Association of Stress-Related Factors With Anxiety Among Chinese Pregnant Participants in an Online Crisis Intervention During COVID-19 Epidemic

Assessing the impact of COVID-19 on middle-aged and older females in China: a comparative study of urban-rural disparities

BACKGROUND

The impact of COVID-19 has been long-lasting and severe. Middle-aged and older females, as a vulnerable group, need special attention. China is a typical urban-rural dualistic society, and the impact of the urban-rural gap on middle-aged and older females is unknown. The purpose of this study was to explore the influence of COVID-19 on middle-aged and older females in Chinese urban and rural areas.

METHODS

This study used CHARLS (China Health and Retirement Longitudinal Study) database. A total of 10,063 participants were included in this study (3,680 in urban and 6,383 in rural). The chi-square test and t-test were used to analyze differences between urban and rural participants, and binary logistic regression (forward: conditional) was used to analyze differences in the factors influencing the two groups in terms of mask wearing.

RESULTS

During the epidemic, there were significant differences between urban and rural middle-aged and older females in terms of demographic characteristics, prevention knowledge, attitude, identification, isolation, personal activities, mental health, containment measures in residential areas and individual preventive behavior. Rural middle-aged and older females had poorer preventive behavior. Age, marital status, preventive knowledge, calling and messaging, internet contact, containment measures in residential areas were the common influencing factors affecting mask wearing behavior of the participants. The mask-wearing behavior of urban participants was also influenced by the attitude towards government's measures, COVID-19 test and fear.

CONCLUSIONS

Middle-aged and older females in Chinese urban and rural areas faced different situations during the epidemic and required targeted measures.

Attachment Style Modifies the Effect of Spousal Support on Postpartum Depression in Women

Objective

This study aims to examine the impact of spousal support on postpartum depression in women with different attachment styles and assessing if attachment style influences this effect.

Methods

From March to May 2022, 96 couples with late-stage pregnant women were randomly selected from tertiary maternity hospitals in Shandong and Guangdong provinces for a prepartum survey. Psychological assessments were conducted using the Adult Attachment Scale, Dyadic Coping Inventory, and the Patient Health Questionnaire-9 (PHQ-9) Depression Scale. To examine the relationship between each variable and postpartum depression, univariate and multiple logistic regression analyses were employed. Additionally, interaction analysis was used to analyze the interplay between different attachment styles and how spousal support influences women's postpartum depression.

Results

The findings revealed that even after accounting for confounding variables, prepartum spousal support was an independent predictor of postpartum depression (adjusted odds ratio (OR) = 0.82, 95% CI: 0.69-0.96, P = .015). Women with a secure attachment style showed a significantly lower incidence of postpartum depression compared to those with insecure attachment styles (24.2% vs. 46%, P = .037). In the secure attachment group, spousal support had a protective effect against postpartum depression (adjusted OR = 0.57, 95% CI: 0.36-0.91, P = .018), and attachment style emerged as a potential interactive factor influencing the impact of spousal support on postpartum depression (P for interaction = .029).

Conclusion

The provision of spousal support, especially to individuals with secure attachment styles, plays a preventive role in postpartum depression. This underscores the importance of considering attachment styles in interventions targeting postpartum depression prevention.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Social support, health literacy and anxiety among pregnant women during coronavirus 2019 pandemic in Thailand

Background

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact. Pregnant women are particularly vulnerable to its effects, which may increase their anxiety levels. This study aims to investigate anxiety levels in pregnant women during the COVID-19 pandemic in Thailand and to identify factors predicting such anxiety.

Methods

The researchers collected data through an online questionnaire from November 2021 to May 2022. The sample included 404 pregnant women. The questionnaire consisted of personal information, health literacy related to COVID-19, social support, and anxiety related to COVID-19. The content validity of the questionnaire were verified by three experts, with content validity indices of 0.87, 0.80, and 0.87 for each domain, respectively. The reliability of the questionnaire were 0.96 for health literacy, 0.95 for social support, and 0.96 for anxiety. Moreover, in-depth telephone interviews were also conducted with pregnant women. The data were analyzed using descriptive statistics, stepwise multiple regression, and content analysis.

Results

Group of 404 pregnant women were studied, and the results showed that pregnant women had a high level of health literacy regarding COVID-19 and pregnancy (mean = 96.36, SD = 14.23) and social support level on a high level (mean = 83.99, SD = 11.34). Most of them were concerned about anxiety related to COVID-19 infection and pregnancy on a moderate level (mean = 47.78, SD = 11.49). The factors predicting the anxiety of pregnant women during the COVID-19 outbreak in Thailand included health literacy related to COVID-19 (β = 0.468) and social support (β = 0.283), with a prediction rate of 32.80% (R2 = 0.328) with statistical significance (p < 0.05).

