Perceived social support and prenatal wellbeing; The mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic

A moderated chain mediation model examining the relation between smartphone addiction and intolerance of uncertainty among master's and PhD students

The theories of relational regulation and compensatory Internet use suggest that intolerance of uncertainty influences smartphone addiction (SPA), which in turn is influenced by other aspects. This study used previous results to examine how intolerance of uncertainty affects SPA in PhD and master's degree programs. A convenience sample comprising 1727 master's and PhD students (99.9 %; 50.7 % female; Mage = 27.71; SD = 3.80; range = 21-43) was recruited. Using established questionnaires, we measured SPA, anxiety, positive coping style, perceived social support, and intolerance of uncertainty. The results demonstrated that intolerance of uncertainty positively affects SPA in terms of predictive power. Furthermore, anxiety and positive coping style mediate that link in a cascade fashion. A greater SPA indicates that the individual is less likely to use a positive coping style, has a higher anxiety level, and has a lower tolerance for uncertainty. While thinking about how intolerance of uncertainty affects anxiety and positive coping style, perceived social support mediates the relationship. Intolerance of uncertainty has less impact on anxiety and positive coping style when perceived social support is high. These results indicate the possibility of examining SPA prevention and intervention from several angles. Therefore, emotional regulation, which modifies anxiety and the tendency to use a positive coping style, may reduce the impact of intolerance of uncertainty on SPA. Another successful strategy for reducing smartphone addiction is to provide social support from loved ones and the community at large.

Relationship Between Stressful Life Events and Online Deviant Behaviors Among College Students: A Moderated Mediation Model

With the gradual penetration of the Internet into the study and life of college students, the Internet not only brings convenience to young adults but also becomes a new channel for them to engage in deviant behaviors. This study explores the relationship between stressful life events and college students' online deviant behaviors, as well as the mediating role of negative automatic thoughts and the moderating role of perceived social support. Data is drawn from 448 college students (Mage = 20.10, SDage = 1.74). Results showed that stressful life events were significantly positively correlated with online deviant behaviors, and negative automatic thoughts mediated the relationship between stressful life events and online deviant behaviors. The relationship between stressful life events and online deviant behaviors, as well as that between negative automatic thoughts and online deviant behaviors, were both moderated by perceived social support. This study provides a practical guiding value for effectively preventing and intervening in college students' online deviant behaviors and maintaining the regular order of the online society.

A machine-learning approach to model risk and protective factors of vulnerability to depression

There are multiple risk and protective factors for depression. The association between these factors with vulnerability to depression is unclear. Such knowledge is an important insight into assessing risk for developing depression for precision interventions. Based on the behavioral data of 496 participants (all unmarried and not cohabiting, with a college education level or above), we applied machine-learning approaches to model risk and protective factors in estimating depression and its symptoms. Then, we employed Random Forest to identify important factors which were then used to differentiate participants who had high risk of depression from those who had low risk. Results revealed that risk and protective factors could significantly estimate depression and depressive symptoms. Feature selection revealed four key factors including three risk factors (brooding, perceived loneliness, and perceived stress) and one protective factor (resilience). The classification model built by the four factors achieved an ROC-AUC score of 75.50% to classify the high- and low-risk groups, which was comparable to the classification performance based on all risk and protective factors (ROC-AUC = 77.83%). Based on the selected four factors, we generated a mood vulnerability index useful for identifying people's risk for depression. Our findings provide potential clinical insights for developing quick screening tools for mood disorders and potential targets for intervention programs designed to improve depressive symptoms.

In the pandemic from the womb. Prenatal exposure, maternal psychological stress and mental health in association with infant negative affect at 6 months of life

For mother-infant health especially, the pandemic has brought multiple stressors inside a susceptible psychobiological system. We study the longitudinal associations between maternal prenatal and postpartum: (a) COVID-19 stressful events exposure, (b) pandemic psychological stress, and (c) mental health and infants' negative affect. A sample of 643 Italian pregnant women completed a web-based survey from April 8th to May 4th, 2020 and a follow-up at 6 months after delivery. Maternal assessment covered prenatal and postpartum measures for: COVID-19 stressful events exposure, pandemic psychological stress, mental health symptoms (i.e., depression, anxiety, posttraumatic stress disorder) and postpartum, social support and report of infants' negative affect. Maternal mental health symptoms during pregnancy, at the peak of pandemic, is longitudinally associated with infant negative affect, with postpartum mental health mediating this association. Also, maternal COVID-19 stressful events exposure in postpartum is associated with negative affect at 6 months mediated by postpartum mental health symptoms. Maternal pandemic psychological stress during pregnancy predicted mental health symptoms in postpartum. The study supports the association between pandemic-related maternal health across pregnancy and postpartum and offspring's development (i.e., negative affect). It also puts the spotlight on mental health risk in women experiencing lockdown during pregnancy, especially when feeling high psychological stress in pregnancy or when directly exposed to COVID-19 stressful events postpartum.

Prevalence and predictors of prenatal depression during the COVID-19 pandemic: A multistage observational study in Beijing, China

OBJECTIVE

While growing psychological health issues among pregnant women during the COVID-19 pandemic have been clearly validated, most research was conducted in countries with relatively lax quarantine measures. This study aimed to compare the prevalence of prenatal depression among pre-, peak-, and post-COVID-19 in Beijing, the region with a stringent response policy in China. We also explore predictors of prenatal depression throughout the outbreak.

METHODS

We investigated prenatal depression among 742 pregnant women who received antenatal checkups in Beijing from March 28, 2019 to May 07, 2021 using the Edinburgh Postnatal Depression Scale and associative demographic, pregnancy-related, and psychosocial characteristics were measured. The phase was divided into pre-, peak-, and post-COVID-19 in light of the trajectory of COVID-19. Pearson's Chi-square test was used after the examination of confounders homogeneity. The bivariable and multivariable logistic regression was conducted to explore predictors.

RESULTS

The pooled prevalence of prenatal depression was 11.9% throughout the COVID-19 pandemic. Rates at different phases were 10.6%, 15.2%, and 11.1% respectively and no significant difference was observed. Multivariable logistic regression revealed that history of mental illness, number of boy-preference from both pregnant women and husband's family, social support, occupation, and living space were independent predictors of prenatal depression in Beijing.

CONCLUSION

Our data suggested that the impact of this pandemic on prenatal depression in Beijing appears to be not significant, which will strengthen confidence in adhering to current policy for decision-makers and provide important guidance for the development of major outbreak control and management policies in the future. Our findings may also provide a more efficient measure to identify high-risk pregnant women for professionals and help raise gender equity awareness of pregnant women and their husbands' families. Future studies should focus on the value of targeted care and family relations on the mental health of pregnant women.

