War in Ukraine vs. Motherhood: Mental health self-perceptions of relocated pregnant women and new mothers

doi:10.21203/rs.3.rs-4656284/v1

Download PDF

Research Article

War in Ukraine vs. Motherhood: Mental health self-perceptions of relocated pregnant women and new mothers

https://doi.org/10.21203/rs.3.rs-4656284/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background: The Russian military’s carnal crimes render certain Ukrainian areas uninhabitable. As a result, a significant portion of the population is experiencing stress-related issues caused by hostilities and forced displacement. This research aimed to examine the self-assessed mental health of pregnant women and new mothers (PNM) who faced relocation.

Methods: This report presents findings from a study conducted as part of the Perinatal Mental Health for Refugee Women (PMH-RW) Project. This study used data from 191 PNM who are either internally displaced persons (IDP) or refugees (REF).

Results: A higher number of REF than IDP were from the capital, but fewer from rural communities, and new mothers were more likely to hail from major cities than pregnant women. The discrepancy in migration options likely causes the frequent relocation of some groups to inadequately equipped areas, thereby increasing their vulnerability. For example, REF experienced far less pregnancy complications than IDP. The Gini coefficient of 0.153 suggests minor income inequality among the respondents. However, there is a stark contrast between this relatively low inequality and the substantial reports on worsened financial conditions post-invasion. This finding underscores the significant impact of war-related financial instability on the perceived distress of postnatal mothers (PNM), with financial burdens emerging as a primary predictor of their distress.

Conclusion: The financial burden and socio-economic background of pregnant and new mothers during wartime migration can define their mental health resilience. The inconsistent availability of essential resources caused by wartime economic woes significantly influences the perceived well-being of PNM.

Trial registration: Clinical trial registration was completed at ClinicalTrials.gov under identifier NCT05654987 (Date: December 16, 2022).

sociodemographics

wartime

relocation

maternal health

motherhood

women

- Several migration trends significantly impact the perceived mental health of Ukrainian pregnant women and new mothers.

- Relocated pregnant women and new mothers face financial burdens and increased stress linked to their original residence.

- Access to medical care is a primary stressor affecting the mothering experience among relocated women.

The ongoing war in Ukraine has profoundly impacted various facets of societal life, specifically mental health. War-related stressors, i.o., air-raid alarms and explosions, significantly increased the anxiety of Ukrainians, negatively affected their mental health, and also caused the remission of somatic symptoms (Stieger et al., 2023). PNM are among the most highly susceptible to various stressful factors engendered by warfare, as noted by Chrzan-Detkoś et al. (2023). Such risk factors can include exposure to violent and traumatic events such as explosions, severe restrictions on personal freedom, acts of violence including sexual violence, forced or violent displacement, and torture (Karatzias et al., 2023). All of the listed can be experienced in Ukraine nowadays, as Russians’ terror continues. After a year of full-scale war, compared to its initial period, the financial level of Ukrainian family’s income and women’s opportunities for employment decreased, but the role of women in planning family life increased significantly (especially the wives of military personnel) (Gradus Research Company, 2023).

A large number of women were forced to flee abroad during the war. The majority of migrants who arrived from Ukraine in the host countries have needs for language learning, financial support, employment, etc. Results of the Survey of Arriving Migrants from Ukraine (Gradus Research Company, 2024) showed that in December 2023 more than 60% remain at the same place of residence as before the beginning of the full-scale invasion of the Russian Federation, more than 20% left their permanent place of residence but have already returned, about 15% left their permanent place of residence and did not return. As for PNM, these ratios may be different, but there is currently no accurate data for this population.

It should be noted that during pregnancy and the postpartum period, even without particularly traumatic events, women have an increased risk of anxiety and depression (Dennis et al., 2017; Rasmussen et al., 2017). Depression and anxiety manifestation is related to the socio-demographic background of PNM. In a study of Indian pregnant women (Bhat et al., 2015), anxiety and depression scores were higher in the first trimester of pregnancy, age and income were significant contributors to anxiety, and age, gestational age, education level, and qualifications also showed significant associations with depression. Makara-Studzińska et al. (2013) obtained similar results in a Polish sample. Symptoms of anxiety were more often experienced by unmarried women, unemployed women, as well as those who rate their housing and financial situation as worse. The most susceptible to depressive symptoms were women with primary education and those who rated their financial and housing situation as worse.

Given the special vulnerability of peripartum women, they are at a higher risk for negative consequences compared to the general population (Roumieh et al., 2019). Pregnant refugee women in Slovenia had higher rates of preterm birth and emergency caesarean section (Bombač et al., 2018). According to Koen et al. (2016), there is a potential association of peripartum trauma with poor maternal foetal outcomes. Keasley et al. (2017) have established a relationship between the impact of the armed conflict and low birth weight, miscarriages, stillbirths, prematurity, congenital anomalies, and premature rupture of membranes.

