Seeking mental health support for feelings of perinatal depression and/or anxiety during the COVID-19 pandemic: A qualitative descriptive study of decision-making

Background: Rates of perinatal depression and anxiety increased during the COVID-19 pandemic. It remains unclear how the COVID-19 pandemic influenced risk perception and help-seeking behaviours among pregnant and postpartum individuals.Objectives: To explore pregnant and postpartum individuals' decision-making process about when and how to seek support for feelings of depression and/or anxiety during the COVID-19 pandemic.Design: A qualitative descriptive design was used.Methods: The current study is a secondary analysis of qualitative data collected for a larger mixed-methods project that recruited participants who gave birth from 1 May 2020, to 1 December 2021, in Ontario and British Columbia, Canada, using maximum variation and purposive sampling. Seventy-three semi-structured interviews were conducted over Zoom or telephone. This analysis focuses on 56 individuals who discussed their self-identified feelings of prenatal or postpartum depression and/or anxiety. Conventional (inductive) content analysis was employed with iterative stages of open coding, focused coding and cross-checking themes.Results: Most participants recognized their need to seek help for their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle. Nearly all participants accessed informal social support for these feelings, which sometimes entailed social contact in contravention of local COVID-19 public health policies. Many also attempted to access formal mental healthcare, encountering barriers both related and unrelated to the pandemic. Participants described the pandemic as having the dual effect of causing or exacerbating their feelings of depression and/or anxiety while also constraining their ability to access timely professional care.Conclusion: Participants struggled to address their feelings of perinatal depression and anxiety during the COVID-19 pandemic, with many describing a lack of readily available resources and limited access to professional mental healthcare. This study highlights the need for improved provision of instrumental mental health support for pregnant and postpartum populations. Seeking mental health support for feelings of perinatal depression and/or anxiety during the COVID-19 pandemic: A qualitative descriptive study of decision-makingIt is not unusual for pregnant and postpartum individuals to experience feelings of depression and/or anxiety. Studies have shown that this became more common during the COVID-19 pandemic. Depression and anxiety can be challenging to recognize and treat in pregnant and postpartum individuals but may lead to long-term negative effects if not addressed. The COVID-19 pandemic brought on public health measures, including social distancing, which created barriers to accessing mental health professionals or social interactions. In this study, we wanted to understand when and how pregnant and postpartum people chose to seek support for their feelings of depression and/or anxiety during the COVID-19 pandemic. We interviewed people who gave birth during the pandemic in either Ontario or British Columbia, Canada and asked them about whether they experienced feelings of perinatal anxiety or depression, and how they chose to seek help for those feelings.Most participants acknowledged their feelings of depression and/or anxiety through discussions with a mental health professional or someone within their social circle, even though many experienced barriers to accessing these supports. Nearly all participants interacted with friends or family outside of their household to cope with their feelings, which sometimes meant acting against local COVID-19 public health policies. Although some participants talked about facilitators for accessing mental health professionals, many who tried also encountered challenges, and a few were unsuccessful. Participants in this study shared that the pandemic sometimes caused or worsened feelings of depression and/or anxiety while also making it harder to access the support they felt was necessary to cope with their feelings. These findings show that there is a need for more frequent conversations about mental health during healthcare appointments and more readily accessible mental health resources for pregnant and postpartum people.