It Takes a Village: The Protective Role of National Social Capital in Perinatal Mental Health during Crises

Background and Purpose: Women in the perinatal period (pregnancy to one-year after birth) are at increased risk for emotional distress, e.g., depression and anxiety, particularly during times of crises, such as pandemics. While previous research has largely focused on individual and family-level risk factors for perinatal depression and anxiety, the role of social capital (SC) has not been adequately explored. This study focused on the role of national social capital (NSC) in perinatal mental health (PMH). NSC refers to broad national structural factors, such as access to health services, income and gender equality, crime rates, civil rights, and general life satisfaction, that contribute to social cohesion and national stability. Women in the perinatal period can be strongly influenced by national social capital, for example, through high utilization of healthcare services or through constraints related to gender inequality, such as limited workplace accommodations during pregnancy or maternity leave. Therefore, a decline in NSC may negatively affect women’s mental health, particularly during times of crisis. Hence, this study examined the impact of NSC on PMH while highlighting implications for social work policy and practice.

Methods: This cross-sectional study analyzed baseline data from the Riseup-PPD COVID-19 cohort, which examined PMH during the COVID-19 pandemic across 12 European and South-American countries. Participants included pregnant women and mothers of infants up to six months old. NSC was assessed using the Social Capital Index, a sub-index of the Global Sustainable Competitiveness Index (GSCI). PMH outcomes were evaluated using the General Anxiety Disorder scale (GAD-7) and the Edinburgh Postnatal Depression Scale (EPDS) for assessing anxiety and depression symptoms, respectively.

Results: Medium and high NSC levels acted as protective factors and were significantly negatively associated with anxiety (GAD-7≥10) and depression (EPDS≥13) symptoms (anxiety: χ²(2)=21.32, p<.001; depression: χ²(2)=60.92, p<.001). Specifically, medium/high NSC were linked to fewer depression symptoms, while medium NSC was associated with reduced anxiety symptoms. Logistic regression analyses identified NSC also as a moderator of pandemic-related risk factors: population-adjusted mortality rates predicted elevated depression symptoms risk only at low NSC level (χ²(2)=12.60, p=.002) and elevated risk of anxiety symptoms at low/high NSC levels (χ²(2)=45.55, p<.001). High levels of NSC were further associated with reduced probability for anxiety symptoms in older women (χ²(2)=15.60, p<.001), and reduced risk of depression symptoms tied to deteriorating living conditions (χ²(2)=12.52, p=.002).

Conclusions and Implications: This study underscores the protective role of NSC in PMH, particularly during crises. Higher NSC was linked to reduced anxiety and depression, while low NSC intensified emotional distress. To address these disparities, policymakers must invest in equitable healthcare, social welfare, and community resilience. Social workers play a key role in bridging research and practice by promoting macro-level interventions. Beyond individual support, they must advocate for policy reforms that enhance NSC and tackle structural barriers to PMH. Aligning social work with systemic change can improve maternal well-being and foster a more just, resilient society for perinatal women and their families.