Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19

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.

Implications of perceived empathy from spouses during pregnancy for health-related quality of life among pregnant women: a cross-sectional study in Anhui, China

BACKGROUND

Empathy is a critical component of nursing care, impacting both nurses' and patients' outcomes. However, perceived empathy from spouses during pregnancy and its impact on health-related quality of life (HRQoL) are unclear. This study aimed to examine pregnant women's perceived empathy from their spouses and assess the relation of perceived empathy on HRQoL.

METHODS

This cross-sectional study, performed in the obstetric clinics or wards of four well-known hospitals in Anhui Province, China, included 349 pregnant women in the second or third trimester; participants were recruited by convenience sampling and enrolled from October to December 2021. A general information questionnaire, the Interpersonal Reactivity Index (IRI), a purpose-designed empathy questionnaire and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) were used to evaluate the pregnant women's general information, perceptions of empathy and HRQoL. Data were analysed using SPSS 22 at a threshold of P < 0.05. Descriptive analysis, Pearson correlation analysis, Student's t test, ANOVA, and multiple regression analysis were used for analysis.

RESULTS

The pregnant women's total empathy, physical component summary (PCS) and mental component summary (MCS) scores were 41.6 ± 9.0, 41.6 ± 7.6, and 47.7 ± 9.1, respectively. Correlation analysis revealed that the purpose-designed empathy questionnaire items were significantly positively correlated with perspective taking and empathic concern but were not correlated with the personal distress dimension and were only partially correlated with the fantasy dimension. Maternal physical condition during pregnancy, planned pregnancy, and occupational stress were predictors of the PCS score (β = 0.281, P < 0.01; β = 0.132, P = 0.02; β = -0.128, P = 0.02). The behavioural empathy item of our purpose-designed empathy questionnaire and empathic concern were important predictors of the MCS score (β = 0.127, P = 0.02; β = 0.158, P < 0.01), as well as other demographic and obstetric information, explaining 22.0% of the variance in MCS scores totally (F = 12.228, P < 0.01).

CONCLUSIONS

Pregnant women perceived lower empathy from their spouses and reported lower HRQoL. Perceived empathy, particularly behavioural empathy, may significantly impact pregnant women's MCS scores but has no effect on their PCS scores. Strategies that foster perceived empathy from spouses among pregnant women are essential for facilitating healthy pregnancies and potentially improving maternal and child health.

Factors associated with stress among pregnant women with a second child in Hunan province under China's two-child policy: a mixed-method study

OBJECTIVE

The purpose of the study was to investigate the status of pregnancy stress and to explore factors associated with pregnancy stress among women by China's two-child policy.

METHODS

A mixed-method study involving both quantitative and qualitative methods was conducted using questionnaires and semi-structured interviews. The questionnaires encompassed socio-demographic and obstetric characteristics, as well as the Pregnancy Stress Rating Scale (PSRS) and the Social Support Rating Scale (SSRS). Initially, the participants were required to complete the questionnaires, enabling us to assess their respective pregnancy stress statuses. Subsequently, we selectively interviewed pregnant women with a second child and exhibited at least mild pregnancy stress. The qualitative study sought to uncover the factors contributing to their stress during pregnancy.

RESULTS

A total of 463 subjects were enrolled; of the subjects, 22 (4.8%) had no stress, 407 (87.9%) had mild stress, 34 (7.3%) had moderate stress. Generalized linear regression analysis revealed significant factors (P<0.05) related to pregnancy stress, including family financial burden, subjective support, fertility desire, gender of the first child, and gender preference. Additionally, 16 subjects were interviewed, and through analysis, three major themes emerged, each comprising 12 sub-themes associated with pregnancy stress. These themes were identified as fertility factors (worry about maternal and child health, birth experience, and parenting stress), family factors ( financial burden, second child care problems, first child's acceptance of the second child, family concerns, fertility desire, and gender preference) and social factors (involving life events, career development and workload).

CONCLUSION

The diver factors contribute to pregnancy stress among pregnant women under China's two-child policy. Our study could be used to develop appropriate interventions to reduce pregnancy stress and to enhance the mental health of women pregnant with a second child.

Perinatal depression and its associated risk factors during the COVID-19 pandemic in low- and middle-income countries: a systematic review and meta-analysis

PURPOSE

Perinatal depression significantly impacts maternal and child health, with further complexities arising during the COVID-19 pandemic. This review is the first to comprehensively synthesize evidence on the prevalence of perinatal depression and its associated risk factors in Low- and Middle-Income Countries (LMICs) during the pandemic period.

METHODS

The study protocol was registered in PROSPERO (CRD42022326991). This review followed the Joanna Briggs Institute (JBI) guideline for prevalence studies. A comprehensive literature search was conducted in six databases: PubMed, Scopus, Web of Science, PsycInfo, CINAHL, and ProQuest. Pooled prevalence estimates were computed for both prenatal and postnatal depression. Identified risk factors were summarized narratively.

RESULTS

A total of 5169 studies were screened, out of which 58 were included in the narrative review and 48 [prenatal (n = 36) and postnatal (n = 17)] were included in the meta-analysis. The pooled depression prevalence for prenatal women was 23% (95% CI: 19-27%), and for the postnatal women was 23% (95% CI: 18-30%). Maternal age, education, perceived fear of COVID-19 infection, week of pregnancy, pregnancy complications, and social and family support were identified as associated risk factors for depression.