Up to date, there are few publications on the impact of armed conflicts on the mental health of Ukrainian women in the perinatal period. In the focus of Punamäki et al. (2018) were Palestinian women from the Gaza Strip during pregnancy, 4 and 12 months postpartum. They were diagnosed with post-traumatic stress disorder (PTSD), depressive, anxiety and dissociative symptoms, as well as complications of pregnancy and subsequent sensorimotor and language development of infants. A study conducted on a sample of Syrian postpartum women indicated a high proportion of women with a high level of postpartum depression (28.2%) (Roumieh et al., 2019). Stevenson et al. (2023), analysing the data of 135 studies, singled out the following key factors of perinatal depression: being a recently arrived immigrant, having poor social support, and having a poor relationship with one’s partner. In a systematic review, Falah-Hassani et al. (2015) also found a higher incidence of postnatal depression among migrant women.

After the annexation of Crimea and the occupation of part of Donbas by the Russian Federation in 2014, Ukraine experienced a significant wave of internal displacement. Few studies on internally displaced pregnant women have shown that these women are more prone to premature termination of pregnancy, and exhibit higher prevalence of somatic diseases compared to non-displaced ones (Romanenko, 2019). Additionally, approximately one-third of these women met the criteria for PTSD (Ancheva & Morozova, 2016).

The objective of this study is to examine the perceived mental health of PNM who were forced to relocate due to the Russian invasion of Ukraine. The specific research questions addressed are: (1) What are the sociodemographic differences among PNM who have chosen to relocate?; (2) How do relocated PNM assess their mental health and need for medical care?; (3) How are birth-related factors linked to relocation decisions and mental well-being in PNM?; (4) What are the primary stresses that PNM experience, and what variables impact their self-assessed level of distress?; (5) What are the primary sources of support and which variables can be regarded as protective for the mental health of PNM?

Study Design and Participants

This paper presents results from a study conducted as part of the Perinatal Mental Health for Refugee Women (PMH-RW) Project. The study protocol, previously published by Rodríguez-Muñoz et al. (2023), guided data collection using the Qualtrics® XM platform on the National University of Distance Education’s website (https://blogs.uned.es/mama/), from December 1, 2022, to October 1, 2023. Participants were selected based on these criteria: (1) being pregnant or a biological mother to an infant up to 12 months old; (2) being 18 years or older; (3) living in Ukraine during or after the Russian invasion, or being a Ukrainian war REF in the EU since February 24, 2022; (4) consenting to participate. Of the 734 respondents, 78 were IDP (10.6%), 113 sought refuge in EU countries (15.4%), and 543 stayed in Ukraine (74.0%). This paper focuses on data from 191 PNM who are either IDP or REF, as illustrated in Figs. 1, 2 [near here].

Measures

Data were gathered using the ‘Assessment, Care, and Trust – In Pregnant and New Mothers (ACT-PNM)’ Questionnaire, detailed in the research protocol by Rodríguez-Muñoz et al. (2023). Comprising 40 items, the ACT-PNM gathers sociodemographic data and assesses perceived mental health impact from the war, serving as a preliminary diagnostic tool, as shown in Table 1 [near here].

Table 1

Assessment, Care, and Trust – In Pregnant and New Mothers (ACT-PNM) Items.
Item	Answer Type
Section 1. Sociodemographic data
Current residence	Dichotomous
Forced migration	Dichotomous
Education	Multiple choice
Pregnancy status	Dichotomous
Prior pregnancies	Open-ended (num.)
Number of biological children (including miscarriages)	Open-ended (num.)
Number of residents at home	Open-ended (num.)
Marital status	Multiple choice
Co-living with partner	Dichotomous
Section 2. War-related impact on mental health
How did the war affect your mental well-being?	Likert’s Scale
In general, how much did the war affect your everyday life?	Likert's Scale
How has the war outbreak changed your stress levels or mental health?	Multiple choice
What is the biggest source of stress due to war right now?	Multiple choice
What are you doing to cope with your stress related to the war outbreak?	Multiple choice
Are you currently receiving treatment for mental health concerns (e.g., depression, anxiety, stress, ADHD, bipolar disorder, eating disorder, or PTSD)?	Dichotomous

Data Analysis

Data analysis was conducted using R software (version 4.3.2, released October 31, 2023). Authors employed Pearson’s Chi-squared test with simulated p-value (based on 2000 replicates), Fisher’s exact test, Gini coefficient, ordinal logistic regression modelling with cumulative link model. All statistical analyses adhered to a common threshold of significance level (p < 0.05).

The demographic characteristics of the study population are detailed in Table 2 [near here]. The Chi-squared test, based on 2000 replicates, underscores substantial disparities in the demographic profiles of PNM, based on their migration status as IDP or REF, particularly with regard to their previous places of residence (χ² = 13.73, p = 0.005). Fisher’s Exact Test further confirms these disparities, indicating significant differences in the distribution of previous residence types between groups (p = 0.003). In detail, a larger percentage of REF (25.0%) compared to IDP (14.3%) originated from the capital city. While both groups showed a significant representation from larger cities – 50.0% of IDP and 33.3% of REF – a higher proportion of IDP are associated with this type of area. Conversely, REF had a greater representation from small towns (32.1% compared to 12.5% for IDP) and fewer REF originated from villages (9.5%) compared to IDP (23.2%), indicating a more rural background among the IDP group. Additionally, there are a difference in the origins of new mothers compared to pregnant women based on Chi-squares test (χ² = 6.19, p = 0.002), which aligns with Fisher’s Test results (p = 0.0004). New mothers more commonly came from big cities (40%) and less frequently from small towns (24.3%), whereas pregnant women were more likely to come from small towns (49%) and less from big cities (29.4%).

