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*Corresponding Author: Banafshe Amiri, Banfsheh Amiri Tooran Poshti, Bachelor of Midwifery, Department of Midwifery, Meybod Branch, Islamic Azad University, Meybod, Iran
Citation: Banafshe Amiri (2022) The effect of covid 19 pandemic on women of childbearing age Journal of Clinical Case Reports and Studies 3(6); DOI: 10.31579/2690-8808/128
Copyright: © 2022 Banafshe Amiri, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 06 May 2022 | Accepted: 15 May 2022 | Published: 28 June 2022
Keywords: Covid 19 pandemic; social interactions; stress; loneliness; panic attacks; anxiety and depression
The Covid 19 pandemic changed people's lifestyles. Decreased social interactions have led to a wide range of emotions in the general public, especially women of childbearing age. A range of emotions including: stress, loneliness, panic attacks, anxiety and depression, variables have been reported. Depression, which is by far the most common and second-ranked disease in the world, is now on the rise. In girls around puberty, if not correctly identified; It can increase the risk of suicide. In pregnant women, it can cause low birth weight, preterm birth, and fetal growth retardation. If a pregnant woman is not properly identified and treated, it can lead to postpartum depression and cause abrupt cessation of breastfeeding and subsequent consequences. In postmenopausal women, it can also destroy their interpersonal relationships and social interactions. Therefore, it is necessary for reproductive health professionals and health care providers, using the public education system, to promote the knowledge of the general public, especially women of childbearing age.
At the end of 2019, Quaid disease put the world in an emergency situation and caused special changes in people's lives [1]. Uncertainty about the length of the quarantine period, insufficient knowledge of the nature of the disease and self-perception are among the changes in the importance of the changes in this period [2]. The effect of Covid 19 on mood is to cause disorders such as anger, confusion and post-traumatic stress disorder [3]. According to the study of Sarafini et al., Behavioral changes in individuals in the Quidd pandemic, from panic behaviors to dramatic behaviors, pervasive feelings of loneliness and hopelessness have been reported differently. Stress, anxiety and depression are among the most important psychological reactions in the Quaid pandemic [4]. It is the most common disease of the present age and the second cause of disability in the world [5]. Depressive disorder is prevalent in all age groups with a relatively high percentage, but is generally more common in the younger age group. Among the younger age group, women are twice as likely as men to be affected, and among women, approximately 20% of people of childbearing age - 15 to 45 years - develop the disorder for the first time [6]. The current situation puts women at serious risk; According to Euston et al., The prevalence of Covid was associated with moderate degrees of depression [7]; Prior to the epidemic, the rate of depressive disorder among women was reported to be 14.4%, which is expected to change with the new changes. In a study by Salamo et al., Which looked at the prevalence of mental disorders in pandemics, the prevalence of mild depressive disorder was 48%; Which indicates an increased risk of disease. Also, in the study of Huang et al., The prevalence of severe depression during this period was reported to be 20.1% [2, 8]. All of which show the importance of paying more and more attention to the issue of depression. Among them, people with a history of previous mental disorders, women, adolescents aged 18-29 and the unemployed are the most at-risk groups [8]. In a study conducted by Fallahzadeh et al., The rate of depression was more prevalent among housewives. Working women are less at risk due to maintaining social relationships, housewives are more at risk due to social constraints on the one hand and having enough time to think about the disease [9]. Spending too much time thinking (more than three hours a day) about illness has a devastating effect on mental health; This issue has a home in women [2]. Social and communication changes on the one hand and the illness of relatives and concerns about their health on the other hand have put people under tremendous pressure [10]; It seems that with the current situation, there is a possibility of developing or exacerbating depressive disorder in all age groups; Therefore, the present review study was performed to determine the effect of Covid 19 pandemic on depression in women of reproductive age.