Conclusion

This study revealed the anxiety level of pregnant women during the COVID-19 outbreak in Thailand, which was moderate. Health literacy about COVID-19 and social support can predict the anxiety level of pregnant women.

Tracking pregnant women's mental health through social media: an analysis of reddit posts

Objectives

Present an artificial intelligence-enabled pipeline for estimating the prevalence of depression and general anxiety among pregnant women using texts from their social media posts. Use said pipeline to analyze mental health trends on subreddits frequented by pregnant women and report on interesting insights that could be helpful for policy-makers, clinicians, etc.

Materials and methods

We used pretrained transformer-based models to build a natural language processing pipeline that can automatically detect depressed pregnant women on social media and carry out topic modeling to detect their concerns.

Results

We detected depressed posts by pregnant women on Reddit and validated the performance of the depression classification model by carrying out topic modeling to reveal that depressive topics were detected. The proportion of potentially depressed surprisingly reduced during the pandemic (2020 and 2021). Queries related to antidepressants, such as Zoloft, and potential ways of managing mental health dominated discourse before the pandemic (2018 and 2019), whereas queries about pelvic pain and associated stress dominated the discourse during the pandemic.

Discussion and Conclusion

Supportive online communities could be a factor in alleviating stress related to the pandemic, hence the reduction in the proportion of depressed users during the pandemic. Stress during the pandemic has been associated with pelvic pain among pregnant women, and this trend is confirmed through topic modeling of depressive posts during the pandemic.

Prevalence and risk factors of anxious and depressive symptoms in first-trimester females and their partners: a study during the pandemic era of COVID-19 in China

BACKGROUND

The pandemic of coronavirus disease 2019 lastingly affects public mental health. Many studies have described symptoms of anxiety and depression in pregnant women before the pandemic. However, the limited study focuses on the prevalence and risk factors of mood symptoms among first-trimester females and their partners during the pandemic in China, which was the aim of the study.

METHODS

One hundred and sixty-nine first-trimester couples were enrolled. The Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Family Assessment Device-General Functioning (FAD-GF), and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF) were applied. Data were mainly analyzed through logistic regression analysis.

RESULTS

17.75% and 5.92% of first-trimester females had depressive and anxious symptoms, respectively. Among partners, 11.83% and 9.47% had depressive and anxious symptoms, respectively. In females, higher scores of FAD-GF (OR = 5.46 and 13.09; P < 0.05) and lower scores of Q-LES-Q-SF (OR = 0.83 and 0.70; P < 0.01) were related to the risk of depressive and anxious symptoms. Higher scores of FAD-GF were associated with the risk of depressive and anxious symptoms in partners (OR = 3.95 and 6.89; P < 0.05). A history of smoking was also related to males' depressive symptoms (OR = 4.49; P < 0.05).

CONCLUSION

This study prompted prominent mood symptoms during the pandemic. Family functioning, quality of life, and smoking history increased risks of mood symptoms among early pregnant families, which facilitated the updating of medical intervention. However, the current study did not explore interventions based on these findings.

Prevalence of perinatal anxiety and its determinants in mainland China: A systematic review and meta-analysis

BACKGROUND

Perinatal anxiety is among the most common mental health conditions that have a huge negative impact both on mothers and their children. This study aimed to establish summary estimates of the prevalence of perinatal anxiety and its influencing factors in Mainland China.

METHODS

A systematic search was carried out from nine major English and Chinese electronic databases to identify studies published up to August 20, 2022 with data on the prevalence of perinatal anxiety. Two reviewers conducted data extraction and quality assessment. Meta-analysis was performed using a random-effects model. Subgroup and meta-regression analyses were performed when possible.

RESULTS

271 studies representing 369,477 women were included in the study. Pooled prevalence of perinatal anxiety was 17.4 % (95 % CI: 16.2 % to 18.7 %), with prenatal anxiety 17.4 % (95%CI: 16.1 % to 18.8 %) and postpartum anxiety 17.5 % (95%CI: 13.5 % to 22.4 %). However, the overall estimates presented substantial heterogeneity (I² = 98.93 %). Qualitative summaries demonstrated some main potential risk factors of perinatal anxiety such as women with abnormal pregnancy-labor history, poor health status, pregnancy complications, and unplanned pregnancies, and some potential protective factors such as high family income, good social support, good interpersonal relationships, and history of multiple deliveries.

LIMITATION

Very large heterogeneity among studies was observed in meta-synthesis, and all included studies used self-report scales to identify anxiety rather than diagnostic interviews.

