Women’s Mental Health in Andhra Pradesh Post-COVID: Global Insights and Perspectives
- Bhavya Bharathi Kotikalapudi
- Shahnaz Sheibani
- 4140-4156
- Sep 10, 2025
- Psychology
Women’s Mental Health in Andhra Pradesh Post-COVID: Global Insights and Perspectives
Bhavya Bharathi Kotikalapudi, Shahnaz Sheibani
Lincoln University College, Kuala Lumpur, Malaysia
DOI: https://dx.doi.org/10.47772/IJRISS.2025.908000336
Received: 16 August 2025; Accepted: 23 August 2025; Published: 10 September 2025
ABSTRACT
The pandemic has substantially altered the landscape of mental health, disproportionately affecting women (J et al., 2020). Married women, mothers, and socioeconomically vulnerable groups have faced unique burdens. This review examines, COVID 19 relationship between among pre-existing risk factors, such as personality traits, socioeconomic status, and marital dynamics, and depression in married women, with a focal point on the differential results of Long COVID.
A comprehensive literature review conducted across multiple databases from 2019 to 2025 identified 36 relevant studies that met the inclusion standards. Those included studies on numerous female populations, pregnant women, pre-K teachers, women with infertility, cancer patients, those with prior depression, adolescents, and divorced women. While this diversity enriches the literature, many of these studies focus on populations other than married women. Sample sizes ranged from small qualitative cohorts to large-scale surveys. Most studies employed validated instruments (EPDS, PHQ-9, and EAT-26), though some qualitative work lacked standardized measures.
Findings imply the pandemic has worsened mental health outcomes throughout all organizations, (WHO, 2022), intensifying depression, anxiety, and stress. Susceptible subgroups, particularly pregnant women, faced distinct challenges. In Andhra Pradesh, especially in Vijayawada, suicide rates have risen. In 2021, Andhra Pradesh recorded 8,067 suicide deaths, marking a 14.5% increase over the 2020 figure of 7,043. The suicide (Senapati RE, 2022)The rate stood at 15.3 per 100,000 population. Of these suicides, a significant number were linked to mental illness (519 cases) and prolonged physical illness (1,779 cases). These figures, while alarming, require contextual interpretation. Suicide rates in Andhra Pradesh exceed the national average of 12 per 100,000, with women, especially those in marital households, bearing a disproportionate share of the burden due to domestic violence, economic stress, and restricted access to care.
In terms of disease burden, Andhra Pradesh ranked among the top states in the middle socio-demographic index (SDI) group in terms of loss. (Vidyasagaran et al., 2023) Of healthy life years due to depressive disorders—793 years per 100,000 population, surpassing most other states in its category. A rural mental health survey from West Godavari district revealed that 14.4% of participants had depression, 10.8% had anxiety,(S et al., 2018) And 3.5% reported suicidal ideation. These issues were especially prevalent among women, individuals aged 30–59, the uneducated, and those who were divorced/separated/or widowed.
A key finding concerns the temporal variation in mental health crises. (Kattimani et al., 2016), with peak incidents occurring between 6-9 pm, followed by 9-3 pm. Despite this pattern, nighttime mental health support remains inadequate, even though symptoms often worsen during these hours. From a feminist perspective, gender oppression plays a significant role in the depression experienced by married women.
This research highlights key gaps in the literature, including the reliance on non-random samples and the absence of validated instruments in a minority of studies.. In Andhra Pradesh. This gap is critical given the documented temporal peaks in crises during vulnerable and nighttime hours. Mental health services must therefore adapt to address the nighttime needs, integrating feminist perspectives and new empirical findings to deliver effective, culturally sensitive support for women.
However, the specific contribution of Long COVID-19 to psychological outcomes remains underexplored. Symptoms such as cognitive fatigue, chronic exhaustion, and neurological impairment have been linked to heightened risks of depression and anxiety, particularly among married women.