Table 2

Comparison of sociodemographic characteristics of PNM groups
Variables	Pregnant		New Mothers		χ² (p)
Variables	IDP	REF	IDP	REF	χ² (p)
Respondents, n	22	29	56	84
Level of education, n(%)	χ² = 8.55, p = 0.104		χ² = 3.16, p = 0.743		4.45 (0.487)
Incomplete secondary	1 (4.5)	2 (6.9)	1 (1.8)	1 (1.2)
Full secondary education	4 (18.2)	2 (6.9)	10 (17.9)	8 (9.5)
Incomplete higher education	3 (13.6)		5 (8.9)	6 (7.1)
Bachelor	4 (18.2)	11 (37.9)	12 (21.4)	22 (26.2)
Masters	9 (40.9)	14 (48.3)	28 (50.0)	46 (54.8)
Scientific degree	1 (4.5)			1 (1.2)
Marital status, n(%)	χ² = 1.45, p = 0.933		χ² = 1.50, p = 0.705		4.60 (0.326)
Single	1 (4.5)	1 (3.4)	1 (1.8)	5 (6.0)
Partnered/Married	14 (63.6)	20 (69.0)	45 (80.4)	64 (76.2)
Divorced/Separated	6 (27.3)	5 (17.2)	9 (16.1)	13 (15.5)
Widowed	1 (4.5)	1 (3.4)	1 (1.8)	2 (2.4)
Other (Unspecified)		1 (3.4)
Place of residence, n(%)	χ² = 0.09, p = 0.999		χ² = 13.73, p = 0.005		6.19 (0.002)
The capital	5 (22.7)	6 (20.7)	8 (14.3)	21 (25.0)
Big city	6 (27.3)	9 (31.0)	28 (50.0)	28 (33.3)
A small town	11 (50.0)	14 (48.3)	7 (12.5)	27 (32.1)
Village			13 (23.2)	8 (9.5)
Financial situation before war, n(%)	χ² = 2.95, p = 0.262		χ² = 2.53, p = 0.513		4.31 (0.255)
Very good	2 (9.1)	7 (24.1)	11 (19.6)	20 (23.8)
Good enough	13 (59.1)	19 (65.5)	32 (57.1)	52 (61.9)
Not very good	4 (18.2)	2 (6.9)	3 (5.4)	4 (4.8)
Very bad				4 (4.8)
Financial situation after war, n(%)	χ² = 3.26, p = 0.635		χ² = 4.09, p = 0.423		2.13 (0.772)
Much better	1 (4.5)			3 (3.6)
Improved	2 (9.1)	1 (3.4)	2 (3.6)	2 (2.4)
Unchanged		1 (3.4)		3 (3.6)
Somewhat worsened	7 (31.8)	13 (44.8)	19 (33.9)	30 (35.7)
Much worsened	4 (18.2)	6 (20.7)	16 (28.6)	23 (27.4)

Predominantly, individuals in both categories are either partnered or married (74.8%), with no significant differences (p = [0.326; 0.933]), highlighting that family ties likely remain stable despite the challenges of displacement. At the same time, there is a shift in education level among the discussed sample in general (p = [0.104; 0.743]) with prevalence of respondents participating with completed higher education – bachelor’s (25.7%) or master’s degree (50.7%) as well. Moreover, the Chi-squared test indicates no significant differences in financial status for different groups both before and after the Russian invasion (p = [0.255; 0.772]). This finding is further underscored by a low Gini Coefficient of 0.153, indicating minimal inequality among respondents. The substantial proportion of individuals reporting worsened financial conditions after full-scale invasion among all subgroups – 61.7% from general sample – provides a stark contrast, pointing to the severe economic difficulties faced by war affected PNM.

The analysis of whether the current pregnancy is the first one for the respondents shows a marginal trend towards significance (р = 0.082) suggesting a possible variation in family planning or birth intervals that does not reach conventional levels of statistical significance, but is still shaping migration processes (See Table 3 [near here]). There is lack of data on other types of pregnancy despite singleton – indicated for only 6,3% of respondents – which reveals possible limitations of presented design. Still, we can assume that the incidence of complications during pregnancy presents a stark contrast. Particularly, among new mothers, where the chi-square values reveal a significant difference (χ² = 13.66, p = 0.004). New mothers REF had significantly fewer complications compared to IDP new mothers. Concerns regarding medical care access were primarily reported only by new mothers that had to refuge from Ukraine (3.6%). The ratio of chosen main stressors, highlighted at Fig. 3 [near here], shows prosocial tendency among the PNM population. Naturally, REF are less likely to refer to safety issues (12.4%) compared to IDP (33.3%). Still REF are more often worried about the war outcomes on relatives (35.7%) and community (27.2%), unlike the IDP (30.2%, 15.9%, respectively).