CONCLUSIONS

Our review demonstrates an increased prevalence of perinatal depression during the COVID-19 pandemic in LMICs. It sheds light on the significant burden faced by pregnant and postnatal women and emphasizes the necessity for targeted interventions during the ongoing and potential future crisis.

Increased postpartum anxiety symptoms after perinatal SARS-CoV-2 infection in a large, prospective pregnancy cohort in New York City

Numerous studies reported an increase of postpartum mood symptoms during the COVID-19 pandemic. Yet, the link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and perinatal mental health is less well understood. We investigated the associations between prenatal SARS-CoV-2 infection and postpartum depressive and anxiety symptoms, including examinations of infection timing and pandemic timeline. We included 595 participants from Generation C, a prospective pregnancy cohort in New York City (2020-2022). Prenatal SARS-CoV-2 infection was determined via laboratory or medical diagnosis. Depression and anxiety symptoms were measured 4-12 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder questionnaire (GAD), respectively. Quantile regressions were conducted with prenatal SARS-CoV-2 infection as exposure and continuously measured EPDS and GAD scores as outcomes. We reran the analyses in those with COVID-19-like symptoms in the trimester during which infection occurred. 120 (20.1%) participants had prenatal SARS-CoV-2 infection. After adjusting for socio-demographic, obstetric and other maternal health factors, prenatal SARS-CoV-2 infection was associated with higher median postpartum anxiety scores (b = 0.55, 95% CI = 0.15; 0.96). Late gestation infection (b = 1.15, 95% CI = 0.22; 2.09) and symptomatic infection (b = 1.15, 95% CI = 0.12; 2.18) were also associated with higher median postpartum anxiety scores. No associations were found with depressive symptoms. The associations were not moderated by time since the start of the pandemic. This study suggests that prenatal SARS-CoV-2 infection increases the risk of postpartum anxiety symptoms among participants reporting median anxiety symptoms. Given that this association was not affected by pandemic timing and that SARS-CoV-2 transmission continues, individuals infected with SARS-CoV-2 during pregnancy should be monitored for postpartum anxiety symptoms.

Does COVID-19 anxiety in pregnant women affect marital adjustment?

In this study, it was tried to determine the relationship between anxiety and marital adjustment in pregnant women during the epidemic, and to explain the variables affecting anxiety and marital adjustment. During the epidemic, many factors cause changes in the perceived anxiety level and marital adjustment in pregnant women. As the level of COVID-19 anxiety increases in pregnant women, marital adjustment scores decrease. It was determined that the anxiety levels were lower and marital adjustment was higher in pregnant women who had a planned pregnancy, did not have fears about childbirth, thought that their physical, mental health were not affected.

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

Investigation of the Relationship Between COVID-19 Anxiety and Perception of Risk in Pregnancy, Fears of Death and Losing Their Baby in the Pandemic

The aim of the study was to determine Covid-19 anxiety, obsession, perception of risk and self-care agency levels of pregnant women during the pandemic and investigate the association between Covid-19 anxiety, obsession, perception of risk and self-care agency levels and the fears of death and losing their baby in the pregnant women. The study was a cross-sectional and descriptive study. Five hundred thirty-eight pregnant women were included in the study. "COVID-19 Anxiety Scale," "COVID-19 Obsession Scale," "Risk Perception in Pregnancy Scale," and "The Exercise of Self-Care Agency Scale" were used to collect data of the study. In this study, the total Cronbach's alpha reliability coefficients of the COVID-19 Anxiety Scale, COVID-19 Obsession Scale, The Perception of Pregnancy Risk Questionnaire, The Exercise of Self-Care Agency Scale were found to be 0.73, 0.70, 0.86 and 0.95 respectively. Statistical analysis of data in the study was conducted using SPSS (22.0, IBM Corp. Armonk, NY) statistical program. Statistically significant differences were identified between the mean score from COVID-19 anxiety scale and the mean scores from COVID-19 obsession scale, the perception of pregnancy risk questionnaire and the exercise of self-care agency scale. These results suggest that education and health policies that focus on the health of pregnant women and their fetus should be developed for antenatal care services.

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Importance

Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.

Objective

To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.

Data Sources

Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.

Study Selection

Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.

Main Outcomes and Measures

Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.

Results

At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.

Conclusions and Relevance

These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.

A pilot study of the depression, anxiety and stress in Greek military personnel during the first year of the COVID-19 pandemic

INTRODUCTION

The ongoing SARS-CoV-2 pandemic is a global health crisis which poses many psychological research challenges. The objective of this study was to evaluate the responsiveness and validity of depression, anxiety and stress in a representative cohort of Hellenic military personnel using the short version of the Greek military version of the Depression-Anxiety-Stress Scales-21 (DASS-21) questionnaire.

METHODS

A total of 158 participants were voluntarily surveyed using an electronically developed structured questionnaire. The anonymous e-questionnaire included a social demographic section and the DASS-21 scale section. It was distributed in September 2020 to the military personnel of the Hellenic Tactical Air Force Units using an intranet network during government restrictive measures due to the COVID-19 crisis.

RESULTS

Our DASS-21 survey indicated a positive outcome at the psychometric level of our military sample population. Age, sex and systemic medications were statistically correlated with anxiety. Inter-correlations between the DASS-21 statements showed that individuals with low-level depression also experienced some degree of stress. Factor analysis indicated the reliability and validity of the questionnaire.

CONCLUSIONS

The low levels of depression and stress among our military sample population demonstrate the importance of periodic monitoring of the psychometric items of the DASS-21 subscales to design and implement psychological prevention strategies, especially during the ongoing and future healthcare crises.

