Maternal self-efficacy and peripartum depression amidst the COVID-19 pandemic

Pregnancy and childbirth are crucial periods for the safety and continuity of the well-being of the mother and her newborn baby as mothers try to adapt with the physical, social, and mental health variation that occurs in this period (Pillitteri, 2010). Maternal self-efficacy (MSE) is significant to facilitate compliance with this maternal experience and motherhood. Maternal self-efficacy is defined as mothers’ belief regarding their abilities in managing and executing tasks in parenting children (Delavari et al., 2018). It is also witnessed that mothers lack of experience inchild care, having more problems in coping with maternal responsibilities, often contributes to lower levels of maternal confidence (Aydemir and Onan, 2020). These experiences may have a combined effect on a mother’s ability to balance their physical, psychological, and social well-being. Yet, the well-being of newly birthed mothers who are at risk of distress is not routinely assessed.

Peripartum depression is a foremost reason of disease burden among women and their families (Cepeda et al., 2019). Across the globe in women of child-bearing age the prevalence of peripartum depression, found to be 10 10% –13%, presents the greatest extent of the burden and is linked with mental or neurological ailments (Rahman et al., 2013; Sidhu et al., 2019). In lower- and middle-income countries (LMICs) the prevalence of perinatal depression lies between 15.6% and –19.8% (Fisher et al., 2012). but in Pakistan these rates are significantly greater than most LMICs, noted to range between 30% and 37% (Atif et al., 2021). Various factors such as poverty, low education level, migration, limited health-care services, severe stress, domestic violence, maltreatment, conflict conditions, multiparity, unintended pregnancy and lack of social support were found to be strongly related with perinatal depression (Sidhu et al., 2019; Atif et al., 2021). However, surprisingly majority of cases of peripartum depression go undiagnosed in Pakistan (Atif et al., 2016). MSE is a strong psychological factor that has been found to be protective against peripartum depression. Low MSE perceptions have been linked with higher levels of anxiety, depression, and stress, strong MSE beliefs are found to be related to decreased maternal stress (Leahy-Warren and McCarthy, 2011). MSE has been positively related to social support and parenting satisfaction which is quite uncertain in current unprecedented times (Leahy-Warren and McCarthy, 2011; Xue et al., 2021).

COVID-19 pandemic has significantly heightened peripartum depression due to unpredicted transition, losses, and uncertainties that disturb their normal rhythm of life. Moreover, lockdown and quarantine have created a challenging situation by hindering personnel interaction and social support from their loved ones that are crucial in assisting new mothers (Xue et al., 2021). It is also witnessed that COVID-19 related measures are expected to have a severe impact on family psychosocial functioning that increases the likelihood of peripartum depression (Cameron et al., 2020). Further, exposure to healthcare services is also limited as visiting clinics and hospital centers for checkups are perceived to place the mother and her newborn at increased risk of contracting the virus. These experiences could decrease maternal confidence and efficiency in caring for their newborn child. Early pandemic conditions also showed that new mothers suffered from peripartum depression due to high unpredictability involving perinatal care of their baby (Farewell et al., 2020).

The long-term mental health repercussion of COVID-19 is quite devastating which calls for the fundamental need of implementing evidence-based measures to support women and their baby in this uncertain time. Therefore, screening services should be integrated into existing maternal programs to assess peripartum depression and to deliver suitable services to mothers in countries like Pakistan which has limited mental health facilities. Rigorous efforts from health care professionals and policymakers should be warranted to deal with the adverse maternal and child health outcomes related to the negative impact on mental wellbeing by the COVID-19 pandemic. Mental health crisis programs should be introduced by using teleconsultation services to support and counsel mothers and to combat the growing burden of peripartum depression related to pandemics. Increasing maternal self-efficacy should be considered, as it is identified to be a protective factor for maternal mental health. In that regard, healthcare professionals (nurses, midwives, obstetricians, psychologists) could utilize internet-based platforms to inquire about worries and concerns of being a mother and provide appropriate information that prepares women for motherhood and increase maternal efficacy. Group-based telehealth platforms may permit opportunities for the first-time mother to virtually share their concerns and feelings with other mothers which could have a positive effect on their well-being. Besides, maternal educational resources (videos or voice-over presentation) as well as social support should be depicted in an explicit and practical manner to rectify misconceptions or fears, and to offer support during the initial days of their motherhood. There is a growing need for research to assess the effect of the pandemic on maternal self-efficacy and its influence on peripartum depression, particularly in LMICs like Pakistan where the mental health framework is poorly evolved, and the consequences could be grave. Hence, timely, scalable and culture-sensitive mental health interventions should be implemented in the health care system for early action.

Financial disclosure

Dr. Manisha Nair (MN) is funded by a Medical Research Council Career Development Award (Ref: MR/P022030/1)

Declaration of Competing Interest

The authors declare no competing interest.