An exploration into the impact of the COVID-19 pandemic on maternal mental health in high-and middle-income countries with a case study in East Sussex

Background The physical isolation that the Coronavirus pandemic enforced resulted in a decline in mental health that disproportionally affected higher risk individuals, including women in the perinatal period. The wellbeing of perinatal women was, at times, neglected due to hospital and governmental isolation regulations. The aim of this study was to conduct a scoping review and Key Informant Interviews (KII) to identify gaps and opportunities for further research, and to distinguish discrepancies and correlations between the two sources of information. Methods Two methods were utilised: a scoping review and KIIs. The scoping review identified relevant articles through a database search on Google Scholar, PubMed and EBSCO. The KIIs were conducted virtually with counsellors working in a maternal mental health charity in South-East England. Both methods collected qualitative data and were thematically analysed. Results 95 articles were eligible for the review and 5 participants were recruited for the KIIs. Thematic analysis revealed 6 themes in both sources (1) demographics; (2) support; (3) policy; (4) insecurity; (5) anxiety; and (6) milestones. Between the two datasets there were no disparities in the impacts of changing policies, fear of the virus, and the grief caused by missing perinatal milestones on mental health. Significant discrepancies were identified in the influence of demographic characteristics, which was a risk factor for adverse mental health outcomes. Conclusion The most prominent theme in the review is the reduced support available, whilst the KIIs indicate that changing hospital policies are the main cause of harm to perinatal mental health. Birth trauma is deemed to be of significance in the interviews but not in the literature. Further research should focus on the impact of the pandemic on recovery following birth trauma to identify long-term implications and facilitate policy changes to reduce the risk of birth trauma/ post-traumatic stress disorder. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the Brighton and Sussex Medical School (BSMS) Research Governance and Ethics Committee (RGEC) on 16 January 2023 (ER/BSMS9EKA/1). Oral consent was obtained from research participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All relevant data are within the manuscript and its Supporting Information files.