Prevalence and associated factors of depression, anxiety, and stress among pregnant women in Herat, Afghanistan: A cross-sectional study

Background and Aims

Pregnancy is an important and natural event in a woman's life. It represents a time of substantial social and bio-psychological challenges for a pregnant woman that may increase vulnerability to emotional disturbances such as depression, anxiety, and stress (DAS). This study aims to assess the prevalence and associated factors of DAS among pregnant women in Herat city of Afghanistan.

Methods

This hospital-based cross-sectional study was conducted between July and November 2019, on 691 Dari-speaking pregnant women aged 15-49 years, who attended the antenatal clinic of Herat Razaei Maternity Hospital. The interview process involved the use of a structured questionnaire that collected data on sociodemographic characteristics of participants, as well as the validated Dari-translated version of DASS-42 questionnaire. A χ 2 test was used to test for association between categorical data. Forward likelihood ratio was used to assess the strength of association between sociodemographic variables and DAS; independently. The significance level was set to 0.05 and the confidence interval to 95% in all statistical analyses. Statistical analyses were performed in IBM SPSS Statistics (version 27).

Results

The mean age of participants was 26.17 ± 6.06. The overall prevalence of DAS among study participants were 42.8%, 40.0%, and 59.5%, respectively. Planning of current pregnancy, women's health, husband's health, women's nutrition, family support, husband's support, women's education, women's employment, and family economy were significantly associated with DAS, while gestational age was not significantly associated with DAS.

Conclusion

The prevalence of DAS among pregnant women in Herat city of Afghanistan is very high. Considering scientific evidence on high prevalence and associated factors of DAS among pregnant women, policymakers, public health authorities, and medical practitioners must devote significant attention in reducing the magnitude of these mental disorders and/or reducing their impact on women, their families, and the society.

Prevalence and risk factors of prenatal anxiety disorders: A cross-sectional study

Background and Aims

Studies regarding the risk factors of prenatal anxiety disorders are inconclusive and sometimes contradictory. The current study aimed to define the prevalence and risk factors for anxiety disorders in women during pregnancy.

Methods

This is a cross-sectional and hospital-based survey of two public hospitals (Ayatollah Rohani and Yahyanejad) of inpatients/outpatients, obstetric wards/clinics, and four private outpatient obstetric clinics in the city of Babol. Convenience sampling was utilized to recruit 432 pregnant women. A trained clinical psychologist conducted the Structured Clinical Interview for DSM-5 (SCID-5) to diagnose anxiety disorders. In addition, the Brief Symptom Inventory 18 (BSI-18) was completed by the participants to assess the severity of psychological distress.

Results

Of 432 pregnant women, 132 (30.5%) were diagnosed with anxiety disorders. Anxiety disorders included 61 cases of pregnancy adjustment disorder (47.7%), 52 cases of generalized anxiety disorder (40.6%), and 15 cases of specific phobia (to delivery) (11.7%). The logistic regression results showed that the age, pregnancy, education, parity, and high-risk pregnancy variables predicted 28% of the variance of anxiety disorders. Furthermore, as the age (β = 0.94, p = 0.003) and gestational age (β = 0.9, p < 0.001) increased, the probability of anxiety disorders in pregnancy decreased. Moreover, university education (β = 1.65, p = 0.049) and high-risk pregnancy (β = 1.72, p = 0.02) were recognized as risk factors for developing anxiety disorders during pregnancy.

Conclusion

The high incidence of anxiety disorders in pregnant women suggests that obstetricians should pay more attention to identifying and treating anxiety disorders in all pregnant women, especially in high-risk pregnancies.

Anxiety and depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China: a cross-sectional study

BACKGROUND

COVID-19 has increased the probability of occurrence of maternal anxiety and depression in pregnant women. However, there is limited research on anxiety and depression among pregnant women during the long-term normal prevention of COVID-19 pandemic period. This study aimed to examine the anxiety and depression and influencing factors among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China.

METHODS

A cross-sectional survey was designed. A total of 1338 pregnant women were studied. The prenatal anxiety and depression were assessed by the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), respectively. Postnatal depression was assessed by the Edinburgh Postpartum Depression Scale (EPDS) in 10-14 days after delivery. The data analysis was processed by SPSS9.0. Descriptive analysis was expressed by mean and standard deviation. The counting data were expressed by percentage, χ2 test, multiple linear regression and binary logistic regression.

RESULTS

The incidence of prenatal anxiety (SAS score ≥ 50) was 27.95% (374 cases), prenatal depression (SDS score ≥ 0.5) was 34.01% (455 cases), and postpartum depression (EPDS score ≥ 0.5) was 25.04% (335 cases). Both the prenatal SAS score (r = 0.635, P < 0.001) and prenatal SDS score (r = 0.738, P < 0.001) were related to postpartum depression. Pregnant women who were younger than 35 years, in middle household income, lower education level, underweight before pregnancy, primiparous, and fear of being infected were at increased risk for developing anxiety and depression during the long-term normal prevention of COVID-19 pandemic.

CONCLUSIONS

The incidences of postpartum depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period were a little lower than those during the COVID-19 outbreak period, but still higher than those before the COVID-19.