Table 3

Comparison of birth-related characteristics of PNM groups
Variables	Pregnant		New Mothers		χ² (p)
Variables	IDP	REF	IDP	REF	χ² (p)
Respondents, n	22	29	56	84
Pregnancy type, n(%)	χ² = 0.08, p = 0.999		χ² = 1.66, p = 0.729		0.91 (0.893)
Singleton	21 (95.5)	27 (93.2)	49 (87.5)	81 (96.4)
Twin		1 (3.4)	1 (1.8)	2 (2.4)
N/A	1 (4.5)	1 (3.4)	5 (8.9)	1 (1.2)
Other Children	χ² = 3.47, p = 0.077		χ² = 3.41, p = 0.079		3.48 (0.082)
First child	16 (72.7)	14 (48.3)	35 (62.5)	43 (51.2)
Not first	5 (22.7)	14 (48.3)	17 (30.4)	41 (48.8)
N/A	1 (4.5)	1 (3.4)	4 (7.14)
Complications	χ² = 0.34, p = 0.911		χ² = 13.66, p = 0.004		6.74 (0.529)
None	16 (72.7)	20 (68.9)	25 (44.6)	55 (65.5)
One	3 (13.6)	5 (17.2)	11 (19.6)	16 (19.1)
Two	2 (9.1)	4 (13.8)	8 (14.3)	8 (9.5)
Three or more	1 (4.6)		11 (19.6)	4 (4.7)
N/A			1 (1.8)	1 (1.2)

Though PNM subgroups assess war’s impact on mental health differently, they seek mental health care similarly (See Table 4 [near here]). Slight differences among new mothers and pregnant women regarding this question with p-values reaching for significance threshold (p = 0.059) are not supported by Fisher’s Exact Test results (p = 0.083), indicating dispersion disproportion among groups. 92.9% of IDP and 91.4% of REF as well stated that they did not intend to seek help. The highest percentage of women who received treatment due to mental health problems was among REF (7.6%); in contrast to IDP (4.8%).

Table 4

Comparison of mental health seeking behaviour among PNM groups
Variables	Pregnant		New Mothers		χ² (p)
Variables	IDPs	REFs	IDPs	REFs	χ² (p)
Receiving mental health care, n(%)	χ² = 0.16, p = 0.999		χ² = 2.69, p = 0.265		1.55 (0.059)
Yes	2 (11.1)	2 (7.1)	1 (2.2)	6 (7.8)
No	17 (88.9)	26 (92.9)	42 (93.3)	70 (90.9)
I don’t want to answer			2 (4.4)	1 (1.3)

Figure 4 [near here] represents preferred ways of coping with the stressful impact of war. PNM selected sociable contacts and activities more often, although their sociability may be predicted by multiple routes. The REF subgroup primarily focused on ‘being in touch’, as noted by one of participants, saving ability to interact and staying up to date informed. REF most commonly cope by chatting with peers (30.5%), spending time on social media (14.5%), and monitoring international news (11%). IDP, unlike REF, preferred prosocial coping including aiding others (4.3% compared to 2.1% among REF), communicating with peers (30.1%) or other PNM (16.2%), and decreasing social media usage (10.0%). IDPs may have been more focused on ‘being present’, as a means of restoration.

Pregnant women tend not to use substances to cope with stress, whereas 3.1% of new mothers prefer this option. Pregnant women more frequently opt for social interactions, while new mothers are more inclined to choose eating comfort food (13.4%), communicating with other pregnant women or parents (18.6%), and increasing time spent on social networks (10.3%). Additionally, new mothers are less likely to choose coping strategies that enhance self-care (such as sleep, meditation, sports, or reading) compared to pregnant women (4.1% compared to 11.2%).

An ordinal logistic regression model was fitted using the cumulative link model to assess the predictors of self-reported distress levels (See Table 5 [near here]). The absence of the Hauck-Donner effect in any of the estimates indicates that the coefficient estimates are reliable. Based on this model, we can assume main perceived stressors in post-invasion experiences of PNM from Ukraine. Concerns regarding the financial consequences of war on respondents’ households were significantly associated with higher levels of general distress in daily life (℮ = 0.382, p < 0.001, OR = 1.465). The perceived stress from financial burdens potentially linked to participants’ original place of residence, as detailed in Fig. 5 and Fig. 6 [near here]. Additionally, respondents who reported negative changes in their financial situation experienced a 75.4% increase in perceived distress (℮ = 0.562, p < 0.001, OR = 1.754).