Keywords: Women’s Mental Health, Married Women, Personality Traits and Prevention, Depression and Anxiety, Nocturnal Mental Health, Caregiving Stress, South Asia, Andhra Pradesh
INTRODUCTION
While significant progress has been made in understanding mental health challenges during pregnancy and post-partum periods during the COVID-19 pandemic, depression in non-pregnant married women remains comparatively underexplored (Jeong et al., 2024) Comparatively underexplored. This gap is notable, given that the pandemic exacerbated many pre-existing social, economic, and psychological vulnerabilities among this demographic. Over the past few years, global crises, most notably Covid 19, have tested the resilience of women’s mental health, introduced new stressors while intensifying existing ones. In Particular, lockdowns, economic instability, and disruptions in healthcare services created conditions that heightened the risk of depression, anxiety, and stress for many married women.
In India, some married women still perceive COVID-19 as a personal health threat in 2025, reflecting a lingering high-risk perception despite the formal end of the acute pandemic phase. This perception can lead to (Wang et al., 2022) Misattribution, where current symptoms are attributed to the pandemic. Such misattribution may also obscure the role of personality-linked vulnerabilities. (Hartveit Kvarstein et al., 2022)Personality traits are known to influence pandemic-related impacts, concerns, and behaviours in culturally variable ways. In the context of Andhra Pradesh, these complexities are compounded by high suicide rates, underreporting of mental illness, and gendered social structures that may limit timely access to care.
By addressing these overlooked intersections between pandemic-era stressors, persistent risk perception, and personality-driven (Conrod, 2016), this narrative review examines the post-pandemic mental health landscape for married women in Andhra Pradesh. Through an analysis of studies published between 2019 and 2025, this study aims to identify persistent risk factors, document temporal patterns of psychological crises, and propose culturally informed strategies, particularly for evening and nighttime support, tailored to this vulnerable population.
METHODOLOGY
Search Strategy
A literature review was conducted in Google Scholar, ScienceDirect, EMBASE, Cochrane Library, Medline, and PubMed to identify studies published between January 2019 and 2025 that were considered with emphasis on studies exploring women’s mental health during and after the COVID-19 pandemic, particularly about married women, personality-linked vulnerabilities, and service availability in India and globally. Search terms combined variations of “COVID-19,” “mental health,” “India,” “personality prevention,” “risk perception,” and “mental health services in India” using Boolean operators. Priority was given to studies that addressed (i)Pandemic-related stressors, (ii)Depression and Anxiety among Women, and (iii)contextual issues relevant to Andhra Pradesh.
Table 1: Databases and keywords used for search strategy
Year | Database | Keywords |
2019-2025 | Google Scholar
ScienceDirect Embase Cochrane Library Medline PubMed |
Covid 19
Married Women Personality traits and depression COVID-19 and married women Subjective Well-being and depression Self-esteem and depression |
-Selection Approach:
Studies were screened for relevance, credibility, and contribution to thematic understanding.
Both quantitative and qualitative research were included to capture diverse experiences.
Particular attention was given to validated instruments (e.g., EPDS, PHQ-9, EAT-26), while also acknowledging qualitative accounts that enriched contextual insights.
Data Presentation
To support transparency and comparison, Table 1 summarizes the databases and keywords used during the search process (2019–2025), while additional tables in the results section highlight study settings, populations, methods, and findings.
