The impact of coronavirus disease 2019 (COVID-19) on people with existing mental health conditions is likely to be high. We explored the consequences of the pandemic on women of lower socioeconomic status with prenatal anxiety symptoms living in urban Rawalpindi, Pakistan. This qualitative study was embedded within an ongoing randomized controlled trial of psychosocial intervention for prenatal anxiety at a public hospital in Rawalpindi. The participants were women with symptoms of anxiety who had received or were receiving the intervention. In total, 27 interviews were conducted; 13 women were in their third trimester of pregnancy, and 14 were in their postnatal period. The data were collected through in-depth interviews and analyzed using framework analysis. Key findings were that during the pandemic, women experienced increased perinatal anxiety that was linked to greater financial problems, uncertainties over availability of appropriate obstetric healthcare, and a lack of trust in health professionals. Women experienced increased levels of fear for their own and their baby’s health and safety, especially due to fear of infection. COVID-19 appears to have contributed to symptoms of anxiety in women already predisposed to anxiety in the prenatal period. Efforts to address women’s heightened anxiety due to the pandemic are likely to have public health benefits.

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ObjectivesA manualised cognitive–behavioural therapy-based psychosocial intervention for prenatal anxiety called Happy Mother Healthy Baby is being tested for its effectiveness through a randomised control trial in Pakistan. The aim of this study was to evaluate the intervention delivery process and the research process.DesignQualitative methods were used to explore in depth the intervention delivery and research process.SettingThis process evaluation was embedded within a randomised control trial conducted in a tertiary care facility in Rawalpindi, Pakistan.ParticipantsData were collected through in-depth interviews (n=35) with the trial participants and focus group discussions (n=3) with the research staff. Transcripts were analysed using a Framework Analysis.ResultsThe evaluation of the intervention delivery process indicated that it can be effectively delivered by non-specialist providers trained and supervised by a specialist. The intervention was perceived to be culturally acceptable and appropriately addressing problems related to prenatal anxiety. Lack of awareness of ‘talking’ therapies and poor family support were potential barriers to participant engagement. The evaluation of the research process highlighted that culturally appropriate consent procedures facilitated recruitment of participants, while incentivisation and family involvement facilitated sustained engagement and retention. Lack of women’s empowerment and mental health stigma were potential barriers to implementation of the programme.ConclusionWe conclude that non-specialists can feasibly deliver an evidence-based intervention integrated into routine antenatal care in a tertiary hospital. Non-specialist providers are likely to be more cost effective and less stigmatising. Inclusion of family is key for participant recruitment, retention and engagement with the intervention.Trial registration numberNCT03880032.

The outbreak of COVID-19 pandemic is constantly posing warning and creating mental health crisis among people without any discrimination. Therefore, the current study purpose is to explore mental health upheaval and transition in future perspectives due to COVID-19. Using exploratory study design, semi structure interviews were conducted. Interviews were recorded, transcribed and analyzed by using Thematic Content Analysis. The major themes which were identified showed that COVID-19 is constantly eliciting panic and mental health issues such as anxiety, stress, and depression, fears of death, xenophobia, OCD and uncertainty about future among general population. Results also indicated the major transition in public future perspectives and perception. Concern related to adjustability in life after pandemic is major emerging future concern among Pakistani People. During pandemic outbreak, people are becoming vulnerable to different mental health problems. To overcome these issues successfully, role of mental health professionals cannot be denied. There is strong need to devise activities and strategies which help people to increase resilience and build strong relationships during the period of social distancing. This paper gives a deep insight into mental health problems among general population due to COVID-19 and it also implicates need of psychological services to overcome these issues.