Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2022

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The COVID-19 Pandemic’s Impact on Women Caregivers’ Mental Health

Marissa A. Kobayashi, PhD; Lindsay Stager, MA; Christina Cordero, PhD & Felicia Marie Knaul, PhD; Child and Family Health SIG

The COVID-19 pandemic led to greater numbers of people experiencing and reporting mental health issues, including depression and anxiety.1 This is particularly apparent among caregivers – the vast majority being women –  who experienced increased levels of stress following the loss of childcare services due to pandemic-related reasons, such as COVID-19 infections in family members, sheltering-in-place, lockdowns, and school/daycare closures.2, 3 Women caregivers  -- mothers, grandmothers, elder sisters, and others – had to manage the demands of work while bearing a disproportionate burden related to childcare, domestic work, and homeschooling when compared to men.4 Indeed, the number of employed women in the U.S. had decreased by 14.5% from late 2019 to June 2020, but it has since recovered.5  COVID-19 also worsened mental health disparities and increased the rates of domestic violence among already vulnerable populations, specifically low-income, racial/ethnic minority women.6,7,8 The above data highlight the necessity for increased understanding regarding the current mental health needs of women caregivers, and the creation of meaningful and timely interventions and policies to address and reduce enduring psychological and financial distress and intergenerational impact.

To date, research on the mental health needs of women caregivers during COVID-19 has been mainly cross-sectional and focused on pregnant mothers or mothers of young children. There is a paucity of research being conducted among diverse women caregivers including those with older children and adolescents. The extant literature shows high and significant levels of anxiety, depression, stress, insomnia, and social dysfunction among pregnant and/or lactating mothers.2 A meta-analysis3 observed elevated prevalence of depression and anxiety in mothers of children <5 years old, 27% and 42%, respectively, which were approximately two- and three-fold greater than previously reported pre-pandemic prevalence estimates. The vast majority of research studies were cross-sectional by design and did not collect information on participants’ pre-pandemic baseline levels of mental health.3,2,9 Further, the existing meta-analyses included only a few studies that were conducted in the United States.10, 11 Regarding research among female caregivers with older children, a study12 found an increase in the prevalence of depression and anxiety symptoms versus pre-pandemic levels among mothers of 9-11 year old children in Canada. This study advanced our understanding of the impact of COVID-19 on mothers with older children but nonetheless is limited by not including more racially/ethnically and socioeconomically diverse participants.

Building an effective evidence base requires the use of longitudinal data to analyze waxing and waning pandemic-related restrictions and uptake of vaccines. The extant literature reflects a paucity of research investigating the pandemic’s impact on women caregivers in the US, a country with multiple ongoing epidemiological cohort studies that could be leveraged. For example, the Collaborative Cohort of Cohorts for COVID-19 Research (C4R; https://c4r-nih.org) includes several cohort studies with racially/ethnically diverse participants, longitudinal mental health data, and information on increased caregiving during the pandemic. This research could help scientists and policymakers create interventions and multi-sectoral policies addressing the heightened mental health needs of women caregivers resulting from the COVID-19 pandemic. The insights gleaned from the US could also be examined for their relevance in other countries in response to the recent call by UN Women and their critical recommendations for reducing the disproportionate effects of COVID-19 on women and girls.13 Further, applying a lens that addresses intersectionality, as well as gender, can generate evidence to remedy the inequities in access to mental healthcare and the prevailing stigma that pre-dated, was exacerbated by, and continues to affect people with lived experience of mental health conditions in the US and around the world.14

 

References:

  1. Aknin LB, De Neve J-E, Dunn EW, et al. Mental health during the first year of the COVID-19 pandemic: A review and recommendations for moving forward. Perspectives on Psychological Science 2022;17:915-936.
  2. Demissie DB, Bitew ZW. Mental health effect of COVID-19 pandemic among women who are pregnant and/or lactating: A systematic review and meta-analysis. SAGE open medicine 2021;9:20503121211026195.
  3. Racine N, Hetherington E, McArthur BA, et al. Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: A longitudinal analysis. The Lancet Psychiatry 2021;8:405-415.
  4. Tani M, Cheng Z, Mendolia S, Paloyo A, Savage D. Working parents, financial insecurity, and child-care: Mental health in the time of COVID-19. Review of Economics of the Household. 2021; 19:123-144.
  5. Smith SM, Edwards R, Duong HC. Unemployment rises in 2020, as the country battles the COVID-19 pandemic. Monthly Labor Review, US Bureau of Labor Statistics 2021.
  6. Di Gessa G, Maddock J, Green MJ, et al. Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies. Br J Psychiatry. 2022 Jan;220(1):21-30.
  7. Lopez L, Hart LH, Katz MH. Racial and ethnic health disparities related to COVID-19. JAMA 2021;325:719-720.
  8. Women UN. Impact of COVID-19 on violence against women and girls and service provision: UN Women rapid assessment and findings. New York: UN 2020.
  9. Hessami K, Romanelli C, Chiurazzi M, Cozzolino M. COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine 2020:1-8.
  10. Farewell CV, Jewell J, Walls J, Leiferman JA. A mixed-methods pilot study of perinatal risk and resilience during COVID-19. Journal of Primary Care & Community Health 2020;11:2150132720944074.
  11. Silverman ME, Burgos L, Rodriguez ZI, et al. Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Scientific Reports 2020;10:1-7.
  12. Racine N, Hetherington E, McArthur BA, McDonald S, Edwards S, Tough S, Madigan S. Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: A longitudinal analysis. The Lancet Psychiatry. 2021; 2(5): 405-15.
  13. Women UN. UN Women response to COVID-19 crisis [online]. Available at: https://www.unwomen.org/en/news/in-focus/in-focus-gender-equality-in-covid-19-response/un-women-response-to-covid-19-crisis.
  14. Thornicroft G et al. The lancet commission on ending stigma and discrimination in mental health. The Lancet 2022: 1438-1480.