Table 5

Ordinal modelling results for perceived distress level predictors
Variable	Estimate	Std. Error	z value	Pr(>\|z\|)	P-value
Financial situation changes	0.562	0.169	3.320	0.001	< 0.001
Finances-related stress	0.382	0.055	6.967	3.23e^− 12	< 0.001
Lack of support sources	0.143	0.052	2.727	0.006	< 0.01
Disruption of social support network	0.313	0.051	6.130	8.81e^− 10	< 0.001
Original place of residence	0.249	0.060	5.121	0.001	< 0.001

Higher ratings of lacking support sources were also associated with increased levels of tension (℮ = 0.143, p < 0.01, OR = 1.154), indicating that the odds of reporting higher distress levels rose by 15.4% for each unit increase in the lack of support sources. Similarly, each one-level increase in the assessment of disruption in the social support network was associated with a 36.7% increase in distress levels (℮ = 0.313, p < 0.001, OR = 1.367). From this point, we can assume that social support as well as financial stability could possibly serve as protector factors of wartime related distress in PNM (OR > 1). Moreover, based on the cumulative link model, the effect of various predictors directly on respondents’ perceived mental well-being was evaluated (see Table 6 [near here]). Concerns about a child’s health due to the war were a primary negative predictor of mental well-being (℮ = 1.095, p < 0.001, OR = 0.334). This indicates that those with concerns about their child’s health due to the war are 66.4% more likely to report a worsening in mental well-being and are likely more ready to relocate. The place of origin residence (℮ = 0.780, p < 0.001, OR = 0.458) was also a predictor of well-being. Those who had migration status of refugee were 54.2% of rose in distress levels, as visualised in Fig. 7 [near here].

Table 6

Ordinal modelling results for perceived mental well-being predictors
Variable	Estimate	Std. Error	z value	Pr(>\|z\|)	P-value
Concerns on child’s health	1.095	0.314	3.489	0.001	< 0.001
Inability to receive medical care	0.679	0.294	2.309	0.021	< 0.05
Concerns on family involvement	0.630	0.308	2.044	0.041	< 0.05
Original place of residence	0.780	0.147	2.439	0.041	< 0.001

Additionally, individuals who encountered difficulties accessing medical care (℮ = 0.679, p < 0.05, OR = 1.971) and those who expressed concerns about potential changes in family support (℮ = 0.630, p < 0.05, OR = 0.533) reported lower well-being following the full-scale invasion. The odds ratio for the access to medical care variable, contrasting with concerns about changes in family support, was greater than 1, suggesting that the perceived stressors associated with these changes were predominantly related to family support, while access to medical care could serve as a protective factor for PNM during wartime. Overall, the regression analysis indicates that financial burdens, the original location of the household, concerns about a child’s health, access to medical care, and expectations regarding future family involvement in childcare were significant predictors of perceived war-related distress, ultimately contributing to reports of deteriorated mental health.

The study identified varying patterns of displacement and migration among PNM, which possibly influenced by the socio-economic and conflict-related factors in different types of regions. At the same time, this variance also reflects post-migration mental health outcomes. Based on the findings of our study, perceived and real financial status were primary protective factors of distress among respondents. As we can assume from prior studies, their place of original residence could serve as moderator of distress level, and define their material and mental well-being (Abbasi-Shavazi, 2021).

There is a substantial body of evidence highlighting the negative impact of wartime events (Buitrago & Moreno-Serra, 2021) and displacement (Kamilova & Gulieva, 2023) on women’s perinatal health. For instance, Syrian REF new mothers have reported higher rates of Caesarean sections, anaemia, lower newborn weights, and lower APGAR scores compared to other groups of new mothers (Alnuaimi et al., 2017). Contrary to these findings, our study revealed that REF new mothers had lower complication rates and better health outcomes compared to IDP. While the difference in the presence and number of pregnancy complications between pregnant REF and IDP was not statistically significant, the number of complications among new mothers was significantly higher in the IDP group. Results also highlighted that only PNM who were forced to flee Ukraine primarily expressed concerns about access to medical care as a source of distress. This underscores the need for additional interventions focused on engaging refugee PNM, as they tend to seek help later and experience additional stress due to their migration status (Chrzan-Dętkoś et al., 2023).

It should be noted that a group of Ukrainian internally displaced women was affected by factors related, on the one hand, to displacement, and on the other hand, to war conditions. As noted by Romanenko (2019), internally displaced PNM have an increased risk of somatic and mental health issues. Moreover, the stress-related states were assessed as risk factors for childbirth and mothering complications (Baas et al., 2020; Rozhkovska et al., 2023). Despite this condition, there were no significant differences in mental health help-seeking behaviour among PNM subgroups. These results can reflect gaps in mental health literacy or maladaptive attitudes related with migration status among the population, as noted by Daehn et al. (2022).

Recent findings show that there is a relationship between social support and mental health in pregnant women (Bedaso et al., 2021) and new mothers (Chojenta et al., 2012). In our study, we received confirmation of this significant factor in the level of distress of PNM, which, together with financial support, turned out to be even more important compared to the factor of direct impact of military events. Moreover, the research findings indicate that women voluntarily employ coping strategies centred around social communication, including interactions with relatives, friends, and other PNM. This form of coping was identified as a potentially protective factor against war-related distress, consistent with earlier findings reported by Renner et al. (2020). But it should be noted that among both subgroups, pregnant women more often use constructive coping, whereas new mothers more often choose destructive coping. As evidence shows, stress caused by war and displacement can interfere with postpartum depressive states (Collins et al., 2011; Dennis et al., 2017). Therefore, this may cause destructive coping strategies among mothers that cannot cope with the stressful situation of wartime migration.

