Intersections of mental health and sexual and reproductive health during the COVID-19 pandemic: A mixed-methods study of women and gender-diverse people with disabilities
Sidrah K. Zafar, Carmela Melina Albanese, Meredith Evans, Alexandra Rego, Keat Welsh, Nkem Ogbonna, Lucy C. Barker, Anne Berndl, Janice Du Mont, Yona Lunsky, Amy C. McPherson, Sara Rotenberg, Lesley A. Tarasoff, Ashley Vandermorris, Hilary K. BrownBackground
The COVID-19 pandemic has had significant mental health impacts globally. However, prior studies have not examined the specific mental health effects of the COVID-19 pandemic on women and gender-diverse people with disabilities, particularly as they intersect with sexual and reproductive health (SRH).
Objectives
Our objective was to examine the impacts of the COVID-19 pandemic on mental health and access to mental health care among women and gender-diverse people with disabilities, including how mental health intersected with SRH.
Design
We conducted a community-engaged concurrent mixed-methods study in Canada with women and gender-diverse people with physical, sensory, psychiatric, and cognitive disabilities recruited using convenience and purposeful sampling.
Methods
Between May, 2022 and March, 2023, participants completed a survey (including identification of anxiety and depression symptoms using the Patient Health Questionnaire-4) and/or in-depth semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using deductive and inductive coding following a constructivist approach.
Results
The study included 116 survey participants and 61 interview participants, with 50 participants completing both the survey and interview. Twenty-nine per cent of participants rated their mental health as poor during the pandemic (vs. 21.6% before), and 58.3% had symptoms of anxiety and/or depression. Participants described social isolation, threat of infection, and ableism as contributing to poor mental health. Over half (54.2%) who sought mental health care reported barriers. Long wait times, inaccessible virtual care, restrictions on support persons at appointments, and economic insecurity impacted access. Mental health and SRH intersected, with pandemic-related psychological distress negatively affecting menstrual health, sexual wellbeing, perinatal health, and menopause. Delays accessing SRH care also contributed to poor mental health.
Conclusion
These data show the need for integration of accessible mental health and SRH services and promotion of disability-affirming mental health care during public health emergencies and beyond.