Spielberger et al., 1970), was
implemented, (Morales et al., 2021). In it contains 40 articles that work to analyze anxiety as a
state of being (momentary and temporary) and as a personality trait (constant and stable), all of
which were answered by a rating scale. The STAI method was applied due to its high internal
validity. It demonstrated to be reliable in the 2011 works of Riquelme and Casal and again the
Gunning et al. (2010) and Riquelme and Casal (2011), respectively. Similarly, to measure for the
symptoms of depression, the Spanish Adaptation (Sanz et al., 2005; Sanz and Vàzquez, 2011) of
the Beck Depression Inventory-II (BDI-II; Beck et al., 1996) was applied, (Morales metal.,
2021). To quickly define, the BDI-II is a self-reported scale to identify the symptoms of
depression, consisting of: crying, changes in hunger, pessimism, sadness, uncontrollable urges to
cry and feelings of guilt. This scale was used also due to its high internal validity and is the most
established and universally used assessment of depressive symptoms with new mothers and
pregnant women, (Morales et al., 2021).
2.8 Procedure
Due to Covid-19 restrictions, all questionnaires are asynchronous and to be fill out
online. As mentioned previously will be primarily comprised of close-ended rating scale type of
questions with singular open-ended question at the end of the survey for the participants include
any final remarks in their own words. To ensure accessibility, generalizability and flexibility, the
survey was uploaded onto Google Forms and then distributed through various social networks by
a combination of word-of-mouth, targeted ads (new mothers, midwifery and obstetric groups)
and snowball sampling. The participants were sent the same questionnaire every three months
over the course of the year and were given a two week allowance from the time they were sent
the survey and the ‘hard’ due date of completion.
2.9 Ethics
Based on the three core principles guiding research, as specified in the TCPS2: respect
for persons, concern for welfare, and justice, I propose that an approval from the University
Research Ethics Board. The only potential concern would be the risk of losing privacy and
confidentiality, but already stated, the only personal information that was relevant to the in the
analyzing the gathered data was acquired. The nature of a longitudinal design, the exclusively
asynchronous online surveys, and voluntary participation, this study is very non-intrusive and
can classified as minimal risk research.
3.0 Expected Results
Hypothetically, if the study was actually conducted, a descriptive statistical would be
used to analyze the data. Using this statistical method would allow interpretation of the data as a
whole (central tendency) and summarize how the data points differ from one another. Based off
the research and other similar studies conducted, I’d theorize that my hypothesis be proven to be
true; new mothers are experiencing higher levels of anxiety and depression symptoms as a result
of Covid-19.
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