The mediating role of psychological capital in the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Although life satisfaction is a predictor of depressive and anxiety symptoms, the mechanisms underlying this association are poorly understood. This study examined how psychological capital (PsyCap), a positive psychological state, mediated the association between life satisfaction and depressive and anxiety symptoms among Chinese medical students during the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted at three medical universities in China. A self-administered questionnaire was distributed to 583 students. Depressive symptoms, anxiety symptoms, life satisfaction, and PsyCap were measured anonymously. A hierarchical linear regression analysis was performed to explore the effects of life satisfaction on depressive and anxiety symptoms. Asymptotic and resampling strategies were used to examine how PsyCap mediates the association between life satisfaction and depressive and anxiety symptoms.

RESULTS

Life satisfaction was positively associated with PsyCap and its four components. There were significant negative associations between life satisfaction, psychological capital, resilience, optimism, and depressive and anxiety symptoms among medical students. Self-efficacy was negatively associated with depressive and anxiety symptoms. Psychological capital (a×b = -0.3201, BCa 95% CI: -0.3899, -0.2446; a×b = -0.2749, BCa 95% CI: -0.3817, -0.1996), resilience (a×b = -0.2103, BCa 95% CI: -0.2727, -0.1580; a×b = -0.1871, BCa 95% CI: -0.2520, -0.1414), optimism (a×b = -0.2100, BCa 95% CI: -0.3388, -0.1150; a×b = -0.1998, BCa 95% CI: -0.3307, -0.0980), and self-efficacy (a×b = -0.0916, BCa 95% CI: 0.0048, 0.11629; a×b = 0.1352, BCa 95% CI: 0.0336, 0.2117) significantly mediated the association between life satisfaction and depressive and anxiety symptoms.

LIMITATIONS

This was a cross-sectional study, and causal relationships between the variables could not be ascertained. Self-reported questionnaire instruments were used for data collection, which may have recall bias.

CONCLUSIONS

Life satisfaction and PsyCap can be used as positive resources to reduce depressive and anxiety symptoms among third-year Chinese medical students during the COVID-19 pandemic. Psychological capital and its components (self-efficacy, resilience, and optimism) partially mediated the relationship between life satisfaction and depressive symptoms, and completely mediated the relationship between life satisfaction and anxiety symptoms. Therefore, improving life satisfaction and investing in psychological capital (especially self-efficacy, resilience, and optimism) should be included in the prevention and treatment of depressive and anxiety symptoms among third-year Chinese medical students. Additional attention is needed to pay for self-efficacy in such disadvantageous contexts.

Maternal COVID-19 infection and the fetus: Immunological and neurological perspectives

Immunoneuropsychiatry is an emerging field about the interaction between the immune and nervous systems. Infection and infection-related inflammation (in addition to genetics and environmental factors) can act as the etiopathogenesis of neuropsychiatric disorders (NPDs). Exposure to COVID-19 in utero may be a risk factor for developing NPDs in offspring in the future. Maternal immune activation (MIA) and subsequent inflammation can affect fetal brain development. Inflammatory mediators, cytokines, and autoantibodies can pass through the placenta and the compromised blood-brain barrier after MIA, leading to neuroinflammation. Neuroinflammation also affects multiple neurobiological pathways; for example, it decreases the production of the neurotransmitter serotonin. Fetal sex may affect the mother's immune response. Pregnant women with male fetuses have been reported to have decreased maternal and placental humoral responses. This suggests that in pregnancies with a male fetus, fewer antibodies may be transferred to the fetus and contribute to males' increased susceptibility/vulnerability to infectious diseases compared to female infants. Here, we want to discuss maternal COVID-19 infection and its consequences for the fetus, particularly the neurological outcomes and the interaction between fetal sex and possible changes in maternal immune responses.

Investigating factors affecting the prevalence of stress, anxiety and depression among citizens of Karaj city: A population-based cross-sectional study

Background & aim

Stress, anxiety, and depression are among the major public health problems worldwide. These problems, which may lead to more challenges, continue to grow. Therefore, the aim of this study was to investigate the main factors affecting the prevalence of stress, anxiety, and depression among citizens of Karaj.

Materials & methods

A total of 920 people participated in the study. The Depression, Anxiety, and Stress Scale (DASS), consisting of 21 items, was used for the assessment of the studied problems. Single and multiple regressions were used for the data analysis. In addition, all statistical analysis was done by Stata version 12 at the 0.05significance level.

Results

We found that the prevalence rate of depression, anxiety, and stress was 4.79%, 13.28%, and 15.13%, respectively. Education level was significantly associated with stress (b: 1.21; p < 0.001), anxiety (b: 2.03; p < 0.001), and depression (b: 0.48; p: 0.039). The association of the female gender with stress (b: 2.05; p < 0.001) and anxiety (b: 1.01; p: 0.002) was also confirmed. The association of being divorced or widowed with stress (b: 1.84; p: 0.005), anxiety (b: 1.21; p: 0.001), and depression (b: 1.85; p: 0.003) was approved. There was also a significant association between family size and stress (b: 0.39; p: 0.041). Gender and economic status were known as the most effective factors in the incidence of the studied problems.

Conclusion

The prevalence rate of depression, stress, and anxiety in Karaj should be taken into consideration. Therefore, the preventive and therapeutic measures need to be considered for reducing the effects of the risk factors.

The effect of marital satisfaction on the self-assessed depression of husbands and wives: investigating the moderating effects of the number of children and neurotic personality

BACKGROUND

Based on the family system theory, there is an interactive relationship in the family, especially the cognitive style and emotional changes of the husband and wife will affect the behavior, cognition and emotion of the partner. Data about the effects of marital relationships on mental health are often paired. Scholars study the effect of individual independent variables on the dependent variables and the effect of spouse independent variables on the dependent variables to explore the actor and partner effect in marital relationships.

