Effects of isolation on mood and relationships in pregnant women during the covid-19 pandemic

      Dear Editor,
      We note that COVID-19 is a global public health emergency that has resulted in a significant psychological impact on the mental health of women during pregnancy [
      • Corbett G.A.
      • Milne S.J.
      • Hehir M.P.
      • Lindow S.W.
      • O’Connell M.P.
      Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic.
      ]. There has been emerging evidence of further secondary morbidity associated with the pandemic with an in increase in domestic violence associated with the strategies implemented to slow its spread, namely social isolation and lockdown [
      • Bradbury‐Jones C.
      • Isham L.
      The pandemic paradox: the consequences of COVID‐19 on domestic violence.
      ]. There is a known increased risk of domestic violence in pregnancy [
      • Johnson J.
      • Haider F.
      • Ellis K.
      • Hay D.
      • Lindow S.
      The prevalence of domestic violence in pregnant women.
      ]. We sought to assess the effects of lockdown on relationships and maternal mood.
      We carried out a prospective study involving pregnant women attending for antenatal care in The Coombe Women and Infants University Hospital, a tertiary level maternity centre in Dublin.
      Women in their second and third trimesters completed a questionnaire in the out-patient setting which was based on maternal mood during the lockdown phase of the COVID-19 pandemic, in addition to details of relationships between partners, family and friends during this time.
      From 6th April to the 28th April 2020, 70 women completed the questionnaire (Table 1). This represented the latter period of “total lockdown” in Ireland with restrictions including an exercise limit of two kilometres from home and all other journeys outside to be made only for provision of essential services or to purchase essential goods.
      Table 1Responses from 70 pregnant women to a questionnaire on their mood and relationships whilst isolating due to Covid 19.
      % PositiveYesNon
      MoodLow mood-lonely44.3313970
      Low mood-reduced activity38.6274370
      Sad-unable to see sick family members18.6135770
      Anxious14.3106070
      Enjoying slower pace of life34.3244670
      RelationshipsImproving relationships with family and friends34.3244670
      Tension between family members11.486270
      Relationship with partner deteriorated4.336770
      Relationships with partner that had not deterioratedGrown closer34.3234467
      Exercised together20.9145367
      Talked more28.4194867
      Undertaken shared tasks28.4194867
      Relationship with partner deterioratedPolice action33.3123
      Seeking help0033
      Leaving home0033
      Most women (67/70; 95.7 %) reported the relationship with their partner had not deteriorated over this time with 4.3 % (3/70) reporting a deterioration. Of this group, one woman thought of seeking help in the form of police action (33 %;1/3). Of those whose relationships had not deteriorated, 34 % (23/67) have grown closer to their partners, with 21 % (14/67) exercising together, and 28 % (19/67) undertaking shared tasks at home. 34 % (24/70) of women reported improving relationships with family and friends by communicating with them more frequently. However, 11 % (8/70) stated that there were tensions between family members/children who were also in isolation in the same household.
      When questioned on mood, 44 % (31/70) reported low mood due to loneliness as they missed contact with friends and family. Anxiety was reported due to financial pressure due to being unable to work in 14 % (10/70). Positively, over one third of women (34 %; 24/70) said they were enjoying the lockdown and isolation as it was relaxing and a break from life’s fast pace.
      The arrival of the COVID-19 global pandemic posed many challenges for public health, one of these being disease containment. In Ireland, the government responded by imposing a lockdown. These measures, however, have impacted the mental health of pregnant women and their relationships with their partners, family members and friends.
      Meta-analyses identified a significant association between social isolation and loneliness with increased morbidity and poor mental health outcomes [

      Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N. and et al., 2017. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157-171.

      ]. Stress, loss of income and social isolation can exacerbate the risk of violence in the home [

      WHO Violence Against Women During COVID-19. [online] Who.int; 2020 [cited 2020 May 10th] Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/violence-against-women-during-covid-19.

      ]. Reports have been surfacing of increased incidence of domestic violence in countries across the world during lockdown. A study done in North England, showed the prevalence of domestic violence to be 17 % amongst pregnant women outside of the pandemic [
      • Johnson J.
      • Haider F.
      • Ellis K.
      • Hay D.
      • Lindow S.
      The prevalence of domestic violence in pregnant women.
      ]. This trend has not been demonstrated in our obstetric population with 4.3 % reporting relationship deterioration with their partners and no women reporting physical violence. Instead, women recorded improving relationships with their partners by talking more, exercising together and sharing tasks.
      This study provides insight into the effects of social isolation on the relationships of our obstetric cohort and its effect on their mental health. The lockdown has had both a positive and negative effect on women’s mental health. The psychological implications of this cannot be ignored and management strategies to improve mental health should be considered by policy makers when implementing a lockdown.

      Financial disclaimers

      None.

      Declaration of Competing Interest

      The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

      References

        • Corbett G.A.
        • Milne S.J.
        • Hehir M.P.
        • Lindow S.W.
        • O’Connell M.P.
        Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic.
        Eur J Obstet Gynecol Reprod Biol. 2020;
        • Bradbury‐Jones C.
        • Isham L.
        The pandemic paradox: the consequences of COVID‐19 on domestic violence.
        J Clin Nurs. 2020;
        • Johnson J.
        • Haider F.
        • Ellis K.
        • Hay D.
        • Lindow S.
        The prevalence of domestic violence in pregnant women.
        BJOG. 2003; 110 ([online]): 272-275
      1. Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N. and et al., 2017. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157-171.

      2. WHO Violence Against Women During COVID-19. [online] Who.int; 2020 [cited 2020 May 10th] Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/violence-against-women-during-covid-19.