Table 2: Selected studies and their primary outcomes
Study Reference | Country | Population | Sample Size | Study Design | Sampling | Use of Validated Instruments | Primary Outcomes |
1. (Indu et al., 2021) | India | Married women, | 133 | Cross-sectional | Yes | The survey indicates severe levels of mental distress and considerable social vulnerability among patients with Personality Disorders. | |
2.(A et al., 2023) | India | General Community | 1978 | Systematic random sampling | Randomised Sampling | Assesses the effectiveness of a web-based coping skills program (with or without coach support) on reducing negative affect (e.g., depression, anger) | |
3(Sagar et al., 2022) | Bnagladesh | Married Women postpartum women | 597 | Qualitative | Convienience | Not-validated | The people who lost their jobs during this period had a higher prevalence of stress. Although this is not well documented, it is pretty understandable that losing a job puts them in an ocean of uncertainty, when psychological symptoms are pretty standard. |
4.(Gulati et al., 2023) | India | Young Lives Phone Survey | 886 | Longitudinal | multistage, purposeful, and random sampling | Not Validated | (Arilha M, 2024)Anxiety levels among women were higher than among men because of the increased burden of household chores and childcare responsibilities |
5. (Arilha M, 2024) | Global Prevalence | Women and young people | 204 | Literature Review | Not reported | Literature Review | Lower education and income, preexisting mental health problems, and living alone or with children were risk factors for higher levels of anxiety and depression. |
6. (Gómez-Chávez et al., 2024) | Mexico | Antenatal Women | 98 | retrospective case-crossover study | 40 | Standardized personnel administered a questionnaire | Examined the relation between risk perception and antenatal visits |
7. (Ana-Maria Andrei, 2023) | Not Reported | Postpartum women | 1024 | Cross-sectional | Convenience sampling | EPDS for PPD; scales for health/death anxiety. Validated | Investigated how COVID-19-related fears predict postpartum depression among new mothers |
8 (Güner & Aydın, 2022) | Turkey | Adult women | 450 | Cross-sectional | Random sampling | Validated | Explored how anxiety and coping styles correlate with emotional eating behaviors in women during COVID-19 |
9.(Prof Nusrat Husain, MD, 2024) | United Kingdom | British South Asian postpartum women | 732 | Randomized Controlled Trial (RCT) | Random sampling | Likely used validated depression measures (e.g., EPDS/PHQ-9) | Evaluated the effectiveness of a culturally adapted CBT intervention in reducing postnatal depression |
10. (Jones & Kimble, 2022) | United States | Black women with SLE | 43 | Cross-sectional | Convenience sampling | Likely used standardized instruments for body image (e.g., Body Image Scale), depression (CES-D/PHQ-9), and HRQoL. | Examined how body image and depression relate to health-related quality of life in Black women with SLE |
11. (Li et al., 2022) | Australia, Malaysia | General Community | 253 | Hospital Anxiety and Depression Scale (HADS). | Convenience sampling | Validated | Moderating effect of cultural group (Australia vs Malaysia) on the relationships between brooding rumination and symptoms of depression and PTSD. In support of Hypothesis 1, we found that Malaysian participants had higher levels of brooding rumination compared to Australian participants. In support of Hypothesis 2, brooding rumination was significantly associated with both greater depression and PTSD symptom severity. |
Study 12:(Szuster et al., 2021) | United States | Women | 1644 | Cross-sectional online survey | Random Sampling | Validated | The results of this study demonstrated that the pandemic was associated with a high occurrence of depressive symptoms and sexual functioning disorders in women. |
Study 13: (Toleon et al., 2023) | United Kingdom | Pregnant Women | 150 | Prospective longitudinal project | Convenience Sampling | Validated | Compared to women without children, pregnant women exhibited higher abilities when it comes to regulating their emotions, and more precisely, in identifying their emotions and accepting their emotional responses. |
Study 14: (Karp et al., 2021) | Kenya | Young Women | 756 | Mixed Method Study | Purposive Sampling | Validated | Pandemic disrupted youth’s romantic and sexual relationships in Kenya, often reducing opportunities for intimacy, with impacts differing by age and relationship type. |
Study 15:(Arbağ et al., 2023) | Australia | Women who are taking cancer treatment for breast and gynaecological problems. | 15 | In-depth qualitative interviews | Purposive Sampling | Validated | In the present study, the women, receiving treatment for breast cancer, were found to experience intense worries about catching COVID-19 and fears about withdrawal of their treatment and death of themselves, their relatives, and their doctors. |