METHODS

This study used the China Family Panel Studies (CFPS) 2018 dataset to collect paired data on the marital satisfaction and self-rated mental health of 9,560 couples. The Actor-Partner Interdependence Moderation Model (APIMoM) was used to analyze whether moderator variables affect the direction and strength of the effect of marital satisfaction on self-rated depression. In the robustness test part, the robustness of the APIMoM model was tested by reanalyzing the independent variables using two kinds of  binary codes respectively, and the results showed that the models were robust.

RESULTS

Individuals' marital satisfaction was significantly negatively correlated with their own depression level and with that of their spouse. The number of family members had a positive moderating effect on the results of the wife's partner effect. Couples who lived in the environment with more family members had lower depression scores. Couples who have more children have higher depression scores. The number of children has a negative moderating effect on the results of partner effect of husbands and wives. The wife's neurotic personality score has a negative moderating effect on the wife's actor effect.

CONCLUSIONS

In terms of measures to prevent depression, women's mental health should be given more priority than men's. Living in a larger family with more children is beneficial for couples' mental health. Efforts to prevent depression in couples should take into account the neurotic character of the members, especially the wife, and design special treatment and preventive measures accordingly. These findings highlight that binary dynamics should be considered in exploring what factors influence the mental health of married couples.

Impact of the COVID-19 pandemic on depression during pregnancy: a cross-sectional study

Purpose: Uncertainty and restrictions on daily life have increased fear, stress, and depression during the coronavirus disease 2019 (COVID-19) pandemic. Depression is the most common mental health problem in pregnant women. The purpose of this study was to evaluate the levels of fear and stress related to COVID-19 experienced by pregnant women, as well as their levels of depression, and to examine the factors associated with depression during pregnancy.Methods: This was a cross-sectional, correlational study conducted among 153 pregnant women who visited a maternity hospital in Busan, South Korea. A self-reported questionnaire was used for data collection from December 18, 2021 to March 8, 2022. Data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and multiple regression. Results: Pregnant women experienced a moderate level of fear related to COVID-19, with an average score of 21.55±4.90. The average score for depression during pregnancy was 14.86±11.10, with 50.3% of the participants experiencing depression (13). The factors associated with depression during pregnancy were fear of COVID-19, contact with a confirmed case of COVID-19, being in the third trimester of pregnancy, high stress levels due to difficulties experienced from social distancing measures, and unintended pregnancy. These five statistically significant factors explained 35.0% of variance in depression during pregnancy.Conclusion: Considering the prevalence of depression in pregnant women during the COVID-19 pandemic, it is necessary to develop interventions to reduce anxiety by providing correct information and alleviating the stress of social distancing.

Educational degree differences in the association between work stress and depression among Chinese healthcare workers: Job satisfaction and sleep quality as the mediators

Background

Depressive status of medical personnel worldwide and especially in China is an important public health and social problem. There is a strong relationship between education and depression, but no studies have studied grouping healthcare workers (HCWs) with different educational degree to discuss whether there are differences in the factors that affect depression. This study aims to examine the role of job satisfaction and sleep quality in the relationship between work stress and depression among Chinese HCWs, and teste whether the mediation models are differed by the differences of educational degree.

Methods

Patient Health Questionnaire-9 (PHQ-9) scale was used to test depression. Work stress was assessed using the Challenge-blocking stress scale (CBSS). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). HCWs’ satisfaction with their current work was assessed using the Job Satisfaction Index (JSI). The representative sample of HCWs was chosen using a multi-stage stratified cluster random sampling procedure and 844 HCWs were utilized to the statistical analysis of the study.

Results

In the overall sample, sleep quality could mediate the relationship between work stress and depression in healthcare workers (p &lt; 0.001, CMIN/DF = 3.816, GFI = 0.911, AGFI = 0.886, IFI = 0.943, TLI = 0.933, CFI = 0.942, RMSEA = 0.058, SRMR = 0.055, AIC = 1039.144), and the mediating effect accounted for 36.5%. After grouping educational qualifications, the model with sleep quality and job satisfaction as mediating variables reported a better fit in the group with low educational qualifications. The intermediary effect accounted for 50.6 and 4.43%, respectively. The highly educated group only has sleep quality as an intermediary variable in the structural model, and the mediating effect accounted for 75.4% (p &lt; 0.001, CMIN/DF = 2.596, GFI = 0.887, AGFI = 0.857, IFI = 0.937, TLI = 0.926, CFI = 0.937, RMSEA = 0.044, SRMR = 0.056, AIC = 1481.322).

Conclusion

In the overall sample, sleep quality could mediate the relationship between work stress and depression in HCWs. Among HCWs with technical secondary school education and below, job satisfaction can mediate the positive relationship between work stress and depression, while this mediating effect is not significant among HCWs with college degree and above.

Antenatal care experiences of uninfected pregnant women during the COVID-19 pandemic: A qualitative systematic review

Background

There is a limited understanding of pregnant women's antenatal care experiences during the COVID-19 pandemic.

Purpose

To review and synthesize qualitative studies on uninfected pregnant women's antenatal care experiences during the COVID-19 pandemic.

Methods

: Five databases were searched for qualitative studies published between January 2020 and January 2023. This study used a thematic synthesis of qualitative evidence and was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Furthermore, this review was registered with PROSPERO and a quality appraisal was assessed.