Health information-seeking internet behaviours among pregnant women: a narrative literature review

BACKGROUND

Pregnant women often turn to the internet as a primary source of pregnancy-related information. However, there is great concern about the accuracy of health-related information on the internet, making research on women's internet behaviours and decision-making critically important. Previous research has been conducted within a number of distinct but related fields, yet existing review papers have often failed to connect across the various disciplines.

OBJECTIVE

This review aims to synthesise the large and cross-disciplinary body of literature on women's health information-seeking internet behaviour regarding pregnancy and childbirth.

METHODS

A narrative literature review, which includes research from both health and social sciences, was conducted.

RESULTS

Findings address the 'who, where, what, why, and how' of information-seeking behaviour on the internet, with suggestions for future research in each area further discussed.

CONCLUSIONS

Additional research which addresses the remaining gaps in the literature can help providers be more aware of their patients' informational needs. Providers can be an important source of information, while also helping guide their patients on how to evaluate information. Enhanced patient portals and communication platforms can help to provide more timely and reliable information. Providing their patients with guides can be important for fostering enhanced health literacy.

The association between fear of childbirth and social support through the Internet and Social Networking Services in pregnant women: A cross-sectional study

Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women.

Virtual(ly) no support: Associations between virtual support group participation and peripartum mental health outcomes during the COVID-19 pandemic

OBJECTIVE

This study examined associations between participation in virtual support groups for peripartum women and mental health outcomes at follow-up approximately 8 months later.

METHODS

This cross-sectional online survey study assessed 383 women from the Perinatal Experiences and COVID-19 Effects (PEACE) study. Initial participants (T1) were re-contacted (T2) and self-reported mental health symptoms of depression (CES-D), anxiety (GAD-7), and COVID-related grief were assessed at both time points. Participants reported involvement in virtual support groups and their perception of the effectiveness of social media in addressing feelings of loneliness.

RESULTS

The majority (62%) of respondents participated in a virtual support group, 99% of whom used informal social media-based groups (e.g. Facebook groups). At initial evaluation, virtual group participants reported higher levels of depressive symptoms (p=0.008) and COVID grief (p=0.004), but not higher levels of anxiety. Across the cohort, self-reported depressive, anxiety, and grief symptoms did not change significantly at follow-up in paired analysis, and virtual group participants did not demonstrate improvement in mental health symptoms.

CONCLUSIONS

Participation in virtual support groups did not seem to improve mental health outcomes for peripartum women, and most women found social media engagement minimally effective at addressing loneliness.

To be a freshman during the COVID-19 pandemic: A cross-lagged model of depression, mentalizing, and epistemic trust

Research has shown that severity of depression increased in freshmen during their first months at university due to increased social and academic pressures. Since the start of the COVID-19 pandemic, several cross-sectional studies have suggested that levels of depression in university students are higher than before the pandemic, but longitudinal data are largely lacking. This study investigated severity of depression and negative affect linked to the pandemic among freshmen during their first semester at a large university in Flanders, Belgium. We also investigated whether epistemic trust predicted severity of depression and pandemic-related negative affect and whether problems with reflective functioning (or mentalizing) mediated these relations. Participants in this two-wave prospective study were 289 first-year students of the Faculty of Psychology and Educational Sciences of a large Belgian university. We conducted paired samples t-tests and cross-panel analysis to answer the research question. The number of students at risk of clinical depression increased by 41% between T1 (early October 2020) and T2 (late December 2020). Epistemic mistrust at T1 was prospectively associated with an increase in the prevalence and severity of depression at T2. Problems with mentalizing and negative COVID-19-related affect were positively associated with severity of depression at T2 and mediated the association between epistemic mistrust and severity of depression at T2. The findings highlight the key role of epistemic trust in the development of depression among freshmen, with the COVID-19 pandemic presenting an additional source of uncertainty.

Associations of rumination, behavioral activation, and perceived reward with mothers' postpartum depression during the COVID-19 pandemic: a cross-sectional study

Introduction

The COVID-19 pandemic has led to increased social isolation for mothers, and rumination exacerbates postpartum depression in mothers with poor social support. Although behavioral activation can help to decrease their depressive symptoms, the mechanism by which behavioral activation reduces postpartum depression remains unclear.

Methods

We examined the effects of rumination and behavioral activation on depression in postpartum women by examining a model mediated by subjective reward perception. A questionnaire was administered to 475 postpartum women (Age: Mean = 30.74 years, SD = 5.02) within 1 year of childbirth using an Internet survey. The measurements included perinatal depression, rumination, and behavioral activation, and we assessed environmental reward. To control for confounding variables, we assessed psychiatric history, social support, parenting perfectionism, and COVID-19 avoidance.

Results

Eighty-four (17.68%) mothers had possible postpartum depression. The covariance structure analysis showed that not only was there a direct positive path from rumination to postnatal depression but also a negative path via reward perception.

Discussion

This finding indicated that the COVID-19 pandemic could have increased depression in many of the mothers. Rumination not only directly relates to postpartum depression, but it could also indirectly relate to postpartum depression by decreasing exposure to positive reinforcers. In addition, having a history of psychiatric illness increases the effect of rumination on postpartum depression. These findings suggest that psychological interventions are needed to reduce rumination and increase contact with positive reinforcements to reduce postpartum depression, especially for high-risk groups.

Women's experiences of changes to childbirth and parenting education in Australia during the COVID-19 pandemic: The birth in the time of COVID-19 (BITTOC) study

OBJECTIVE

As changes to Childbirth and Parenting Education (CBPE) classes during the COVID-19 pandemic remain unexplored in Australia, our objective was to understand how changes to CBPE in Australia during the COVID-19 pandemic impacted on women's birth and postnatal experiences.

METHODS

Survey responses were received from 3172 women (1343 pregnant and 1829 postnatal) for the 'Birth In The Time Of Covid-19 (BITTOC)' survey (August 2020 to February 2021) in Australia. One of the survey questions asked women if they had experienced changes to CBPE class schedules or format during the pandemic, with a follow up open ended text box inviting women to comment on the impact of these changes. The majority of women experienced changes to CBPE, with only 9 % stating they experienced no changes to classes. A content analysis was undertaken on the 929 open text responses discussing the impact these changes had on women's experience of pregnancy, birth and postpartum.