Study 16: (Gellasch et al., 2024) | United States | Women with a history of depression | 139 | Secondary qualitative descriptive study and Inductive content Analysis | Convenience sampling | Not validated | Most study participants perceived the responsive bassinets as improving their infants’ sleep, which in turn subjectively improved maternal sleep and mood. External stressors and challenges, however, presented barriers to good sleep for infants and the participants. When the responsive bassinet was used, infants were swaddled and in a safe sleep position. |
Study 17: (Johnson et al., 2024) | Norway | Pregnant Women | 21 | Mixed Method | Purposive Sampling | Validated | The study provides insights into to experiences of childbearing women during the lockdown phase of the novel COVID-19 outbreak. At that time, uncertainties regarding the virus’s transmission, mortality rate, and the duration of the lockdown measures prevailed, resulting in unique challenges for pregnant women globally. |
Study 18: (Jeong et al., 2024) | Korea | Post-Divorced Women | 401 | Latent Growth Modelling to understand the pattern of changes | Purposive Sampling | Validated | Depressive symptoms are highest immediately after divorce, decrease over time, but rise again later. Living alone slowed recovery. Education, economic status, and health status predicted severity. |
Study 19: (Wei Lin, 2021) | Shenzhen city | Pregnant Women | 751 | Cross-Sectional Survey | Snowball sampling | Validated | These interesting findings suggested that pregnant women probably had minor mental symptoms matched with a low subjective risk of contracting infection, yet an overestimate of subjective psychological impact. |
Study 20: (Lucchini et al., 2022) | New York City | Postpartum Women | 232 | Univariate and multivariate study | Convenience Sampling | Validated | The study findings indicate that maternal COVID-19 infection during pregnancy did not significantly influence maternal sleep postpartum in any domain. However, women who delivered after the first peak of the pandemic in NYC (May-December 2020) reported worse global PSQI scores, sleep latency, and disturbances than those who delivered during the first peak in NYC (March-April 2020). These differences remained significant even when we accounted for psychosocial factors. |
Study 21: (Anteneh Asefa, 2025) | Conakry, Guinea. | Antepartum Women | 417-Quantitative344- Qulaiitative | Mixed Method Prospective Study | Purposive Sampling | Not Validated | The findings of this study show a high prevalence of symptoms suggestive of antepartum depression among pregnant women attending ANC in health facilities in urban Guinea, with one in three women affected. |
Study 22: (Micheline R. Anderson, 2022) | United States | Pregnant and post-partum women | 60 | Randomized Controlled design | Purposive Sampling | Validated | Women reported negative impacts on their emotional well-being, especially a resurgence of mental health symptoms. Participants also articulated positive experiences during the pandemic, including an appreciation for increased time with family, especially infants. |
Study 23: (H. S et al., 2023) | England | Postnatal women | The usable response rate to the surveys was 47% in 2014 (n = 4571) and 29% in both 2018 (n = 4509) and 2020 (n = 4611) | Population Survey | Not applicable | Validated | The study-based national maternity surveys in England indicate that almost one in four women who gave birth in May 2020, during the Covid-19 pandemic in the UK, reported symptoms indicating probable clinical depression six months after giving birth |
Study 24: (Kinser et al., 2022) | United States | Pregnant and postpartum women | 54 | Hermeneutic Phenomenological Study | Purposive Sampling | Not Validated | Evaluating the effectiveness of COVID-19 interventions through experimental methods |
Study 25: (Awad-Sirhan et al., 2022) | Spain | Pregnant Women | 695 | Observational, Correlational, and cross-sectional | non-probabilistic convenience and snowball sampling | Partially validated | The socio-health restrictions and the consequent lockdown resulted in the emergence of significant concerns from the pregnant population. |
Study 26: (Gluska et al., 2022) | Israel | Postpartum Women | 421 | Observational Cross-Section Study | Purposive Sampling | Not Validated | Results suggest that the prevalence of PPD symptoms during the pandemic among women was similar across the entire cohort, regardless of its ethnic diversity; there were no differences in PPD symptoms among women from different ethnicities, education, marital status, or religious beliefs. |
Study 27: (Eri et al., 2022) | Norway | Postpartum Women | 806 | Inductive Thematic Analysis | Purposive sampling | Not validated | Feelings of insecurity, anxiety, stress, and worries throughout pregnancy were experienced by many. They had limited knowledge about what to expect, or what or who would be available for them, either during antenatal check-ups or at the place where they were going to give birth. |