The cumulative link model allowed to indicate the predictors of PNM’s mental well-being. Concerns about the child’s health because of the war, concerns about future changes in family support, as well as to be faced with one or more problems with accessing medical care are variables that predict a low level of mental well-being of PNM, who are REF or IDP during the ongoing war. Support from friends, partners, and family are factors that reduce the risk of antenatal depression among pregnant immigrant women (Marcos-Nájera et al., 2019). As follows from the results of our study, such support predicts a higher level of mental well-being of PNM. The obtained results specify and confirm the results of the qualitative study of the perinatal experience of Ukrainian women at the beginning of the full-scale war in Ukraine (Krupelnytska & Morozova-Larina, 2023). Among the highlighted in-depth interview’s themes were ‘Positive attitudes towards the child (or unborn child)’, ‘Suffering associated with separation from a husband and relatives’, ‘Family relationships and support during the war’, and two themes regarding medical support indicating the importance of this aspect of PNM life: ‘Dissatisfaction with medical support during the war’, and ‘Satisfaction with medical support during the war’. Overall, this study demonstrates the importance of social support for PNM, ensuring their confidence in their own financial well-being to reduce perceived stress levels, as well as a sufficient level of support for their children’s health and access to medical care in conditions of war and migration.

Limitations

There are several limitations in this study. Firstly, the sample of PNM is relatively small in size, and secondly, the sample included only PNM who live or lived in the territory of Ukraine, which was not occupied at the time of the study. Thirdly, among the REF, the majority of women had a bachelor's degree or a master's degree. Therefore, the results obtained in the study relate primarily to this category of PNM. Fourthly, the research plan did not provide information about the exact age of the PNM and no data were collected regarding migration decision-making.

It found that despite safety concerns, the problems that PNM consider to be the main causes of their own distress are mostly was not war-related. Mental wellbeing of pregnant women and new mothers from Ukraine, who faced relocation, can be influenced by several demographic and contextual factors. For instance, social support network and availability of medical care and support sources, as well as financial wealth and socio-economic background can serve as protective factors of perceived war-related distress. At the same time, child’s health and family involvement concerns were identified as primary stressors and perceived threat for displaced pregnant women and new mothers. The level of complications during pregnancy in the group of internally displaced new mothers turned out to be significantly higher than among REF new mothers. There is no reason to claim that there are healthier and more prosperous women outside of Ukraine. Staying in host countries is associated with a language barrier, often ignorance of their rights and social insecurity, which make it difficult to contact relevant specialists or prevent PNM from seeking help. However, despite this, the level of availability of medical care for such women may be higher, compared to such care in their home country, where the war continues. Professionals who provide care for PNM should consider that concerns about the health of the child, as well as the experience of facing problems with access to health care, are the main variables that predict low levels of mental wellbeing in these women.

PNM – pregnant women and new mothers

REF – refugees

IDP – internally displaced persons

PMH-RW - Perinatal Mental Health for Refugee Women

Ethics approval and consent to participate

The study protocol was approved by the Research Ethics Committee of Universidad Nacional de Educación a Distancia (21-PSI-2022) andthe Research Ethics Committee of the Faculty of Psychology of Taras Shevchenko National University of Kyiv (Date: August of 2022, Decision No. 04, Protocol No. 01). Informed consent was obtained from all respondents in a digital form.

Consent for publication

Not applicable

Availability of data and materials

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation

Competing interests

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding

This paper is based upon work from the COST Action Riseup-PPD CA 18138 and was supported by COST under COST Action Riseup-PPD CA18138 www.cost.eu.

Authors' contributions

LK did the study design, coordinated the study, recruited participants and drafted the manuscript, AV did the study design, recruited participants, analyzed the study data, edited the manuscript, NYa did the study design, analyzed the study data, edited the manuscript, MCh recruited participants, edited the manuscript, OM-L did the study design, recruited participants, edited the manuscript, AU recruited participants, edited the manuscript, MFR-M recruited participants, edited the manuscript. All authors contributed to the article and approved the submitted version.