RESULTS

929 women (29 %) made 1131 comments regarding changes to CBPE classes during the pandemic. The main finding 'I felt so unprepared', highlights how women perceived the cessation or alteration of classes impacted their birth preparation, with many reporting an increased sense of isolation. Some women reported feeling 'It was good enough' with adequate provision of online classes, and others feeling 'I was let down by the system' due to communication and technological barriers.

CONCLUSIONS

Results highlight the importance of ensuring continued provision of hybrid/online childbirth education models to enable versatility during times of crisis. Gaps in service provision, communication and resources for childbirth and parenting education need addressing.

Meaning in Life and Loneliness as Mediators between COVID-19 Anxiety and Life Satisfaction in the Post-Pandemic among the General Population in Turkey: A Serial Mediation Model

The COVID-19 pandemic has impacted global society, leading to negative well-being and mental health outcomes. However, little is known about how COVID-19-related anxiety affects life satisfaction through psychological factors. This study examined the mediating roles of meaning in life and loneliness in the relationship between COVID-19 anxiety and life satisfaction in 333 Turkish general population (59.2% females; Mage = 33.9 ± 7.8). Participants completed measures of COVID-19 anxiety, life satisfaction, meaning in life, and loneliness. The results showed that COVID-19 anxiety predicted meaning in life, loneliness, and life satisfaction. Meaning in life predicted loneliness and life satisfaction, while loneliness predicted life satisfaction. Serial mediation analysis revealed that COVID-19 anxiety predicts life satisfaction through meaning in life and loneliness, even after controlling for age and gender. These findings contribute to our understanding of the underlying mechanisms between COVID-19 anxiety and life satisfaction, with implications for future research and practice.

Why Cannot I Stop Phubbing? Boredom Proneness and Phubbing: A Multiple Mediation Model

Background

With the popularity of smartphone and their increasingly rich functions, people's attachment to their phones is increasing. While people enjoy the convenience that smartphone bring (eg, accessing information and socializing), it also leads to problematic smartphone use (eg, phubbing). Previous research has shown that boredom proneness can trigger phubbing. However, the underlying psychological mechanisms are not yet clear.

Methods

To address this research gap, we surveyed 556 Chinese college students (Mage = 18.89 years, SD = 1.18) during the COVID-19 pandemic and all participants completed a self-report questionnaire. Drawing the Interaction of Person-Affect-Cognition-Execution model (I-PACE) for addictive behaviors, this study developed and examined a multiple mediation model incorporating boredom proneness, loneliness, fear of missing out (FoMO), and phubbing.

Results

(1) Boredom proneness could positively predict phubbing; (2) loneliness and FoMO mediated the relationship between boredom proneness and phubbing, respectively; and (3) loneliness and FoMO sequentially mediated the relationship between boredom proneness and phubbing.

Conclusion

These findings are not only valuable for understanding the underlying mechanisms linking boredom proneness and phubbing, but also suggest that three types of interventions could be effectively used to decrease the risk of phubbing among college students, namely, reducing boredom proneness, relieving loneliness, and decreasing FoMO.

Maternal Social Loneliness Detection Using Passive Sensing Through Continuous Monitoring in Everyday Settings: Longitudinal Study

BACKGROUND

Maternal loneliness is associated with adverse physical and mental health outcomes for both the mother and her child. Detecting maternal loneliness noninvasively through wearable devices and passive sensing provides opportunities to prevent or reduce the impact of loneliness on the health and well-being of the mother and her child.

OBJECTIVE

The aim of this study is to use objective health data collected passively by a wearable device to predict maternal (social) loneliness during pregnancy and the postpartum period and identify the important objective physiological parameters in loneliness detection.

METHODS

We conducted a longitudinal study using smartwatches to continuously collect physiological data from 31 women during pregnancy and the postpartum period. The participants completed the University of California, Los Angeles (UCLA) loneliness questionnaire in gestational week 36 and again at 12 weeks post partum. Responses to this questionnaire and background information of the participants were collected through our customized cross-platform mobile app. We leveraged participants' smartwatch data from the 7 days before and the day of their completion of the UCLA questionnaire for loneliness prediction. We categorized the loneliness scores from the UCLA questionnaire as loneliness (scores≥12) and nonloneliness (scores<12). We developed decision tree and gradient-boosting models to predict loneliness. We evaluated the models by using leave-one-participant-out cross-validation. Moreover, we discussed the importance of extracted health parameters in our models for loneliness prediction.

RESULTS

The gradient boosting and decision tree models predicted maternal social loneliness with weighted F1-scores of 0.897 and 0.872, respectively. Our results also show that loneliness is highly associated with activity intensity and activity distribution during the day. In addition, resting heart rate (HR) and resting HR variability (HRV) were correlated with loneliness.

CONCLUSIONS

Our results show the potential benefit and feasibility of using passive sensing with a smartwatch to predict maternal loneliness. Our developed machine learning models achieved a high F1-score for loneliness prediction. We also show that intensity of activity, activity pattern, and resting HR and HRV are good predictors of loneliness. These results indicate the intervention opportunities made available by wearable devices and predictive models to improve maternal well-being through early detection of loneliness.

Perinatal Understanding of Mindful Awareness for Sleep (PUMAS): A single-arm proof-of-concept clinical trial of a mindfulness-based intervention for DSM-5 insomnia disorder during pregnancy

OBJECTIVES

Cognitive-behavioral therapy is effective for prenatal insomnia, but unresolved cognitive arousal limits patient outcomes. Therapies aimed at reducing cognitive arousal may benefit pregnant women with insomnia. This proof-of-concept trial evaluated Perinatal Understanding of Mindful Awareness for Sleep (PUMAS, which combines mindfulness with behavioral sleep strategies) on insomnia, depression, and cognitive arousal.

METHODS

A single-arm trial of 12 pregnant women with DSM-5 insomnia disorder (n = 5/12 with comorbid depression) who received six sessions of PUMAS delivered individually via telemedicine. Pretreatment and posttreatment outcomes included the insomnia severity index (ISI), Edinburgh postnatal depression scale (EPDS), pre-sleep arousal scale's cognitive factor (PSASC; nocturnal cognitive arousal), perinatal-focused rumination (appended to PSASC), and Glasgow sleep effort scale.