Study 28: (Atmuri et al., 2022) | Melbourne, Australia | Pregnant Women | 15 | Qualitative Descriptive Design | Convenience sampling | Not Validated | The themes identified in the study indicate that the experiences of pregnant women were framed by not only COVID-19 as an infection but by their responses to physical distancing and other restrictions. |
Study 29: (H et al., 2022) | United States | Women who reported a live birth at either T2 or T3 | 2341 | Longitudinal Study | Purposive Sampling | Validated | Study findings corroborate the importance of social support — prenatally and during birth — to women’s birth satisfaction. Perceived social support has previously been linked with better birth experiences, and yet support availability was reduced by the COVID-19 pandemic for many women. |
Study 30: (Sharma et al., 2023) | Women with young babies | 89 Focused Group-14 | Randomized Controlled Study | Randomized sampling | Not validated | This study demonstrates that a 6-week online songwriting intervention for women with young babies can reduce loneliness and symptoms of PND and increase social connectedness | |
Study 31: (Lucchini et al., 2022) | New York | Post Partum Women | 232 | In-depth qualitative interviews | Not mentioned | Validated | Findings indicate that maternal COVID-19 infection during pregnancy did not significantly influence maternal sleep postpartum in any domain. |
Study 32:. (Vall-Roqué et al., 2021) | Spain | Adolescent and young women | 2601 | cross-sectional and retrospective design | Not Reported | Validated | Evaluating the effectiveness of COVID-19 interventions through experimental methods |
Study 33: (Bhatt et al., 2023) | Nepal | Married Women of reproductive age | 420 | Cross-sectional web-based survey | Purposive and snowball sampling | Validated | Study findings revealed a high prevalence of IPV among women in Nepal, with more than half of the participants (52.62%) experiencing at least one form of IPV. This reported prevalence is twice the magnitude of IPV reported by NDHS in 2016 and is even higher than the global prevalence of IPV as per the WHO. |
Study 34: (Victoria Fallon, 2021) | UK | Postnatal women | 614 | Cross-sectional survey design | Convenience Sampling | validated | Descriptive findings from the overall sample indicated a high percentage of mothers self-reported psychological and social changes as a result of the introduction of social distancing measures. |
Study 36: (Lorentz et al., 2021) | Rio Grande do Sul, the Brazilian state | Puerperal Women | 50 | Prospective Cohort Study | Not Reported | Evaluating the effectiveness of COVID-19 interventions through experimental methods | |
Study 37:
(Maheshwari et al., 2025) |
Vansh Maheshwari, Suruchi Mishra | Postmenopausal and Older Women | 28,160 | cross-sectional study | secondary data | One-fifth of postmenopausal women in India experience sleep problems | |
Study 38:
(Katarzyna Nowakowska-Domagała, 2025) |
Katarzyna Nowakowska-Domagała | Young Adults | 306 | cross-sectional study | Snowball sampling method | The daytime sleepy type showed more prevalent symptoms of depression. | |
Study 39:(Nagashima-Hayashi et al., 2022) | Asia-Pacific region | Phnom Penh city, Mondulkiri, and Kampong Cham | 21 | qualitative study design | purposive sampling | Participants across countries explicitly described the overall increase in the number of calls to helplines and of police reports of physical violence against women since the pandemic began, although empirical data are still to be collected. |
DISCUSSION
Recent studies summarized in Table 1 demonstrate significant progress in understanding women’s mental health during and after the COVID-19 pandemic, but also reveal critical service and knowledge gaps, particularly for non-pregnant married women in South Asia. Globally, many interventions and studies have been (Nagashima-Hayashi et al., 2022)youth-focused or designed for(Perkins et al., 2023) Mixed -gender populations. Similarly, interventions tend to be content-specific, for example, substance misuse, anxiety, or PTSD, rather than context-sensitive, overlooking how situational.(Deshmukh et al., 2025) Factors such as time of day, family environment, decision-making preferences, or caregiving pressures shape women’s mental health experiences.
A notable gap is the limited integration of personality screening into preventive interventions. While Trait Activation (Robert P. Tett, 2021)Theory suggests that personality traits become more predictive in specific contexts, for example, in help-seeking or high neuroticism, manifesting more strongly at night. Current progress rarely operationalizes (Prof Nusrat Husain, MD, 2024)This is real-time prevention. Tools that exist for personality-targeted prevention have been tested mostly in adolescents or substance (Bhattacharya et al., 2019)misuse populations, but no existing intervention framework applies this model to adult married women in high-risk contexts, such as nighttime or domestic caregiving environments.