Results

: Nine published qualitative studies were included in this review. The studies were conducted in eight countries and included 3,709 participants. Five themes were identified: (1) disruptions of normal antenatal care services, (2) feelings of uncertainty, (3) desire for sufficient spousal support, (4) coping strategies, and (5) trust in healthcare providers.

Discussion

The themes can be utilized to reform current interventions for pregnant women by nurse-midwife managers and by healthcare policymakers to improve current practice and direct new research to prepare for future pandemics.

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.

The COVID-19 Pandemic Significantly Impacts Pregnancy Planning and Mental Health of Women With Inflammatory Bowel Disease

BACKGROUND AND GOALS

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted daily life, particularly in those with inflammatory bowel disease (IBD). We aimed to determine the impact of the pandemic on the pregnancy planning and mental health of women with IBD.

METHODS

Women with IBD (age 18 to 45 y) were asked to complete anonymous surveys on the impact of the COVID-19 pandemic on pregnancy planning and mental health symptoms such as stress (Perceived Stress Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Univariate and multivariable analyses were conducted to identify risk factors associated with stress, depression, and anxiety during the pandemic.

RESULTS

Seventy-three women with IBD were included (mean age: 32.1). Of 39 patients who were preconception, 20 (51.3%) reported a significant impact of the pandemic on pregnancy planning, with common reasons for not planning conception being fear of transmission of the virus to the fetus, lack of social supports, and no desire to be in hospital during pregnancy. Over half of all women reported an increase in stress and depression symptoms during the pandemic, with over half also reporting symptoms of anxiety. On multivariable linear regression analyses, increased anxiety levels were a significant predictor of increased stress and depression symptoms during the pandemic. Urban residence and younger age were significant predictors of increased anxiety symptoms during the pandemic.

CONCLUSION

A significant proportion of women with IBD experienced an impact of the COVID-19 pandemic on pregnancy planning and mental health illnesses such as stress, depression, and anxiety.

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.

Comparison of pregnancy stress, impact and fear of COVID-19 between working and non-working pregnant women in Korea

The purpose of the study was to investigate and compare the pregnancy stress, impact and fear of COVID-19 between working and non-working pregnant women in Korea. The influencing factors of pregnancy stress considering the pandemic situation were explored in each group. A descriptive cross-sectional study design was used in the study. A total of 150 participants were recruited from Korean online communities where only women can register and exchange information about pregnancy and childbirth. The survey questionnaires included the Prenatal Distress Questionnaire, Pregnancy Experience Scale - brief, COVID-19 Experiences, and Fear of COVID-19. The survey data of 140 participants (74 working pregnant women and 66 non-working pregnant women) were analyzed. Working pregnant women appeared to have more pregnancy stress than non-pregnant women (p < 0.05). They described more concerns about labor and delivery, and caring for infant. Non-working pregnant women were having more negative impact of COVID-19 on pregnancy experience (p < 0.05). They had more concerns related to prenatal care, obtaining living supplies, and giving birth during the pandemic situation. There were no significant differences in fear of COVID-19 between groups. In both groups, negative pregnancy experience and pregnancy types were significantly related with higher pregnancy stress (p < 0.05). While pregnancy stress was significantly higher in the working pregnant women, the negative impact of COVID-19 on pregnancy experience was greater in the non-working pregnant women group. We suggest tailored prenatal management, education, and social supports considering the differences in psychological distress between the groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04105-8.

The impact of telemental health interventions on maternal mental health outcomes: a pilot randomized controlled trial during the COVID-19 pandemic

Background

The lethal potential of COVID-19 was often emphasized and repeatedly brought to the attention of pregnant women, leading to a higher level of anxiety, depression, and COVID-19-specific phobia among this population. Furthermore, legislation forced social distancing and isolation to interrupt the infection cycle. Together these factors resulted in higher maternal mental health distress requiring intervention. Nevertheless, there is a lack of evidence regarding the impact of low-intensity psychosocial telemental interventions on maternal mental health outcomes. Therefore, the objective of this pilot study is to assess the efficacy of video low-intensity psychosocial telemental maternal intervention on COVID-19-specific phobia, antenatal depression, and anxiety among pregnant women. We hypothesized that the intervention arm would be superior to the control arm. A parallel design randomized interventional controlled trial with 1:1 randomization was conducted at the Women Wellness and Research Center. We enrolled fifty-eight pregnant women in their second trimester who spoke English or Arabic. We assessed antenatal anxiety, depression, and Covid-19-specific phobia at baseline (T₀), and thirty-three pregnant women completed the follow-up after four weeks (T₁). Pregnant women receiving psychotropic medications and follow up in mental health services were excluded.

Results

A low-intensity psychosocial telemental maternal session helps reduce antenatal anxiety. We found statistically significant differences in antenatal anxiety scores between the intervention (2.4 ± 2.2) and control (4.2 ± 1.6) groups (p = 0.013) with a large effect size of Hedges' g value (0.96, 0.22-1.74). The absolute risk reduction was 27.27 percent. However, the intervention had no statistically significant effect on reducing antenatal depression or COVID-19-specific phobia.

Conclusions

Low-intensity psychosocial telemental maternal sessions effectively reduce antenatal anxiety. While our findings are promising, further RCTs are needed to replicate these findings.

Trial registration

2a-ClinicalTrials.gov identifier: NCT04594525.. Registered on 20/October/2020; updated 9/March/ 2022. Available from: Maternal Telemental Health Interventions in Response to Covid-19* - Full Text View - ClinicalTrials.gov.