RESULTS

Eleven of 12 patients completed all sessions. Intent-to-treat analyses revealed a 10.83-point reduction in ISI (Cohen's dz = 3.05), resulting in 83.3% insomnia remission. PUMAS produced large reductions in EPDS (Cohen's dz = 2.76 in depressed group), resulting in all five baseline depressed patients remitting from depression. PUMAS produced large reductions in nocturnal cognitive arousal, perinatal-focused rumination, and sleep effort (all Cohen's dzs>2.00). Patients were highly satisfied with PUMAS and identified the telemedicine format and meditation app as positive features of its delivery. Patients rated sleep restriction and guided meditations as the most helpful treatment components.

CONCLUSION

Prenatal insomnia patients were highly engaged in PUMAS, which produced large acute reductions in insomnia, depression, and cognitive arousal. These findings support the concept and feasibility of PUMAS for pregnant women with insomnia who present with or without comorbid depression.

CLINICALTRIALS

GOV ID

NCT04443959.

Effectiveness of mHealth consultation services for preventing postpartum depressive symptoms: a randomized clinical trial

BACKGROUND

Although many conventional healthcare services to prevent postpartum depression are provided face-to-face, physical and psychosocial barriers remain. These barriers may be overcome by using mobile health services (mHealth). To examine the effectiveness of mHealth professional consultation services in preventing postpartum depressive symptoms in real-world settings, we conducted this randomized controlled trial in Japan, where universal free face-to-face perinatal care is available.

METHODS

This study included 734 pregnant women living in Yokohama city who could communicate in Japanese, recruited at public offices and childcare support facilities. The participants were randomized to the mHealth group (intervention, n = 365), where they could use a free app-based mHealth consultation service with gynecologists/obstetricians, pediatricians, and midwives whenever and as many times as they wanted between 6 p.m. and 10 p.m. on weekdays throughout their pregnancy and postpartum periods (funded by the City of Yokohama government) or the usual care group (control, n = 369). The primary outcome was the risk of elevated postpartum depressive symptoms, defined as Edinburgh Postnatal Depression Scale score ≥ 9. Secondary outcomes were self-efficacy, loneliness, perceived barriers to healthcare access, number of clinic visits, and ambulance usage. All outcomes were collected three months post-delivery. We also conducted subgroup analyses assessing the differences in the treatment effect by sociodemographic status.

RESULTS

Most women completed all questionnaires (n = 639 of 734, response rate: 87%). The mean baseline age was 32.9 ± 4.2 years, and 62% were primipara. Three months post-delivery, women in the mHealth group had a lower risk of elevated postpartum depressive symptoms (47/310 [15.2%]) compared to the usual care group (75/329 [22.8%], risk ratio: 0.67 [95% confidence interval: 0.48-0.93]). Compared with the usual care group, women in the mHealth group had higher self-efficacy, less loneliness, and fewer perceived barriers to healthcare access. No differences were observed in the frequency of clinic visits or ambulance usage. Furthermore, in the subgroup analyses, we did not find differences in the treatment effect by sociodemographic status.

CONCLUSIONS

Local government-funded mHealth consultation services have a preventive effect on postpartum depressive symptoms, removing physical and psychological barriers to healthcare access in real-world settings.

TRIAL REGISTRATION

UMIN-CTR identifier: UMIN000041611. Registered 31 August 2021.

Women's experience of perinatal support in a high migrant Australian population during the COVID-19 pandemic: a mixed methods study

BACKGROUND

As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk.

AIM

To explore women's experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness.

METHODS

A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis.

RESULTS

There were 24 participants interviewed both antenatally and postnatally (22 antenatal; 18 postnatal). Fourteen women were migrants and 10 Australian born. Main themes included; 'Significant disruption and loss of peripartum support during the COVID-19 pandemic and ongoing impact for migrant women'; 'Husbands/partners filling the support gap' and 'Holding on by a virtual thread'. Half of the participants felt unsupported antenatally. For Australian born women, this dissipated postnatally, but migrants continued to feel unsupported. Migrant women discussed partners stepped into traditional roles and duties of absent mothers and mothers-in-law who were only available virtually.

CONCLUSION

This study identified disrupted social support for migrant women during the pandemic, providing further evidence that the pandemic has disproportionately impacted migrant populations. However, the benefits identified in this study included high use of virtual support, which could be leveraged for improving clinical care in the present and in future pandemics. The COVID-19 pandemic impacted most women's peripartum social support with migrant families having ongoing disruption. Gains in the pandemic included greater gender equity for domestic work as husbands/partners increased their contribution to domestic work and childcare.

Parental Burnout, Quality of Life, and Pregnancy During COVID-19

Background: Parents may be at greater risk to experience parental burnout after experiencing challenges during the COVID-19 pandemic. Given the unique experiences of parents with young children during the first two years of the pandemic, this study explored the relationship between parental burnout, quality of life (QOL), and perceived threat of COVID-19 among a sample of adults who parented at least one child under the age of five. Method: A brief survey was conducted through convenience sampling (N = 48) and included the Brief Parental Burnout Scale, The QOL Scale, and a perceived COVID threat scale. Results: Logistic regression analysis found that pregnancy was a significant predictor of burnout risk even after controlling other effects on burnout risk. Conclusion: Findings suggest that the pandemic negatively impacted parental burnout and pregnancy during the first 2 years of the pandemic increased risk for burnout. Awareness is important for appropriate assessment and intervention by clinicians.

A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health

This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.

Laboring Alone: Perinatal Outcomes during Childbirth without a Birth Partner or Other Companion during the COVID-19 Pandemic

During the first wave of the COVID-19 pandemic in the spring of 2020, the government of the Czech Republic issued a nationwide ban on visitors to maternity wards. We studied whether the absence of a close person during labor due to this ban impacted perinatal indicators. This study was performed using an administrative observational questionnaire focused on absolute frequencies of events sent to maternity facilities across the Czech Republic. Completed answers were received from 33 facilities covering 4805 births during the study period in 2019 and 4514 births in 2020. The differences in individual parameters were tested using Pearson's chi-squared homogeneity test. There were no significant differences between the two periods in spontaneous pre-term births (p = 0.522) or in the number of cesarean sections (p = 0.536). No significant changes were seen in either local or systemic analgesia. Data showed a significantly shorter (p = 0.026) first stage of labor in 2020 compared to 2019, while there was no significant difference (p = 0.673) in the second stage of labor. There was no statistically significant difference found for newborn perinatal adaptation. There were also no significant differences in intrapartum maternal injuries. Overall, we found no significant differences in basic perinatal indicators during the first wave of COVID-19 in 2020 compared to 2019. Although the absence of a close person may cause stress for the laboring women, it does not impair objective clinical outcomes.

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.

