Maternal Mental Health Responses to COVID-19 Shocks and Uncertainty in Rural Pakistan

The COVID-19 pandemic was a health and economic shock with devastating effects, especially for low- and middle-income countries (LMICs), where a larger fraction of the population lives in precarious health and economic conditions. In addition to the increase in morbidity and mortality stemming from the disease, COVID-19 lockdowns prompted extensive earnings losses and economic uncertainty about the future. Together, illness, death, job loss and increasing economic uncertainty likely contributed to the widespread deterioration in mental health observed during the pandemic (Adams-Prassl et al. 2020; Biroli et al. 2021; Giuntella et al. 2021; Witteveen and Velthorst 2020; Bau et al. 2022; Baranov et al. 2022). Most of the current literature investigating the impacts of COVID-19 has focused on the impacts of experienced negative shocks. Yet, the anticipation of future shocks, has been shown to predict poor mental health outcomes in adults (Baranov, Bennett, and Kohler 2015), and the psychiatry literature suggests a strong link between economic uncertainty and mental health by increasing anxiety and depression symptoms, rates of PTSD, and reports of general distress (Di Quirico, 2023; Massazza et al., 2022). In this paper, we document how different dimensions of the COVID-19 pandemic impinged on women's mental health in rural Pakistan. We consider four COVID-related stressors capturing both direct effects of experienced health and economic shocks as well as effects through the anticipation of future risks. Specifically, we investigate the association between a battery of mental health measures and (i) experienced morbidity and mortality due to COVID-19, (ii) worry about the disease risk, (iii) experienced economic shocks, and (iv) economic uncertainty about 2 the future induced by the pandemic. We find that an environment of heightened economic uncertainty might impact mental health, above and beyond the effects of realized shocks.