CONCLUSION

Varying degrees of perinatal anxiety is prevalent among Chinese women. Screening and evidence-based interventions are urgent and necessary to address this public concern and promote their health and well-being.

The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis

BACKGROUND

This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women.

METHODS

All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed.

RESULTS

This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic.

DISCUSSION

It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times.

OTHER

The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.

Prevalence and risk factors of COVID-19-related generalized anxiety disorder among the general public in China: a cross-sectional study

Objective

This study aimed to estimate the prevalence of generalized anxiety disorder in China during the coronavirus disease 2019 (COVID-19) pandemic and identify its associated factors.

Methods

A cross-sectional study was conducted among the general population in China from March 16 to April 2, 2020. The participants were recruited using stratified random sampling. Data on demographic characteristics and COVID-19 related factors were obtained using self-administered questionnaires. The anxiety score was measured based on the Chinese version of the Generalized Anxiety Disorder 7-item Scale (GAD-7).

Results

The study comprised 10,824 participants, of which 37.69% had symptoms of anxiety. The risk factors for anxiety symptoms included poor self-reported health (OR = 1.672, p < 0.001), chronic diseases (OR = 1.389, p < 0.001), and quarantine (OR = 1.365, p < 0.001), while participants' perceptions that COVID-19 would be controlled was a protective factor (OR = 0.774, p < 0.001). The interactions between quarantine and self-reported health (p < 0.001), as well as between perceptions of COVID-19 and self-reported health (p < 0.001) were found to have a significant effect on GAD-7 scores.

Conclusions

Self-reported health status, chronic diseases, quarantine, and perceptions of COVID-19 were significantly associated with GAD-7 scores, indicating that mental health interventions are urgently needed during pandemics, especially for high-risk groups.

Self perceived health and stress in the pregnancy during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had numerous maternal and neonatal consequences, especially at the mental level. Pregnant women experience a rise in anxiety symptoms and prenatal stress.

Aims

The aim was to describe self-perceived health status, general stress and prenatal stress and to analyze relations and associations with sociodemographic factors.

Methods

A quantitative, descriptive and cross-sectional study was conducted using non-probabilistic circumstantial sampling. The sample was recruited during the first trimester of pregnancy during the control obstetrical visit. The Google Forms platform was used. A total of 297 women participated in the study. The Prenatal Distress Questionnaire (PDQ), the Perceived Stress Score (PSS) and the General Health Questionnaire (GHQ-28) were used.

Results

Primiparas presented higher levels of worry about childbirth and the baby (10.93 ± 4.73) than multiparous women (9.88 ± 3.96). Somatic symptoms were present in 6% of the women. Anxiety-insomnia was scored positively by 18% of the women. In the Spearman correlation analysis, statistically significant values were found between almost all study variables. A positive correlation was observed between self-perceived health and prenatal and general stress levels.

Discussion

During the first trimester of gestation, prenatal concerns increase when levels of anxiety, insomnia and depression also increase. There is a clear relationship between prenatal worries, anxiety, insomnia and depression with stress. Health education that focuses on mental health of pregnant women would help reduce worries during pregnancy and would improve the pregnant women perception of her health and well-being.

The effects of chronic unpredicted mild stress on maternal negative emotions and gut microbiota and metabolites in pregnant rats

Background

Chronic long-term stress is associated with a range of disorders, including depression and a variety of other chronic illnesses. It is well known that maternal exposure to psychosocial stress during pregnancy significantly increases the likelihood of adverse pregnancy outcomes. The gut microbiota has been a popular topic, it is a key mediator of the gut-brain axis and plays an important role in human health; changes in the gut microbiota have been related to chronic stress-induced health impairment, however, the relationship between maternal negative emotions and abnormal gut microbiota and its metabolites during maternal exposure to chronic stress during pregnancy remains unclear.

Methods

Pregnant rats were subjected to chronic unpredicted mild stress (CUMS) to establish the rat model of chronic stress during pregnancy. The behavioral changes were recorded using sucrose preference test (SPT) and open-field test (OFT), plasma corticosterone levels were determined by radioimmunoassay, and a comprehensive method combining 16S rRNA gene sequencing and gas chromatography-mass spectrometry (GC-MS) metabolomics was used to study the effects of stress during pregnancy on the function of intestinal microbiota and its metabolites.