Dysfunctional Attitudes Toward Motherhood and Depressive Symptoms in Portuguese Pregnant Women During COVID-19 Pandemic: the Mediating Roles of Self-Compassion and Mindful Self-Care

Objectives

There is evidence that the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the mental health of pregnant women, such as an increase in the prevalence of depression. Given the negative consequences that depressive symptoms can pose for pregnant women, it is crucial to understand how cognitive processes influence women's depressive symptoms during the COVID-19 pandemic among this specific vulnerable population. The present study aimed to examine the relationship between pregnant women's dysfunctional attitudes toward motherhood and their depressive symptoms, considering the mediating roles of self-compassion and mindful self-care.

Method

A cross-sectional online survey was conducted in Portugal between October 2020 and April 2021. A sample of 244 pregnant women answered a set of questionnaires to assess dysfunctional attitudes toward motherhood, depressive symptoms, self-compassion, and mindful self-care.

Results

More dysfunctional attitudes toward motherhood were associated with higher levels of depressive symptoms, and this relation was mediated through self-compassion and mindful self-care.

Conclusions

These results highlight that self-compassion and mindful self-care are important psychological mechanisms and the importance of considering them in psychological interventions to prevent and/or treat depressive symptoms in pregnant women with dysfunctional attitudes toward motherhood during stressful events such as a pandemic.

Social Support Levels, Mental Health Status and Related Factors in Postpartum Women During the Pandemic

The aim of this study was to determine the social support levels, mental health status and related factors of women in the postpartum period during the pandemic process. The data of the descriptive study were collected between 12 May and 27 June 2022. The study was conducted with 264 postpartum mothers who gave birth in a university hospital. Data were collected using Personal Information Form, General Health Questionnaire (GHQ-28) and Multidimensional Scale of Perceived Social Support (SDS). The total mean score of the mothers' GHQ-28 questionnaire was 5.70±5.44, and it was determined that 47.3% of them perceived their mental health as risky. There is a statistically significant difference in the GHQ-28 score distributions according to the mothers' age, education level, smoking, family and friend relations, desired pregnancy status, and previous psychological problems. In addition, when the factors related to SBL were examined, it was determined that the level of education, financial situation, friend relationship, and previous psychological problems were statistically significant. There is a positive and significant relationship between mothers' mental health status and social support levels. As a result, almost half of the mothers are at risk for their mental health. Some introductory characteristics of mothers affect their general health status and social support levels. According to these findings, it is recommended that more social support be given to mothers with risky mental health conditions by their families and health personnel.

Maternal Anxiety and Its Associated Factors During the First and Second Wave of COVID-19 Pandemic in Serbia: A Cross-Sectional Study

Aim

The COVID 19-pandemic affects people differently, while pregnant women are among the most sensitive populations. The data about maternal mental health during the COVID-19 outbreak are in some ways consistent but also country-specific.

Purpose

The study aims to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify its associated factors.

Patients and Methods

This cross-sectional study included a sample of 358 pregnant women during the first and second waves of the pandemic in Serbia. An anonymous survey included basic demographic questions, pregnancy-related background questions, the question of self-reported COVID-19-related fear, State-Trait Anxiety Inventory (STAI), and Multidimensional Scale of Perceived Social Support (MSPSS).

Results

The study revealed no pregnant women with low anxiety levels measured by STAI-T and STAI-S, while the STAI-S and STAI-T scores indicated high anxiety in 32.4% and 42.7% of pregnant women, respectively. The obtained results pointed out the nonlinear dependence of state anxiety on observed associated factors and their complex interactions, including the data collecting period.

Conclusion

Our findings reveal that COVID-19 affects pregnant women's mental health and makes it necessary for psychological monitoring and support for pregnant women, which may be reflected in their mental health but also the development of their offspring.

Exploring the Relationship between Perceived Community Support and Psychological Well-Being of Tourist Destinations Residents

To explore the relationship between community support in tourist destinations and residents' psychological well-being in the post-COVID-19 pandemic period, this study adopts the questionnaire survey method and draws the following conclusions by constructing a structural equation model: (1) perceived community support is very helpful for the psychological well-being of residents, (2) psychological resilience significantly mediates the relationship between perceived community support and residents' psychological well-being, (3) the resident-tourist interaction mediates the relationship between perceived community support and residents' psychological well-being, and (4) the resident-tourist interaction and psychological resilience play an ordered chain-mediating role between perceived community support and residents' psychological well-being. These findings not only fill the gap in tourism research regarding destination-based community support studies but also provide a theoretical basis for maintaining residents' psychological well-being in a given destination in the context of the COVID-19 pandemic. To a certain extent, improving residents' well-being is helpful for promoting the healthy and sustainable development of tourism activities and realizing a "win-win" situation in which tourist destinations develop economically while promoting their residents' living standards.

'Those whom I have to talk to, I can't talk to': Perceived social isolation in the context of anxiety symptoms among pregnant women in Pakistan

Anxiety during pregnancy is highly prevalent in low- and middle-income countries. The relative importance of different sources and types of perceived support in the Pakistani context is unknown. We explored social support during pregnancy and the role of social isolation in Pakistani women's experiences of antenatal anxiety. We conducted semi-structured interviews with 19 pregnant women with symptoms of anxiety and 10 female healthcare providers at a public urban hospital. We used inductive and deductive thematic coding to analyse the data. Many pregnant women reported feelings of physical and social isolation, even when living in joint families with larger social networks. Often fearing censure by their in-laws and peers for sharing or seeking help with pregnancy-related anxieties, women reported relying on husbands or natal family members. Normative expectations around pregnancy such as male gender preference, perceived immutability of wives' domestic responsibilities and expectations of accompanied travel by women may serve as sources of disconnectedness in the antenatal period. Providers viewed social isolation and deficits in social support during pregnancy as contributing to worse anxiety symptoms, reduced access to care and poorer health behaviours. One limitation is that the hospital setting for this study may have resulted in underreporting of abuse or neglect and limited inclusion of pregnant women who do not utilise facility-based antenatal care. In conclusion, husbands and natal families were key in reducing social isolation in pregnancy and mitigating anxiety, while in-laws did not always confer support. Targeted strategies should enhance existing support and strengthen in-law family relationships in pregnancy.

Support from friends moderates the relationship between repetitive negative thinking and postnatal wellbeing during COVID-19

BACKGROUND

Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postnatal psychological wellbeing - potentially intensifying RNT.

OBJECTIVE

We examined whether perceived social support (from friends, family, and a significant other) played a moderating role in the relationship between RNT and maternal postnatal anxiety and depressive symptoms.