Adolescents in transition from puberty
Adolescence is the most important period of life and a turning point for the beginning of physical and psychological changes [11]. This period has been referred to as the period of sexual, psychological and social maturity from childhood to adulthood [12]. Statistically, adolescence covers a large part of the world's population. According to the World Health Organization, in 2014, adolescents between the ages of 10 and 19 made up 60 percent of the world's population pyramid. 79% of adolescents live in developing countries [11]. Girls' adolescence, which begins with the signs of puberty, can cause psychological changes. Thus, in the transition from puberty, depressive symptoms are observed for the first time in adolescents. Studies have shown that parents, especially mothers, may also develop symptoms during their child's puberty [13]. The prevalence of depression and the use of antidepressants in adolescents 19-19 years of age has increased significantly since 2000 in girls and boys, before puberty was the same; However, it is more common in girls after puberty [14]. According to Amani, about 10% of adolescents suffer from anxiety and depression together or independently [15]. Depression is a change in mood that can be manifested by symptoms such as severe sadness, insomnia, irritability, anorexia, failure, crying, suicidal thoughts, guilt, etc. [16]. If not identified and treated in time, the symptoms will worsen and can lead to suicide in adolescents [17]. The current new conditions prevailing in the world after the outbreak of Covid disease have caused or exacerbated mental disorders, especially depression [18]. The introduction of new restrictions by health systems to control the disease, including home quarantine, teleworking, and social distance, can be named as the most important causes of depression [19, 1]. According to an online survey conducted during the early stages of Quid 19 in various Chinese cities, more than half of those surveyed suffer from some psychological consequences, including depression, anxiety, and stress [20]. Lack of various daily programs, reduced physical activity and reduced social communication, especially communication with peers due to school closures, is the main cause of the prevalence of depression in adolescents, especially girls [21]. Adolescents' mental health is affected by the family system, and in the Quaid pandemic, family interactions have changed dramatically. Due to home quarantine practices, the family environment is considered one of the key risk factors for depression [22]. Parents are in a tight spot due to stress such as mourning others, changing economic conditions and bearing the burden of educating adolescents due to school closures. However, they play a very important role in increasing the mental health of the family; Because they teach the teen how to manage the situation. The main problem is that due to the long duration of the outbreak, the parents themselves become depressed and lose their spirit of resistance; Therefore, it is necessary for health care providers to try to identify and treat adolescents in a timely manner, especially girls in the transition period from puberty. The current critical situation in the country should be properly described for teenagers. Teenagers will be taught in the form of group workshops, adaptation strategies, and problem-solving skills, taking into account the constraints imposed on gatherings [21, 23].
Pregnancy and postpartum
Depression is one of the most common health problems and the second cause of disability in the world, which is seen in the population of women, especially pregnant women, due to physiological changes. Stress can also trigger or exacerbate depression as a stimulus. Stress and depression during pregnancy can impair the fetal nervous development and, as a result, increase the risk of mental illness for the unborn child. It can also damage the relationship between mother and baby, reduce parental attachment to the baby, and cause postpartum depression. In the meantime, genetic, hormonal, immune and sleep disorders during pregnancy can all be effective in aggravating the mental state of pregnant women [24]. During pregnancy, it can not be easily detected due to the overlap of pregnancy symptoms and depressive symptoms such as sleep disorders, changes in appetite, decreased energy, fatigue and changes in libido [25]. The Covid epidemic has increased the community's need for psychiatric support by increasing fear and stress [26]. Among all groups in the society, pregnant women are considered as one of the groups in need of urgent attention due to the decrease in prenatal care, reduced contact with health professionals, including health care providers, midwives and gynecologists [24].
The Covid 19 epidemic has left pregnant women with limitations such as financial problems, loneliness, reduced contact with specialists and reduced number of prenatal care, which has significantly increased psychological problems in the prenatal period. And after childbirth [24]. The increase in these restrictions during pregnancy has raised concerns about the impact of corona on the quantity and quality of prenatal care. Women are concerned about the possibility of vertical transmission of the infection from mother to fetus, and the adverse outcomes of pregnancy and childbirth due to Covid 19 have all been able to affect the mental health of pregnant women [27]. Hospital restrictions, including the absence of a spouse during childbirth, can also reactivate traumatic memories and exacerbate the symptoms of PTSD [27].
Breastfeeding
Breastfeeding is a desirable way for infants to feed and grow, with the World Health Organization emphasizing exclusive breastfeeding. Early cessation of breastfeeding, decreased breastfeeding duration, and increased breastfeeding problems are positively correlated with postpartum depression [28]. According to Kashkoli and Zia study, the prevalence of postpartum depression is reported to be 22%.