Globally, women’s safety and well-being in nighttime contexts, for example, in commuting to public events, have been studied through behavioural or (Katarzyna Nowakowska-Domagała, 2025)Environmental perspectives. However, personality-based prevention models for women’s nocturnal mental health are very limited. This created a mismatch, while the risk. (Melis, 2025)Contexts are well-defined on women’s experiences in urban public spaces, such as commuting, nighttime movement, and safety in public areas. Interventions remain generic, focusing largely on environmental or infrastructural improvements like lighting, surveillance, and transport safety. However, these strategies do not personalize prevention to women’s lived psychological risk profiles, leaving a critical gap in designing adaptive, personality strategies to women’s lived risk profiles, a gap that the Integrated Nocturnal Mental Health model directly seeks to address in India.
Another limitation across most studies in the table is methodological. The majority rely on quantitative cross-sectional surveys, which provide prevalence data but offer little insight into women’s lived experiences, especially in regions like India, where somatic distress. (Mo Daming, 2021)Presentations are common. Few studies employ longitudinal designs to examine how personality traits, resilience.(Igor Londero, 2024) , and social support interact over time to influence long-term trajectories of depression and anxiety.
Approximately 22.5% of married women in India spent over 70 hours per week on chores, unmatched by men or (Panchal et al., 2023)Unmarried women. In severe cases, prolonged stress led to critical mental health conditions, including suicidal thoughts. Furthermore, the neurological impact of COVID-19 might have aggravated mental health issues for those who were already at risk. (Shetty et al., 2023), demonstrating how social and biological pressures combined to worsen women’s mental health struggles.
In the Indian context, research remains fragmented and heavily maternal-focused, with postpartum depression. (Richa et al., 2025)Dominating the literature. Non-pregnant married women, who face the double burden of paid work and unpaid caregiving, remain largely invisible. Unlike global studies that have begun exploring (Richa et al., 2025), risk perception, or digital access, Indian studies rarely test these dimensions. Moreover, there is no established community-based intervention model that explicitly addresses women’s mental health high high-risk nocturnal contexts. This highlights an urgent need for innovative frameworks such as an Integrated Nocturnal Mental Health Service Model that combines personality screening for risk identification, context-sensitive tools, and culturally adapted interventions responsive to stigma and gender norms in South Asia.
The service gap is equally striking. While India has initiated programs such as (Kirpekar et al., 2024)SMART Mental Health Project, these efforts emphasize scaling basic mental health access in rural areas and do not yet incorporate adaptive, personality-driven, or situationally responsive strategies. In contrast, some global interventions, for example, personality-targeted CBT in South Asia Women (Lau et al., 2022)in the UK, studies show that culturally adapted, personality-aware models can yield strong outcomes, yet such evidence is limited in India. This reinforces the need to anchor research more firmly in the context of married women, who face the dual burden of caregiving and economic insecurity. Unlike adolescents or postpartum mothers, married women in Andhra Pradesh navigate persistent marital dynamics, household responsibilities, and Long Covid risk that compound their vulnerability.
CONCLUSION
This review highlights that while global research has advanced in identifying pandemic-related mental health stressors among women, significant conceptual and service gaps persist for married women in South Asia. Available studies emphasize youth, mixed -gender, or maternal populations, overlooking the unique vulnerabilities of married women navigating professional responsibilities, unpaid caregiving, and marital dynamics in high-risk contexts such as nighttime. Three gaps are most evident: the Contextual gap, like current interventions rarely integrate situational variables like time of day, caregiving environment, or social support. Personality screening gap, few interventions use personality screening for real-time, adaptive preventive strategies, despite(Christina M. Juchem, 2024). Effectiveness of personality-based preventive approaches. In terms of Service, India lacks community-based, culturally responsive programs designed for married women’s mental health needs. By situating diverse findings back within the framework of married women’s mental health, this review highlights the urgency of developing interventions that address their distinctive intersection of caregiving, marital, and health-related stressors.
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