METHODS

A sample of women (N = 251) who had given birth in the preceding 12 months completed an online battery of standardised measures during the COVID-19 'lockdown' of May 2020.

RESULTS

As predicted, social support moderated the relationship between RNT and depression such that the association between RNT and depression was stronger for women who reported lower levels of social support. Interestingly, this finding emerged for social support from friends only; for support from family and significant other, social support did not play a moderating role. Further, and unexpectedly, overall social support did not moderate the relationship between RNT and postnatal anxiety, however, social support from friends was a significant moderator.

CONCLUSIONS

High levels of perceived social support from friends (but not family or significant others) buffered the effects of RNT on depression and anxiety during the postpartum period. Strategies to bolster peer social support may be a valuable inclusion in interventions to prevent and treat postnatal depression and anxiety.

Antenatal anxiety and depression: Frequency and correlates during the COVID-19 pandemic in Pakistan

Context

Mental health ailments like anxiety and depression are common during the antenatal period. Uncertainty during COVID-19 pandemic has markedly increased its prevalence in the general population. Pregnancy, being emotionally and physically exhausting, makes mothers more susceptible to developing mental disorders like anxiety and depression.

Aims

To investigate prevalence and associated risk factors of antenatal anxiety and depression among women in Karachi, Pakistan.

Settings and Design

This cross-sectional study was conducted in the department of obstetrics and gynecology during May 2020 till May 2021.

Methods and Material

The study explored anxiety, depression, and associated factors in pregnant women attending antenatal clinics at a tertiary care hospital located in Karachi, Pakistan, during the COVID-19 pandemic by using the hospital anxiety and depression scale (HADS) as a screening tool.

Statistical Analysis

Data was entered in SPSS version 21 for statistical analysis.

Results

A total of 390 patients were enrolled in the study with mean age of 28.06 ± 4.52 years. Mean week of pregnancy at the time of enrolment into the study was 32.7 ± 3.1. Prevalence of anxiety and depression was 46.7% and 33.1%, respectively. On multivariable analysis, polyhydramnios was a risk factor of anxiety, whereas low income and unplanned pregnancy were substantially linked to depression. Fear of visiting doctor was a common risk factor for both anxiety and depression.

Conclusion

In a catastrophe like the COVID-19 pandemic, attempts to address heightened anxiety during antenatal visits will undoubtedly benefit maternal and fetal mental health. As a response, strategies to manage high anxiety symptoms should be taken into consideration.

Mattering and Depressive Symptoms in Portuguese Postpartum Women: The Indirect Effect of Loneliness

BACKGROUND

Postpartum depression is described as the most prevalent clinical condition in the postpartum period, with several negative consequences. The current study aimed to understand the relationship between mattering, loneliness and depressive symptoms in Portuguese postpartum women and to examine the potential mediating role of loneliness in the relationship between mattering and depressive symptomatology among postpartum women.

METHODS

This cross-sectional study included a sample collected online composed of 530 Portuguese women in the postpartum period, who answered self-report questionnaires to assess depressive symptoms, mattering, and loneliness.

RESULTS

It was found that the relationships between mattering, loneliness, and depressive symptoms were significant, p < 0.001: (a) higher levels of mattering were associated with lower levels of loneliness and depressive symptomatology and (b) higher levels of loneliness were associated with higher levels of depressive symptomatology. The relationship between mattering and postpartum depressive symptoms occurred directly and indirectly through loneliness, 95% CI = [-0.75, -0.46].

CONCLUSIONS

These results highlight the importance of studying loneliness as a possible risk factor for postpartum depression and alert to the pertinence of considering mattering and loneliness in the assessment and intervention with women in the perinatal period.

Repetitive negative thinking in the perinatal period and its relationship with anxiety and depression

BACKGROUND

Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period.

METHODS

We conducted a scoping review of studies that have investigated the relationship between RNT and perinatal depression and anxiety. We identified 87 papers eligible for inclusion in the review; they included cross-sectional and longitudinal studies, as well as treatment evaluations (pilot trials and randomised controlled trials).

RESULTS

Cross-sectional studies provided evidence of an association between RNT (i.e., rumination and worry) and depression and anxiety, in both pregnancy and postpartum. Longitudinal findings were mixed. Whilst antenatal worry consistently predicted subsequent depression and anxiety (both later in pregnancy and postpartum), rumination did not consistently predict depression. However, there was some evidence that rumination interacted with other processes to predict later psychopathology. Three randomised controlled trials evaluated whether psychological treatments reduce RNT in the perinatal period, only one of which included a clinical sample.

LIMITATIONS

No experimental investigations were eligible for inclusion in the review.

CONCLUSIONS

Further studies are needed to further our understanding of the nature and role of RNT in pregnancy and postpartum, and its consequences for maternal mental health. These include (but are not limited to) experimental investigations, studies with large clinical samples, and RCTs evaluating the effectiveness of psychological interventions targeting RNT to prevent and treat perinatal depression and anxiety.

A qualitative analysis of feelings and experiences associated with perinatal distress during the COVID-19 pandemic

Background

Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative experiences of distress. This study aimed to extend published quantitative findings resulting from the same data set (Harrison et al., Women Birth xxxx, 2021;  Harrison et al., J Reprod Infant Psychol 1–16, 2021) to qualitatively explore: 1) the feelings and symptoms associated with maternal perinatal distress during the COVID-19 pandemic; and 2) the associated sources of distress.

Methods

As part of an online survey during May 2020, 424 perinatal women responded to an open-ended question regarding a recent experience of distress. Qualitative data were analysed using an initial content analysis, followed by an inductive thematic analysis adopting a realist approach. Data were explored in the context of self-reported perinatal anxiety and depression symptoms.

Results

Initial content analysis of the data identified twelve distinct categories depicting participants’ feelings and symptoms associated with psychological distress. Despite the high rates of probable depression in the sample, women’s descriptions were more indicative of anxiety and general distress, than of symptoms traditionally related to depression. In terms of the associated psychosocial stressors, a thematic analysis identified five themes: Family wellbeing; Lack of support; Mothering challenges; Loss of control due to COVID-19; and Work and finances. Unsurprisingly given the context, isolation was a common challenge. Additionally, psychological conflict between maternal expectations and the reality of pregnancy and motherhood, loss of autonomy and control, and fears surrounding family health, safety, and wellbeing underlay many of the themes.