Acknowledgements

Not applicable

Abbasi‐Shavazi, M. J. (2021). COVID‐19, economic recession, and the Refugee situation. International Migration, 59(1), 289–292. https://doi.org/10.1111/imig.12820
Alnuaimi, K., Kassab, M., Ali, R., Mohammad, K., & Shattnawi, K. (2017). Pregnancy outcomes among Syrian refugee and Jordanian women: A comparative study. International Nursing Review, 64(4), 584–592. https://doi.org/10.1111/inr.12382
Ancheva, I., & Morozova, K. (2016). Post-traumatic stress disorder amongst internally displaced pregnant females. Journal of Applied Life Sciences International, 9(1), JALSI.28130. Retrieved from https://repo.odmu.edu.ua:443/xmlui/handle/123456789/7411
Baas, M. A., van Pampus, M., Braam, L., Stramrood, C. A., & Jongh, A. (2020). The effects of PTSD treatment during pregnancy: systematic review and case study. European Journal of Psychotraumatology, 11(1), 1762310. https://doi.org/10.1080/20008198.2020.1762310
Bedaso, A., Adams, J., Peng, W. & Sibbritt, D. (2021). The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reproductive Health, 18, 1-23. https://doi.org/10.1186/s12978-021-01209-5
Bhat, M. A., Hassan, R., Shafiq, M., & Shaikh, Sh. (2015). Sociodemographic factors: A major predictor of anxiety and depression among pregnant women. Delhi Psychiatry Journal, 18(1), 86-94. https://doi.org/10.1186/s12905-017-0411-1
Bombač, L., Premru-Sršen, T., Lučovnik, M., & Lipovec Čebron, U. (2018). Perinatal outcomes of pregnant refugees/asylum seekers in Slovenia during the 2015-2016 humanitarian corridor. Gynaecologia et Perinatologia, 27(3-4), 53–58. Retrieved from https://hrcak.srce.hr/251871
Buitrago, G., & Moreno-Serra, R. (2021). Conflict violence reduction and pregnancy outcomes: A regression discontinuity design in Colombia. PLoS Medicine, 18(7), Article e1003684. https://doi.org/10.1371/journal.pmed.1003684
Chojenta, C., Loxton, D., & Lucke, J. (2012). How Do Previous Mental Health, Social Support, and Stressful Life Events Contribute to Postnatal Depression in a Representative Sample of Australian Women? Journal of Midwifery & Women’s Health, 57(2), 145–150. https://doi.org/10.1111/j.1542-2011.2011.00140.x
Chrzan-Dętkoś, M., & Murawska, N. E. (2023). “We are in this together” – Polish midwives’ reflections on perinatal care for Ukrainian women after the outbreak of war. Health Psychology Report, 11(3), 177–187. https://doi.org/10.5114/hpr/161996
Collins C. H., Zimmerman C., & Howard L. M. (2011). Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Archives of Women's Mental Health, 14, 3–11. https://doi.org/10.1007/s00737-010-0198-7
Daehn, D., Rudolf, S., Pawils, S., & Renneberg, B. (2022). Perinatal mental health literacy: knowledge, attitudes, and help-seeking among perinatal women and the public–a systematic review. BMC Pregnancy and Childbirth, 22(1), Article 574(2022). https://doi.org/10.1186/s12884-022-04865-y
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315–323. https://doi.org/10.1192/bjp.bp.116.187179
Falah-Hassani, K., Shiri, R., Vigod, S., & Dennis, C.-L. (2015). Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. Journal of Psychiatric Research, 70, 67–82. https://doi.org/10.1016/j.jpsychires.2015.08.010
Gradus Research Company. (2023). Shift in roles: how the war has affected the family life of Ukrainian women. Special survey for the University of East Anglia. Retrieved from https://shorturl.at/OgQEx
Gradus Research Company. (2024). Experiences, hopes and aspirations of forcibly displaced persons from Ukraine. Results of the Survey of Arriving Migrants from Ukraine (SAM-UKR), conducted by EUAA in collaboration with OECD and with a perspective from Gradus Research. Retrieved from https://gradus.app/en/open-reports/experiences-hopes-and-aspirations-internally-displaced-persons-ukraine/
Kamilova, N. M., & Gulieva, L. A. (2023). Analysis of the course of pregnancy, childbirth and the status of newborns born by displaced women. Actual Problems of the Modern Medicine: Bulletin of Ukrainian Medical Stomatological Academy, 23(81), 31–34. https://doi.org/10.31718/2077–1096.23.1.31
Karatzias, T., Shevlin, M., Ben‐Ezra, M., McElroy, E., Redican, E., Vang, M. L., … Hyland, P. (2023). War exposure, posttraumatic stress disorder, and complex posttraumatic stress disorder among parents living in Ukraine during the Russian war. Acta Psychiatrica Scandinavica, 147(3), Article acps.13529. https://doi.org/10.1111/acps.13529
Keasley, J., Blickwedel, J., & Quenby, S. (2017). Adverse effects of exposure to armed conflict on pregnancy: a systematic review. BMJ Global Health, 2(4), Article e000377. https://doi.org/10.1136/bmjgh-2017-000377