Contributors to COVID-19-Related Childbirth Anxiety among Pregnant Women in Two Pandemic Waves

COVID-19 has impacted all levels of daily life for people everywhere, with particularly serious implications for pregnant women. This paper examines the COVID-19-related childbirth anxiety (CCA) of Israeli women in the first two waves of the pandemic. We first present two psychotherapeutic case studies with pregnant women in the two waves. This is followed by an empirical study that compared the contribution of background variables, psychological distress, economic concerns, and personal resources to CCA in two samples, Wave 1, March-April 2020 (n = 403) and Wave 2, September-October 2020 (n = 1401), and two subpopulations, Jewish and Arab women. Findings reveal that CCA was significantly lower in Wave 2 than in Wave 1. Furthermore, poorer health, higher education, being an Arab, later gestational week, at-risk pregnancy, wave, higher psychological distress, greater economic concerns, and lower self-compassion contributed to higher childbirth anxiety. Wave moderated the association between optimism and anxiety. The findings of the empirical study, together with insights from the case studies, provide evidence of a decrease in CCA later in the crisis, and indicate the significance of resources for coping with the psychological implications of the pandemic. Moreover, they suggest the importance of empowering self-reliance techniques, such as self-compassion, which was significantly associated with lower anxiety, above and beyond the background and psychological variables. Clinical Impact Statement: Using both psychotherapeutic cases and empirical findings, this study points to the risk and resilience factors that contributed to pregnant women's COVID-19-related childbirth anxiety (CCA) in the first two waves of the pandemic. The study suggests that CCA was higher in the first wave, as well as among women from a minority group. At the same time, the research shows that resilience resources of optimism and self-compassion contributed to the reduction of anxiety. These findings may guide interventions for the vulnerable group of pregnant women in times of crisis.

The effect of pregnant women’s health-seeking behavior and preference for mode of birth on pregnancy distress during the COVID-19 pandemic

In this study, the researchers investigated to the impact of pregnant women's health-seeking behavior and mode of birth preferences on pregnancy distress during the COVID-19 pandemic. This study was conducted with 351 pregnant women. The risk rate of pregnancy distress using the Tilburg Pregnancy Distress Scale (TPDS) cut-off point was 16.5%. 13.3% of pregnant women changed their mode of birth preferences due to the pandemic. The risk of pregnancy distress in women who changed their mode of birth preferences due to the pandemic increased 5.4 times more than in those who preferred vaginal birth before and during the pandemic (OR: 5.4, p<0.001). We determined that the increase in the Health Seeking Behavior Scale total scores had a reducing effect on pregnancy distress due to a lack of partner involvement for TPDS.

The Consequences of the Pandemic for Subjective Well-Being: Data for Improving Policymaking

The pandemic has affected people's lives and emotions in profound ways, which governments ignore at their peril. Among the often disregarded consequences of the pandemic, especially in developing countries, are its toll on subjective well-being and its implications for health policymaking. This paper uses a battery of surveys with over 1800 observations collected in 2019 and 2020, which inform on many aspects of subjective well-being before and during the pandemic in Cali, Colombia. The results show a dramatic and widespread reduction in life satisfaction in several dimensions of well-being beyond health, and not just among those directly affected by COVID-19. This analysis focuses on differences in well-being by gender and health status, providing information about gender variances and differences in subjective well-being between those who experienced and those who did not experience physical illness (including the COVID-19 infection) during the pandemic. This analysis aims at contributing to the body of research that studies the consequences of the pandemic for life satisfaction and well-being, in the context of a city experiencing profound social unrest during the pandemic.

Mental health symptom changes in pregnant individuals across the COVID-19 pandemic: a prospective longitudinal study

BACKGROUND

Initial studies found that mental health symptoms increased in pregnant and postpartum individuals during the COVID-19 pandemic. Less research has focused on if these putative increases persist over time and what factors influence these changes. We examined the longitudinal change in mental health symptoms in pregnant and postpartum individuals and investigated moderation by maternal emotion dysregulation and the incidence of coronavirus.

METHODS

Pregnant and postpartum individuals at the University of Utah were invited to join the COVID-19 and Perinatal Experiences (COPE) Study. Beginning on April 23, 2020 participants were sent a survey comprised of demographics, medical and social history, pregnancy information and self-assessments (Time 1). Participants were contacted 90 days later and invited to participate in a follow-up questionnaire (Time 2). Daily coronavirus case counts were accessed from the state of Utah and a 7-day moving average calculated. Within-subject change in mental health symptom scores, as measured by the Brief Symptom Inventory, was calculated. Linear mixed effects regression modeling adjusted for history of substance abuse and mental health disorders.

RESULTS

270 individuals responded between April 23rd, 2020 and July 15th, 2021. Mental health symptom scores improved by 1.36 points (0.7-2.0 p < 0.001). The decrease in mental health symptoms was not moderated by the prevalence of COVID-19 cases (p = 0.19) but was moderated by emotion dysregulation (p = 0.001) as defined by the Difficulties in Emotion Regulation Scale short form. Participants with higher emotion dysregulation also had higher mental health symptom scores.

CONCLUSION

Mental health symptoms improved over the course of the pandemic in the same pregnant or postpartum participant. Our findings do not negate the importance of mental health care during the pandemic. Rather, we believe this identifies some aspect of resiliency and adaptability. Examining emotion dysregulation, or asking about a history of mental health, may be helpful in identifying persons at higher risk of heightened responses to stressors.