Results

Chronic stress during pregnancy not only increased maternal plasma corticosterone (P < 0.05), but also caused maternal depression-like behaviors (P < 0.05). Chronic stress during pregnancy changed the species composition at the family level of maternal gut microbiota, the species abundance of Ruminococcaceae in the stress group (23.45%) was lower than the control group (32.67%) and the species abundance of Prevotellaceae in the stress group (10.45%) was higher than the control group (0.03%) (P < 0.05). Vertical locomotion and 1% sucrose preference percentage in pregnant rats were negatively correlated with Prevotellaceae (r =  - 0.90, P < 0.05). Principal component analysis with partial least squares discriminant analysis showed that the integration points of metabolic components in the stress and control groups were completely separated, indicating that there were significant differences in the metabolic patterns of the two groups, and there were seven endogenous metabolites that differed (P < 0.05).

Conclusions

The negative emotional behaviors that occur in pregnant rats as a result of prenatal chronic stress may be associated with alterations in the gut microbiota and its metabolites. These findings provide a basis for future targeted metabolomics and gut flora studies on the effects of chronic stress during pregnancy on gut flora.

Pregnant Women’s Anxiety and Depression Symptoms and Influence Factors in the COVID-19 Pandemic in Changzhou, China

Background

With the coronavirus disease 2019 (COVID-19) pandemic, pregnant women’s psychological conditions have become a global challenge. The aim of the study was to identify the prevalence of anxiety and depression symptoms and analyze their influence factors among pregnant women in Changzhou, China during the COVID-19 pandemic and provide them with appropriate healthcare strategies.

Methods

Participants were 681 pregnant women who visited various obstetrics and gynecology clinics in Changzhou, China between 25 February 2020 and 7 March 2020. They were asked to complete an online survey. The Generalized Anxiety Disorder Scale-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to detect anxious and depressive symptoms. The chi-squared test and multivariate logistic regression analysis were carried out to examine the associated factors in these groups.

Results

Overall, the prevalence rates of anxiety and depression symptoms among pregnant women were 31.72 and 36.12%, respectively, but most of them were mild. Having an irregular diet with poor subjective sleep quality, perceiving little family support, spending too much time on news related to the coronavirus, and having severe subjective life impact by the coronavirus were related to anxiety and depression symptoms. In addition, lack of physical exercise and exposure to electronic screens over 5 h per day were associated with depression symptoms.

Conclusion

Pregnant women with an irregular diet, poor sleep quality, little family support, excessive attention to COVID-19 news, and lives impacted by the coronavirus severely are at high risk for anxiety and depression symptoms during the COVID-19 pandemic. This indicates that targeted measures to address mental health in pregnant women during the pandemic period are needed.

Anxiety, Stress, and Social Support in Pregnant Women in the Province of Leon during COVID-19 Disease

The COVID-19 pandemic has posed a high risk to the mental health of the entire population. Pregnant women are strongly affected by the consequences of COVID-19, resulting in increased anxiety and stress. Social support can be a protective factor when it comes to mental health disturbances such as anxiety, fear, or stress in pregnant women. This research aims to describe the anxiety and stress of women in the first trimester of pregnancy in times of pandemic and its relationship with social support. A quantitative, descriptive, cross-sectional study was conducted. A total of 115 women in the first trimester of pregnancy participated. Anxiety was found in 78.3% of the women. Self-perceived stress correlated significantly with the dimensions "concern for changes in oneself", "feelings about oneself", "concern about the future", and very weakly with social support. In addition, a negative correlation was observed between "feelings about oneself" and social support. During the COVID-19 pandemic, anxiety levels of women in our population are elevated. Pregnant women during the first trimester of pregnancy showed higher levels of fear of childbirth and concern about the future than multiparous women. Increased social support and decreased stress seem to influence "feeling about oneself".

Risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic: Evidence from meta-analysis

BACKGROUND

The prevalence of anxiety and depression in pregnant women has significantly increased after the spread of COVID-19 throughout the world. We carried out this meta-analysis to reveal the information about risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic.

METHODS

We searched the PubMed, Embase and CNKI (China National Knowledge Infrastructure) databases for all articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the risk factors for mental health. The statistical heterogeneity among studies was assessed with the Q-test and I2 statistics.

RESULTS

We collected 17 studies including 15,050 pregnant women during the COVID-19 pandemic. Our results found that factors including decrease in the perception of general support and difficulties in household finances have damage effects on anxiety, and factors including undereducated, unemployed during pregnancy, with a chronic physical illness before pregnancy, decrease in the perception of general support, difficulties in household finances, disobey the isolation rules, and smoking during pregnancy have increased risk of depression.

CONCLUSION

Our meta-analysis revealed some risk factors for mental health in pregnant women during COVID-19 pandemic. Mental health interventions in pregnant women may involve targeted methods individually.