Koen, N., Brittain, K., Donald, K. A., Barnett, W., Koopowitz, S., Maré, K., … Stein, D. J. (2016). Psychological trauma and posttraumatic stress disorder: risk factors and associations with birth outcomes in the Drakenstein Child Health Study. European Journal of Psychotraumatology, 7(1), Article 28720. https://doi.org/10.3402/ejpt.v7.28720
Krupelnytska, L. & Morozova-Larina, O. (2023). Perinatal experiences of Ukrainian women at the beginning of the war. Journal of Reproductive and Infant Psychology, 1–8. https://doi.org/10.1080/02646838.2023.2240827
Makara-Studzińska, M., Morylowska-Topolska, J., Sygit, K., Sygit, M., & Goździewska, M. (2013). Socio-demographical and psychosocial determinants of anxiety symptoms in a population of pregnant women in the regions of central and eastern Poland. Annals of agricultural and environmental medicine : AAEM, 20(1), 195-202.
Marcos-Nájera, R., Rodríguez-Muñoz, M. de la F., Soto Balbuena, C., Olivares Crespo, M. E., Izquierdo Méndez, N., Le, H.-N., & Escudero Gomis, A. (2019). The Prevalence and Risk Factors for Antenatal Depression Among Pregnant Immigrant and Native Women in Spain. Journal of Transcultural Nursing, Article 104365961989123. https://doi:10.1177/1043659619891234
Punamäki, R.-L., Diab, S. Y., Isosävi, S., Kuittinen, S., & Qouta, S. R. (2018). Maternal pre- and postnatal mental health and infant development in war conditions: The Gaza Infant Study. Psychological Trauma: Theory, Research, Practice, and Policy, 10(2), 144–153. https://doi.org/10.1037/tra0000275
Rasmussen, M.L.H., Strøm, M., Wohlfahrt, J., Videbech, P., & Melbye, M. (2017). Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study. PLOS Medicine, 14(9), Article e1002392. https://doi.org/10.1371/journal.pmed.1002392
Renner, A., Hoffmann, R., Nagl, M., Roehr, S., Jung, F., Grochtdreis, T., … Kersting, A. (2020). Syrian refugees in Germany: Perspectives on mental health and coping strategies. Journal of Psychosomatic Research, 129, Article 109906. https://doi.org/10.1016/j.jpsychores.2019.109906
Rodríguez-Muñoz, M. F., Chrzan-Dętkoś M,, Uka A., García-López, H. S., Krupelnytska, L, Morozova-Larina, O., … Le H.-N. (2023). The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol. Frontiers in Psychology, 14, Article 1152478. https://doi.org/10.3389/fpsyg.2023.1152478.
Romanenko, I. Y. (2019). Perebih vahitnosti, polohiv ta perynatalni naslidky rozrodzhennia zhinok iz zahrozoiu pereryvannia vahitnosti ta statusom vnutrishno peremishchenykh osib, yaki prozhyvaiut u Luhanskii oblasti [The course of pregnancy, childbirth and perinatal outcomes in women with threatened interruption of pregnancy and the status of internally displaced persons, living in the Luhansk region]. Actual Problems of Pediatrics, Obstetrics and Gynecology, 2, 63–69. http://doi.org/10.11603/24116-4944.2019.2.10926.
Roumieh, M., Bashour, H., Kharouf, M., & Chaikha, S. (2019). Prevalence and risk factors for postpartum depression among women seen at Primary Health Care Centres in Damascus. BMC Pregnancy and Childbirth, 19(1). Article 519(2019). http://doi.org/10.1186/s12884-019-2685-9
Rozhkovska, N. M., Nadvorna, O. M., & Zhelezov, D. M. (2023). Dysfunction of the placenta in pregnant women with post-traumatic stress disorder. Actual Problems of Pediatrics, Obstetrics and Gynecology, (1), 44–47. https://doi.org/10.11603/24116-4944.2023.1.13939
Stevenson, K., Fellmeth, G., Edwards, S., Calvert, C., Bennett, P., Campbell, O., & Furh, D. C. (2023). The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health, 8, e203–e216. https://doi.org/10.1016/S2468-2667(22)00342-5
Stieger, S., Lewetz, D., Paschenko, S. & Kurapov, A. (2023). Examining terror management theory in Ukraine: impact of air-raid alarms and explosions on mental health, somatic symptoms, and well-being. Frontiers in Psychiatry, 14, Article 1244335. https://doi.org/10.3389/fpsyt.2023.1244335

No competing interests reported.

Download PDF

Editorial decision: Revision requested
14 Oct, 2024
Reviewers agreed at journal
14 Oct, 2024
Reviews received at journal
12 Oct, 2024
Reviewers agreed at journal
11 Oct, 2024
Reviews received at journal
03 Oct, 2024
Reviewers agreed at journal
25 Sep, 2024
Reviewers agreed at journal
19 Aug, 2024
Reviews received at journal
24 Jul, 2024
Reviewers agreed at journal
11 Jul, 2024
Reviewers agreed at journal
11 Jul, 2024
Reviewers invited by journal
06 Jul, 2024
Editor invited by journal
03 Jul, 2024
Editor assigned by journal
03 Jul, 2024
Submission checks completed at journal
03 Jul, 2024
First submitted to journal
28 Jun, 2024

You are reading this latest preprint version

War in Ukraine vs. Motherhood: Mental health self-perceptions of relocated pregnant women and new mothers

Status:

Version 1

Abstract

Figures

Highlights

Introduction

Materials and Methods

Study Design and Participants

Measures

Data Analysis

Results

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1