Conclusions

This study presents an array of feelings and symptoms expressed by perinatal mothers which may be useful to consider in relation to perinatal wellbeing. Furthermore, our data highlights several common sources of distress, including multiple COVID-19 specific factors. However, many were related to more general perinatal/maternal experiences. Our findings also point to considerations that may be useful in alleviating distress in pregnancy and early motherhood, including social support, realistic perinatal/maternal expectations, and support for those with perceived perinatal trauma.

Pregnancy-related psychopathology: A comparison between pre-COVID-19 and COVID-19–related social restriction periods

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic impacted in a still undefined way pregnant women’s mental health. There are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant population. The greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational period. We hypothesised that pregnant women in the pre-pandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction period.

AIM

To compare pregnant women for anxiety, prenatal depression, psychopathology, and social support before and after the awareness of the pandemic.

METHODS

We administered to women willing to participate in their 2^nd-3^rd trimesters of pregnancy the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory Form Y (STAI-Y), and the Symptom CheckList-90-Revised (SCL-90R); we further collected sociodemographic variables and explored women’s social support. The comparison was cross-sectional. The first sample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak (January 2020-February 2020) was declared, and the second sample termed COVID-19 because participants were already subjected to the COVID-19–related restrictive measures (January 2021-February 2021). Since normal distribution was not met (Shapiro-Wilk test applied), we applied nonparametric Mann-Whitney’s U-test to compare psychometric tests. Ethical standards were met.

RESULTS

The nonCOVID-19 group reported higher support from partners only, while the COVID-19 group reported multiple support (χ² = 9.7181; P = 0.021); the nonCOVID-19 group scored higher than the COVID-19 group only on state anxiety among psychometric scales [STAI-Y1, nonCOVID-19 median = 39 (95%CI: 39.19-51.10) vs COVID-19 median= 32 (95%CI: 30.83-38.90); Mann-Whitney’s U=117.5, P = 0.00596]. Other measures did not differ meaningfully between the two groups. Scores on the EPDS, the state and trait subscales of the STAI-Y, and most SCL-90R subscales inter-correlated with one another. The anxiety component of the EPDS, EPDS-3A, correlated poorly with other measures, while it was the Global Symptom Index of the SCL-90-R that correlated most strongly with most measures. Our results are at odds with most literature and do not confirm increased depression and anxiety rates in pregnant women during the pandemic.

CONCLUSION

The ability of pregnant women to deal with novel generalised threats involves mobilization of inner resources. Increasing sources of social support may have produced anxiolysis in the COVID-19 sample.

Emotional Experiences of Pregnant and Postpartum People with Confirmed or Suspected COVID-19 Infection During the Initial Surge of the Pandemic

Objectives:

The COVID-19 pandemic may have a unique emotional impact on pregnant people. This qualitative study aimed to characterize the emotional effects of the COVID-19 pandemic on pregnant and recently pregnant patients who had either suspected or confirmed COVID-19 infection during the initial 6 months of the pandemic.

Methods:

Pregnant and recently pregnant participants (n = 20) from Massachusetts General Hospital Obstetrics and Gynecology clinical sites with suspected or confirmed COVID-19 infection were interviewed about their experiences during the COVID-19 pandemic. Interviews were transcribed and coded using NVivo 12 software. Using data display matrices, thematic analysis was performed to identify emergent, crosscutting themes.

Results:

Twenty pregnant and postpartum patients participated of whom 12 had confirmed COVID-19 infection and 8 had suspected infection. The most frequently described emotions were anxiety (90%), uncertainty (80%), fear (70%), relief (65%), and sadness (60%). The following three crosscutting themes were identified: risk, protection, and change. The ways in which participants articulated their emotional reactions to the themes of risk, protection, and change were complex and varied.

Conclusions:

There was a broad range of negative and positive emotional experiences of pregnancy, birth, and the postpartum period during the first 4 months of the COVID-19 pandemic. A better understanding of pregnant people's emotional experiences may lead to changes in clinical practice and institutional policies that are more supportive of their needs and congruent with their values.

Socioemotional development in infants of pregnant women during the COVID-19 pandemic: the role of prenatal and postnatal maternal distress

BACKGROUND

An upsurge in psychological distress was documented in pregnant women during the COVID-19 pandemic. We investigated with a longitudinal design whether prenatal and postnatal maternal distress during the COVID-19 pandemic was associated with lower infant socioemotional development.

METHODS

Pregnant women (N = 468, M_age = 30,00, 97.6% White) were recruited during the first COVID-19 mandatory lockdown in Quebec, Canada, from April 2nd to April 13th 2020 and were re-contacted at two months postpartum to complete self-reported measures of general (i.e. not specifically related to the COVID-19 pandemic) anxio-depressive symptoms and infant development. Structural equation modeling analyses were performed using maximum likelihood parameter estimation.

RESULTS

Higher maternal prenatal distress significantly contributed to poorer infant socioemotional development. A mediation model showed that postnatal distress significantly mediated the association between prenatal distress and infant socioemotional development, whereas the direct effect of prenatal distress was no longer significant. Prenatal and postnatal maternal distress accounted for 13.7% of the variance in infant socioemotional development.

CONCLUSION

Our results call for special means of clinical surveillance in mothers and for innovative (online) interventions aiming to support maternal mental health during pregnancy and after delivery.

The postpartum period during the COVID-19 pandemic: investigating Turkish women's postpartum support and postpartum-specific anxiety

OBJECTIVES

This study aimed to examine how Turkish women were affected by the COVID-19 pandemic in the postpartum period in terms of postpartum support and anxiety variables.

METHODS

The study was conducted with 130 women who gave birth during the COVID-19 period. Data were collected online using a personal information form, Postpartum Support Scale and Postpartum Specific Anxiety Scale. Descriptive statistics were used, with Kruskal-Wallis and regression analysis performed.

RESULTS

All postpartum women stated that they were affected negatively by COVID-19. The most common issues described were feeling alone (25.51%), having economic difficulties (15.5%) and experiencing difficulties accessing health services (21.7%). The mean Postpartum Support Scale score was 102.43 ± 27.67, while the mean Postpartum Specific Anxiety Scale score was 188.07 ± 96.71. COVID-19 exposure level had a significant effect on postpartum-specific anxiety (p=0.00). The variables of having a problem during pregnancy (p=0.006), having a baby willingly (p=0.007), and partner's educational status significantly predicted the degree of being affected by COVID-19 (p=0.025). The degree to which COVID-19 affected the women was determined by having problems during pregnancy, having a baby willingly, and a highly educated partner.

