Abstract
Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic. An anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies (https://corona.pregistry.com) and advertised in social media channels and online parenting forums. Participants completed measures on demographics, COVID-19 exposure and worries, information seeking, COVID-19 prevention behaviors, and mental health symptoms including posttraumatic stress via the IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions of women scored at or above the cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source (e.g., social media, news, talking to others) five or more times per day was associated with more than twice the odds of elevated posttraumatic stress and anxiety/depression, in adjusted models. A majority of women (86%) reported being somewhat or very worried about COVID-19. The most commonly reported worries were related to pregnancy and delivery, including family being unable to visit after delivery (59%), the baby contracting COVID-19 (59%), lack of a support person during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries related to children (i.e., inadequate childcare, their infection risk) and missing medical appointments were associated with significantly higher odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to mental health symptoms or loneliness. Elevated posttraumatic stress, anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum women across 64 countries during the COVID-19 pandemic. Excessive information seeking and worries related to children and medical care are associated with elevated symptoms, whereas engaging in hygiene-related preventive measures were not. In addition to screening and monitoring mental health symptoms, addressing excessive information seeking and women’s worries about access to medical care and their children’s well-being, and developing strategies to target loneliness (e.g., online support groups) should be part of intervention efforts for perinatal women. Public health campaigns and medical care systems need to explicitly address the impact of COVID-19 related stressors on mental health in perinatal women, as prevention of viral exposure itself does not mitigate the pandemic’s mental health impact.
Highlights
The United Nations Children’s Fund estimates that there have been 116 million births in the ten months since COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11 2020 [1, 2]
We examined the relation of type and amount of information seeking via various channels to women’s mental health and loneliness
The final analytic population consisted of 6,894 women residing in 64 countries ranging in age from 18 to 46 years
Summary
The United Nations Children’s Fund estimates that there have been 116 million births in the ten months since COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11 2020 [1, 2]. The unique challenges facing pregnant and postpartum women include concerns about greater severity of COVID-19 disease in this population, potential vertical transmission from an infected mother to her newborn, and increased risk of adverse neonatal outcomes [3, 4]. Perinatal women who have a history of psychological disorders, are experiencing higher concerns regarding their family’s health, their baby’s future and society due to the COVID-19 pandemic [15]. Obstetricians report that perinatal women are contacting them expressing concern about hospital visits, protection methods, their infant’s safety, anxieties due to social media and fears of contracting COVID-19 [16]. Identifying the factors that influence mental health of pregnant and postpartum women during the COVID-19 pandemic is critical for both their own well-being and that of future generations
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