Child & Youth Services

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wcys20

Covid-19 and Intergenerational Anxiety and

Trauma

Cecilia M. Jevitt

To cite this article: Cecilia M. Jevitt (2020): Covid-19 and Intergenerational Anxiety and Trauma,
Child & Youth Services, DOI: 10.1080/0145935X.2020.1835163

To link to this article: https://doi.org/10.1080/0145935X.2020.1835163

Published online: 16 Oct 2020.

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CHILD & YOUTH SERVICES
https://doi.org/10.1080/0145935X.2020.1835163

COMMENTARY

Covid-19 and Intergenerational Anxiety and Trauma

Cecilia M. Jevitt
Department of Family Practice, Faculty of Medicine, University of British Columbia,
Vancouver, Canada

In the 1980s, I worked for the US Federal Community and Migrant Health
Service in Florida. Our Birthing Team included midwives, obstetricians, a
case management nurse, a social worker and Spanish-speaking community
resource workers. The program was designed to improve perinatal out-
comes through health and parenting education, shared decision making to
reduce maternal and family stress and support arranged by the social
worker. The prime directive of the community resource workers was, “No
asustes a la mama,” they cautioned over and over, “o trendra un bebe nerv-
iosa.” “Don’t scare the mother or you’ll get a nervous baby.” Any bad news
or shock could cause el susto, the fright. El susto was sometimes dismissed
as just the traditional way for rural Mexicans to manage anxiety.
Almost 40 years later, multiple research studies affirm that if you scare
the mother, you get a nervous baby. The COVID-19 pandemic is hard to
top as a source of el susto. At the start of the epidemic, the effect of the
coronavirus during pregnancy to mother and fetus was unknown. Many
viral respiratory illnesses such as measles, are known to affect pregnant
women more seriously than those who are not pregnant, and many includ-
ing the Zika virus can cause permanent damage to the fetus. For most,
COVID-19 was a moderate to severe respiratory illness. Deaths in repro-
ductive age women are small with 0.8% of adults ages 25–34 and 1.8% for
those ages 35–44 dying after coronavirus infection. The death rate jumps to
12% at age 55, 21% at 65 and 30% at age 85 heightening fears in younger
women. Case analyses from China demonstrated no increase in illness
severity during pregnancy with little evidence that COVID-19 crosses the
placenta; however, there are documented cases of in utero infection, imme-
diate postpartum transmission of coronavirus from an infected mother to
the newborn and COVID-19 has been isolated from breast milk. Learning
to fear for the child is a developmental task of pregnancy but recent quali-
tative research in British Columbia shows that COVID-19 generates fears

CONTACT Cecilia M. Jevitt cecilia.jevitt@ubc.ca Department of Family Practice, Faculty of Medicine,

University of British Columbia, Vancouver, Canada.
ß 2020 Taylor & Francis Group, LLC
2 C. M. JEVITT

and uncertainty that cannot be calmed because of the incomplete know-

ledge about coronavirus in pregnancy.
Current research investigates three causative lines for childhood anxiety:
genetic inheritance, intrauterine epigenetic changes to the hypothalamic–
pituitary–adrenocortical axis (HPA axis), and postpartum disruptions to
effective parenting in the maternal–newborn dyad. There is evidence of
specific genes associated with anxiety and depression but new epigenetic
research broadens potential mood priming mechanisms. The main output
of the HPA axis, cortisol, is elevated during stress and anxiety. Women
who are shocked, anxious, or chronically depressed have hypothalamic-
pituitary-adrenal axis changes including chronically elevated cortisol levels
that may hormonally prime the fetus for anxiety and depression by methyl-
ating genes and changing gene function to alter fetal HPA reactivity.
Anxiety and depression might be more primed than inherited, starting
even before the newborn meets the home-parenting environment.
Maternal anxiety and depression can affect more than the next gener-
ation. A female fetus forms all the eggs she will have for life while in her
mother’s uterus. Those eggs are subject to the same epigenetic changes that
the fetus experiences. A scared grandmother can prime a female grandchild
for anxiety. In addition to fear for self, newborn, family and friends from
the disease, the COVID-19 pandemic-associated recession imposes
unemployment with ensuing loss of income, food insecurity and for many,
loss of housing. In the US, these COVID-19 associated stresses imposed on
the day-to-day stresses of racism, and education, housing, and employment
inequities may account for increased disease and death rates among blacks
and Hispanics exposed to coronavirus. Although the data are incomplete,
in many states the case and death rates for black and Hispanics are 2–4
times higher than those of whites are.
Before the COVID-19 pandemic, the incidence of maternal postpartum
depressive and anxiety disorders were approximately 10% and 20%, respect-
ively. Preliminary COVID-19 related postpartum research shows that anx-
iety and depression have increased sharply, eroding maternal caregiving
energy. Both maternal prenatal anxiety and emotional stress are associated
with higher reaction intensity in children, higher negative emotionality, sig-
nificantly higher rates of behavioral problems and lower prosocial behavior
in children. A growing body of studies finds significant links between pre-
natal stress and anxiety and child development up to adolescence. The
social isolation of the COVID-19 pandemic separates pregnant women
from their social support systems and mental health resources. The isola-
tion also denies women the enjoyment of celebratory pregnancy rituals:
gender-reveal parties, baby showers, postpartum visits by family and friends
to congratulate the parents and meet the newborn. Early in the isolation,
 CHILD & YOUTH SERVICES 3

maternity care providers worldwide moved to the World Health

Organization’s limited prenatal care visit schedule. Any visits that could be
provided by phone or video-conferencing were accomplished at a distance,
limiting the support that could be provided during prenatal care. Hospitals
moving to limit coronavirus transmission prevented women from having
partners, family members or doulas with them in labor. Known supportive
others have been demonstrated to shorten phases of labor and increase
rates of uncomplicated vaginal birth.
What are the summative effects of the grand COVID-19 susto? Increased
maternal and family anxiety and depression during the perinatal period
and infants of two generations at risk for compromised parenting, anxiety
and childhood depression. Social Work has an indispensable role in amelio-
rating the effects of the COVID-19 susto, by providing increased prenatal
support for the mother and the family, securing support for food and hous-
ing, promoting family companionship for women during labor and birth,
assuring easy access to counseling and mental health services, and early
assessment of parenting and infant development. Analysis of data from
Denmark, a country known for its accessible health care and social services,
reports a 70% reduction in preterm labor and low birth weight newborns
following two months of COVID-19 lockdown. Researchers have various
explanations for these reductions but most include increased maternal rest,
time with families that reduces stress, and a broad social safety net.
Denmark may be a living lab in the analysis of the effects of accessible
health care and social services during a pandemic. While medicine searches
for a COVID-19 cure, social work can bridge the immediate needs of the
susto and the lasting risk for anxiety and depression two genera-
tions forward.