CONCLUSIONS

These variables may inform a resource to empower postpartum women during COVID-19. Healthcare systems need to be organised considering pandemic conditions to provide increased postpartum support, evaluate psychological health, deliver healthcare services, and consider pregnancy periods.

The associations of use of social network sites with perceived social support and loneliness

Research shows that use of social network sites is associated with loneliness and this may be amplified in tertiary students by their transition from home life, especially if they struggle to integrate with peers. The buffering effects of social support may offer a solution and the online dimension may offer a suitable outlet for lonely and isolated students. In this study, N = 111 university students, aged 18-40, completed a frequency assessment of Instagram and WhatsApp, the Spanish version of the UCLA loneliness scale and the Multidimensional Scale of Social Support in an online survey. The statistical analysis was completed by Structural Equation Modeling using AMOS 25.0. The construct validity of social network sites was established by good factor loadings for WhatsApp and Instagram, but Facebook was excluded as it did not load adequately on to the latent measurement model, in keeping with the diminishing trend for Facebook use in young students. Loneliness emerged as pivotal in a mediation model, and online social support from friends/significant others, emerged as salient in the predictive model in contrast to family. However, these associations may not have the same advantageous weight for mature students given the observed negative associations with age. Results may have implications for policy and planning through highlighting the psychological variables that are operative in the dynamics of integration, retention, and adjustment to tertiary level experience.

Postpartum depression in Covid-19 risk-stratified hospital zones: A cross-sectional study from India

Objective

To determine point prevalence of postpartum depression (PPD) and whether quarantine policies required in postpartum COVID-19 suspects increased the risk of depressive symptoms when compared COVID -19 non suspects in early postpartum period.

Methods

A cross-sectional study conducted in the postnatal ward of Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi from August 2020 to February 2021 using Edinburgh Postnatal Depression Scale (EPDS) to estimate point prevalence of postpartum depression (PPD) in the stratified zones (suspect and nonsuspect) of the hospital.

Results

Total of 408 postpartum women,204 each (COVID-19 suspects, and nonsuspects zone) were enrolled. Prevalence of Postpartum depression using an EDPS score of >9 was 11.9%. Prevalence of depression (17.9%; vs 4.85%, p <0.001) and level of depression (5.01±3.41 vs 4.14± 2.54, p 0.004) was significantly higher in mothers in isolated quarantine wards of COVID-19 suspect zone as compared to nonsuspect zones. Anhedonia was reported significantly higher (p <0.001) in suspect zone mothers. Multivariate analysis showed 'stay in COVID-19 suspect zone' and 'COVID-19 Suspect status' as a significant predictor of PPD.

Conclusion

Covid -19 postpartum suspects are at increased risk of developing postpartum depressive symptoms due to isolation and quarantine measures required in suspect zones to mitigate viral transmission.

Limitations - Due to the cross-sectional nature of the study long-term impacts on mental health due to isolation could not be assessed. Factors such as marital relationship, COVID -19 related risk factors weren't assessed which may have bearing on the risk of developing PPD.

The influence of perceived parental phubbing on adolescents' problematic smartphone use: A two-wave multiple mediation model

Using a two-wave longitudinal design, the current study examined the relationship between early perceived parental phubbing and subsequent problematic smartphone use. As loneliness is a sensitive indicator of interpersonal problems and fear of missing out is a strong predictor of Internet-related addiction, we examined these two variables as possible mediators in this relationship based on existing literature. A total of 1447 Chinese adolescents (572 males and 875 females, mean age = 16.15 years) completed questionnaires regarding perceived parental phubbing, loneliness, fear of missing out, and problematic smartphone use. The results indicated that: (a) early fathers' phubbing (fphubbing) and mothers' phubbing (mphubbing) predicted adolescents' subsequent problematic smartphone use; (b) loneliness mediated the relationship between early fphubbing/mphubbing and adolescents' subsequent problematic smartphone use; and (c) loneliness and fear of missing out sequentially mediated the relationship between early fphubbing/mphubbing and adolescents' subsequent problematic smartphone use. These results suggested that three types of interventions could be effectively used to decrease the risk of problematic smartphone use among adolescents, namely, reducing perceived parental phubbing, relieving loneliness, and decreasing fear of missing out.

One Year Into the Pandemic: A Systematic Review of Perinatal Mental Health Outcomes During COVID-19

Obstetric guidelines have rapidly evolved to incorporate new data and research on the novel coronavirus disease (COVID-19), with data on perinatal mental health building over the last year. Our aim in the present manuscript is to provide a systematic review of mental health outcomes in pregnant and postpartum women during the COVID-19 pandemic in the context of neonatal and obstetric guidelines addressing symptoms and complications of COVID-19 during pregnancy, mother-to-neonate transmission, Cesarean-section delivery, neonatal prematurity, maternal/neonate mortalities, maternal-neonatal separation, and breastfeeding. We summarize data from 81 mental health studies of pregnant and postpartum women and underscore protective and risk factors identified for perinatal mental health outcomes amidst the COVID-19 pandemic. Data reviewed here suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID-19. Our systematic review integrates the most current obstetric and neonate guidelines, along with perinatal mental health outcomes associated with COVID-19, highlighting the best available data for the care of women and their neonates amidst the current COVID-19 pandemic.

The Association Between Social Support, COVID-19 Exposure, and Medical Students' Mental Health

Background: The coronavirus disease-2019 (COVID-19) pandemic has halted in-person medical education worldwide. Limited studies have reported on the mental health status of medical students during this public health emergency. This study aimed to explore the association of personal virus exposure, regional epidemic condition, and social support with medical students' depressive and anxiety symptoms during the COVID-19 outbreak in China. Methods: In February 2020, 5,982 medical students (60.0% females, Mean_age = 21.7 years, Median_age = 22 years) completed an online survey consisting of demographics, personal virus exposure, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale. Results: The prevalence rates of mild to severe depressive symptoms and anxiety symptoms were 35.2 and 22.8%, respectively. Multivariate linear regression showed that students with low- or medium-level social support had a higher risk of experiencing depressive or anxiety symptoms than those with high-level social support. COVID-19 exposure was positively associated with mild to severe depressive or anxiety symptoms. Respondents living in provinces with 500-1,000 confirmed COVID-19 cases had an increased risk of experiencing mild to severe depressive symptoms compared with those living in provinces with <100 cases. Other related factors were gender and years of training. Conclusions: Some medical students suffered from a poor psychological status during the COVID-19 outbreak. Low social support was a stronger factor related to poor mental status compared with COVID-19 exposure or the provincial epidemic condition. Thus, we suggest that colleges or universities provide social support and mental health screening.