It is well established that mental health problems increase vulnerability to COVID-19. Similarly, those contracting the virus are at higher risk of nervous system disorders and mental illness. The Mom2B study, led by Prof Alkistis Skalkidou and colleagues, explores the mental health of pregnant women and those who have recently given birth.
Read their original paper: https://doi.org/10.1101/2020.12.18.20248466
Download the Mom2B app here:
Hello and welcome to Research Pod. Thank you for listening and joining us today.
In this podcast we are exploring the research of Professor Alkistis Skalkidou from Uppsala University and her colleagues based on the wide-reaching BASIC study (standing for Biology, Affect, Stress, Imaging and Cognition) undertaken in Sweden, which looked into the mental health and emotional wellbeing of new and expecting mothers. This study was conducted over a span of 10 years, between 2009 and 2019. The risk factors identified in this study were used to inform the innovative Mom2B study, an ongoing evaluation that listeners currently pregnant or new mothers can join in with; this new study aims to develop predictive models for depression during and after pregnancy using mobile phone apps.
The BASIC study was completed in 2019, with all data collected, collated and analysed.
The plans were then laid for the follow-up Mom2B study, starting 2019, to assess peripartum wellbeing using mobile platforms, and develop predictive models from the pooled data.
And then, a global pandemic.
To date, the global death toll exceeds 1 million and the number of confirmed cases, more than 50 million people, is still growing with the long-term outcomes unclear.
It has been well established that mental health problems increase vulnerability to corona virus, COVID-19, and those contracting the virus are at higher risk of nervous system disorders and mental illness. Importantly, the mental health effects of COVID-19 are expected to persist long after the roll out of the vaccines; Those affected continue to suffer from the effects of infection on the nervous system, the trauma of illness, loss of loved ones, and increased stress due to financial challenges.
Professor Alkistis Skalkidou and her colleagues were therefore extremely concerned about the impact COVID-19 would have on pregnant women and new mother’s mental health, especially given their recent findings from the BASIC study, and the ongoing Mom2B study offered a unique opportunity for a sub-study at this critical time.
Mental health problems in the perinatal period can lead to severe mental illness and have a significant impact on long term educational, social, and emotional development of the baby. Therefore, it was crucial that health systems have insights into what is happening biologically, emotionally, and psychologically for the woman to develop methods of prevention and treatment for mental ill health during the perinatal period.
The findings from the BASIC study showed that there were significant biological changes in women experiencing depressive symptoms postnatally and some changes antenatally. They also identified some triggers for symptoms of depression in early motherhood.
Many different hormonal changes that normally occur during pregnancy could not only be experienced by the women as increased anxiety (feeling their heartbeat loudly, dizziness etc) but sometimes lead to serious metabolic disorders such as diabetes. The researchers found that depressed women, and those taking antidepressant treatments had often different levels of these hormones during pregnancy. Changes also were noted in their immune system regulation; Inflammatory markers, those preparing the body to fight infection, were triggered more antenatally, among those with antidepressant treatment, and postnatally in those women with depressive symptoms.
Psychologically, the journey through depressive experiences is influenced by maternal characteristics such as challenging relationships, limited finances, and isolation. Women who experienced prolonged nausea in pregnancy or excessive bleeding postnatally were also more likely to develop depressive symptoms in early motherhood, but in vitro fertilization treatment was not a risk for postnatal depressive symptoms.
After giving birth, women with neuroticism traits and attachment anxiety experienced more depressive symptoms. .
These findings from the BASIC study provided the foundation for the Mom2B study. This was originally undertaken to develop and evaluate effective digital methods for the prediction of depression and anxiety, but was also in place at just the right time to assess wellbeing and life changes during the COVID-19 pandemic in Sweden. The data was collected using a mobile phone application, also called “Mom2B”. This study used surveys and questionnaires, voice recordings, and mobile sensors which collect data passively from expectant mothers in various specified periods before and after pregnancy.
The overarching aim of this research is to develop a predictive model of peripartum depression using Machine Learning, informed by mood and wellbeing data contributed by trial participants, to predict, and respond to, the concerns of future mothers all the more quickly.
The Mom2B study is still recruiting participants in Sweden, with more expecting mothers signing up by the day. If you’re hearing this and want to take part, just download the app to get started.
This data will be utilized in a variety of research papers, such as the one that was recently published online as pre-print on the impact of COVID-19 on peripartum depression. Using this novel data collection technique, Professor Alkistis Skalkidou and her colleagues have already determined there were important effects of COVID-19 on the mental wellbeing of participants.
Sweden, unlike many other countries, did not have a ‘lockdown’ in response to the pandemic. They developed voluntary social distancing guidelines, including working from home when possible, reducing travel and social contacts and avoiding public transport. Therefore, it may seem unsurprising that the women mostly said that their life situations were only slightly affected. Despite this, rates of depression and anxiety in perinatal women was much higher in 2020 , often more than doubled in comparison with data from 2009-2019.
They found that when the rates of infection and associated deaths were at their highest, April and October 2020, so was the level of anxiety and depression in the women. Unsurprisingly, wellbeing was at its highest in January and June to August when COVID-19 cases and deaths were at their lowest.
Interestingly, though, the experiences of depression and anxiety were not related to whether the women or members of their family had symptoms of the virus: women who reported having no COVID-19 virus symptoms had higher anxiety levels than those with symptoms or a close friend or relation with symptoms. Participants reported even various concerns associated with this lack of wellbeing and experience of depressive symptoms. These concerns were identified as: worry about the impact of the virus on health, worry about access to healthcare, as well as social and economic impacts secondary to the pandemic.
The rates of depression and anxiety were highest in those feeling isolated – this was also linked to reduced wellbeing and reduced mobility. Some specific anxieties were that their partner would not be able to attend the birth and the cancellation of health care appointments. The women’s sense of wellbeing reduced when mobility reduced but their internet searches related to the corona virus increased.
Through using the Mom2B app as a modern data gathering device for this study, the researchers were able to follow and promptly response differences in mood and wellbeing among pregnant women during the pandemic. Professor Alkistis Skalkidou and her colleagues believe the use of the Mom2B app allowed data collection in a user-friendly way as the pandemic progressed, which indicates that applications like this one could be used in other crisis situations.
The goal of maternity care is to identify and reduce the risk of ill health including mental ill health. These risks need to be promptly identified, especially in crisis situations, and preventative measures put in place. For this, smart phone applications appear to be ideal to reduce risks of mental ill health in women and its devastating effect on their babies.
The Mom2B study continues to explore mental health in the perinatal period, and recruitment for participants is ongoing – if you leave in Sweden and are an expecting mother or have recently had a baby and would like to contribute your feelings to this study, you can register with the app on Apple and Android smart phones. If you are a researcher and interested in being involved with this study, please contact Professor Alkistis Skalkidou using the website in the episode description for this podcast.
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