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The Toll of COVID-19 on Mental Health in Pregnant Women: Investigating Risk and Protective Factors of the Lockdown on Anxiety and Depression

Fri, April 9, 11:35am to 1:05pm EDT (11:35am to 1:05pm EDT), Virtual

Abstract

Background: A global pandemic has kneeled the world, with unknown and possibly unprecedented effects on the current and future generation. Pregnant women, who are already at heightened risk for perinatal symptoms of anxiety and depression (PSAD; e.g. Fontein-Kuipers et al., 2015) constitute a point of concern to monitor and contain during a major global crisis. This study set out two objectives: i) assess and compare PSAD during and prior to COVID-19 in community samples of Dutch women, and ii) assess risk (coronavirus exposure within one’s social network, work and financial uncertainties) and protective factors (support from one’s partner and social network). We hypothesized that pregnant women during COVID-19 experienced worse PSAD compared to pre-COVID-19 pregnant women, and that these symptoms are heightened in the context of coronavirus exposure and work and/or financial problems. Additionally, we hypothesized that better support would mitigate PSAD.
Method: We conducted a national survey in The Netherlands from the 4th of April until the 10th of May, during the most stringent lockdown restrictions. A sample of 1419 pregnant women filled in The COVID-19 and Perinatal Experiences (COPE) questionnaire (Thomason et al., 2020). Depression was assessed with the Edinburgh Depression Scale (EDS; Cox et al., 1987), and anxiety with the State-Trait Anxiety Inventory (STAI; Spielberger et al., 1983). We used established cut-off scores for anxiety (≥40) and depression (≥13). The comparison sample consisted of a group of 1439 Dutch pregnant women that filled in the same questionnaires in 2017 and 2018.
Results: Results from ANCOVA analyses with age, gestation weeks, education and parity as covariates showed significantly higher [F(1, 2079)=21.13, p<.001, ηp2=.010] scores of depression in the COVID-19 sample [M=6.29, SE=.17], compared to the pre-COVID-19 sample [M=5.33, SE=.12]. Likewise, anxiety was significantly higher [F(1, 2079)=257.85, p<.001, ηp2=.110] in the former group [M=41.38, SE=.33] compared to the latter [M=34.69, SE=.24; Figure 1]. Frequency analyses (Table 1) revealed that 12% of women experienced clinically relevant depression symptoms during COVID-19 outbreak, compared to 6% prior to COVID-19. Likewise, clinical anxiety rates increased from 24 to 52%. Concerning risk factors, regression analyses suggest that fear of contracting the virus both for oneself and close ones positively predicted symptoms of depression and anxiety (all p<.001). Work and financial-related worries also positively predicted anxiety and depression symptoms (all p<.001). Regarding protective factors, pregnant women reported feeling more supported by their partner during COVID-19 compared to before [t(1163)=4.39, p<.01], and less by their social network [t(1103)=-7.15, p<.001]. Moreover, support from perinatal healthcare professionals, but not social support nor partner is associated with lower anxiety and depression symptoms.
Conclusion: This unique and timely study highlights the heavy toll of the COVID-19 pandemic on pregnant women’s mental health. The number of women scoring above anxiety and depression clinical cut-offs doubled during the height of the lockdown. These dramatic changes in future mothers’ mental health may hold important implications for offspring birth and developmental outcomes. Currently, we are assessing pregnancy outcomes, which we will elaborate on during the conference.

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