According to the American Association of Obstetricians and Gynecologists, risk factors for perinatal depression include: maternal anxiety, stressful life, history of depression, lack of social support, unwanted pregnancy, domestic violence, low income, poor relationship status, depression during pregnancy, Anxiety during pregnancy, stressful life events during pregnancy or early postpartum, traumatic delivery experience, premature birth, neonatal admission, history of depression, and breastfeeding problems have been reported [29]. In the current context of the world, the concern of transmitting the virus through breast milk is considered as the key risk factor for early cessation of breastfeeding and consequently increase the likelihood of postpartum depression. In the meantime, infecting a breastfeeding mother can also cause fear for families. What is the right action and how should the new situation be managed [30]? Of course, the Quaid pandemic has had both positive and negative effects on the experience of lactating women. The fact that women stay at home for a long time reduces external stress and can easily increase the number of times they are breastfed. Being at home can help improve the mental health of breastfeeding women by reducing the contagious diseases of infancy and subsequently reducing the stress of frequent visits. In the meantime, the continuous closures have caused the husbands to be involved in breastfeeding, in other words, to support and encourage more women. On the other hand, the application of restrictions has reduced the social and psychological support of those around them and the formation of a feeling of loneliness in breastfeeding women. It has been reported that in some women, due to sufficient time to breastfeed and focus on it, it causes them to hate breastfeeding [31, 32]. It seems that the current situation will be associated with different experiences for breastfeeding women. Therefore, health care providers need to check the current situation.
Menopause
Menopause is defined as the reproductive condition after 12 consecutive months of amenorrhea and the end of the reproductive period. For most women, menopause occurs at an average age of 51 years [33], during this period of the life cycle with some biological events, hormonal changes, Socially, familially and personally, the likelihood of depression increases [34]. Menopausal depression refers to mood swings that include a feeling of sadness and hopelessness that ranges from mild to severe, which affects physiological behavior, attitudes, thinking, and physiological actions [35]. This effect causes behavioral problems and emotional disorders both during menopause and during the transition period [36]. The study of Kazemian et al. Showed that women entering menopause; They are more at risk for depression than others. Disability, disruption of interpersonal functions, loss of social and occupational functions and heavy economic costs for the family system and health system are the most important consequences of not recognizing and treating depression in postmenopausal women in time.
The Covid 19 epidemic poses a new challenge to postmenopausal women. Fear and anxiety about the spread of the disease and how it is transmitted, misinformation about Covid 19, travel bans, public orders to control infection, frustration and insufficient financial resources, and economic losses have all affected the psyche of postmenopausal women [37]. Physical illness, caring for family members, marital problems and empty nest syndrome can also be other predisposing factors for depression, which in the current situation, due to limited travel and rapid transmission of the disease, somehow affects health. And the quality of life of postmenopausal women [38]. Due to the uncertainty of when the disease will end, it is necessary to examine the quality of life of postmenopausal women and the prevalence of depression in them, then through mass media to their group training to improve the quality of life and adapt to the new and changed lifestyle of Covid. Let's pay.
Provide a solution
About two year after the onset of Covid disease, the various effects of the disease on the mental health of women of childbearing age - from adolescent girls to postmenopausal women - are somewhat clear. Forced changes in people's lifestyles have affected their quality of life and mental health. Given the issues clearly stated above, it is necessary for the general public to become familiar with the important and forgotten issue of depression. Non-pharmacological treatment methods such as: cognitive-behavioral therapies, regular exercise, relaxation, improving the social support network, spiritual therapy, telemedicine should be introduced to individuals [39]. The mass media, which are the most important source of medical information today, explain the cases of self-care in case of depression in well-written programs with the help of health experts.
The Covid 19 pandemic had different effects on the lives of people, especially women. One of the most important effects of quarantine and reduced social interaction is the increased risk of depression in general and in women of childbearing age in particular. Given that the most important source of information for individuals are the mass media and health care providers; It is necessary for health care providers, reproductive health professionals and health care providers to make proper plans for timely screening and referral. To complement the role of health advocates, it is necessary for the mass media to increase public awareness of depression and non-pharmacological complementary therapies.
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