Anxiety of pregnant women in time of catastrophic events, including COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

In March 2020, daily life was disrupted by the new virus SARS-CoV-2, which causes COVID-19. Pandemic-related prenatal anxiety could lead to depression, a risk factor for adverse pregnancy outcomes and abnormal neonatal development. This study aimed to investigate the impact of anxiety on the mental health of pregnant women exposed to catastrophic events as compared to those without such exposure.

MATERIALS AND METHODS

PubMed/MEDLINE, Web of Science, Cochrane Library, Scopus, and EMBASE were searched for relevant studies. This study compared the prevalence of anxiety among pregnant women during a catastrophic event.

RESULTS

Fifteen full texts were assessed for inclusion, with 3 included, 10 excluded for not meeting criteria, and 2 excluded for other reasons. The included studies were published before the current COVID-19 pandemic but included the SARS 2003 outbreak. During the current COVID-19 pandemic, 10 further studies were conducted, but they failed to meet the inclusion criteria. A meta-analysis of two studies using STAI revealed that women exposed to a catastrophic event had a higher mean STAI score of 1.82 points (95% CI: 0.47-3.18 points).

CONCLUSION

Women with complications during pregnancy should be assessed for anxiety independently from catastrophic events. During financial crises, environmental or other disasters, special attention should be given to women with low risk, normal pregnancies.

Design and validation of theory-based perceptions concerning the physical literacy questionnaire for pregnant women (P2LQ-PW)

Background

There is evidence that physical literacy plays an essential role in understanding the importance of maintaining appropriate physical activity and thereby preventing illnesses during pregnancy. The present study aimed to design and validate a physical literacy questionnaire focused on pregnant women.

Methods

In this exploratory psychometric study, theory-based perceptions concerning the physical literacy questionnaire for pregnant women were designed. Face-to-face interviews were conducted to develop the initial items. The findings from the interviews were merged with the literature review. The content, construct, and face validity was assessed by the participation of midwives, health educationists, and pregnant women. The content validity ratio, content validity index, and impact score of the items were calculated. The construct validity of the questionnaire was calculated through confirmatory and exploratory factor analysis. The reliability of the questionnaire was calculated by the standard error of measurement, intra-class correlation coefficient, composite reliability, and Cronbach’s alpha.

Results

The highest score was seen in the knowledge subscale and the value of Cronbach’s alpha for the subscales was 0.89 to 0.97, and the value of ICC was 0.76 to 0.89. The correlation according to the opinion of experts was satisfactory in all items of the questionnaire. The minimum loading factor for varimax rotation in the knowledge subscale was 0.41, the attitude was 0.56, the nurture factor was 0.38, and enabling factor was 0.27. The compatibility of the model among the constructs was confirmed by the normed chi-square (χ²/ df) < 5.0, comparative fit index ≥0.90, Tucker-Lewis index ≥0.9, and root mean square error of approximation < 0.08.

Conclusion

The physical literacy questionnaire for pregnant women is the first tool based on the PEN-3 model that other researchers can use to collect data and conduct educational interventions to change physical literacy behavior among Persian women during pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14204-7.

Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study

BACKGROUND

While there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety.

METHODS

Data were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used.

RESULTS

Objective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety.

LIMITATIONS

Participants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status.

CONCLUSIONS

These findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.

Psychosocial outcomes of the COVID-19 pandemic on pregnant women

The aim of this study was to compare the levels of anxiety and social support evaluated in pregnancy before and during the COVID-19 pandemic. This study was designed prospectively and observationally. Participants were asked to fill in two different questionnaire forms for the Multidimensional Scale of Perceived Social Support and The State-Trait Anxiety Inventory. Independent t-test and Pearson correlation analysis were used for statistical analysis. The mean age of 386 pregnant was 29.1 ± 4.91 years, and the gestational week was 29.12 ± 4.54. The values of the total social support scale were determined 61.52 ± 5.53-51.15 ± 5.86 before and during the pandemic, while the total state anxiety scale was found 39.81 ± 9.04 and 63.38 ± 10.55, respectively. The total trait anxiety scale was found at 38.23 ± 7.39 and 53.22 ± 8.74 in the same respect. A significant difference was obtained in the data between before and during the pandemic (p < .05). The study showed that pregnant are deprived of social support and their anxiety levels increase during the COVID-19 pandemic.IMPACT STATEMENTWhat is already known on this subject? During the COVID-19 pandemic, the prevalence of depression and anxiety in pregnant women have been reported as 25.6 and 30.5%, respectively. Social support is an important determinant of physical and psychological well-being, especially during pregnancy when individuals take on new responsibilities and roles.What do the results of this study add? The study showed that pregnant women were deprived of social support and their anxiety levels increased during this pandemic. The results highlight that there is a high need to mitigate mental health risks and adjust interventions under pandemic conditions.What are the implications of these findings for clinical practice and/or further research? It is necessary to provide social support from family, friends, and close circles. States and health professionals need to put forward serious programs and studies to reduce the stress and anxiety experienced by the society and especially pregnant women and to provide accurate information about COVID-19.

The Structure of the Relationship between Physical Activity and Psychosocial Functioning of Women and Men during the COVID-19 Epidemic in Poland

Since the coronavirus disease (COVID-19) pandemic is a serious crisis in many countries around the world, it is important to conduct empirical research aimed at identifying risks and factors protecting the functioning of people affected by it. For this reason, the goals of the present research were to determine the level of physical activity and the severity of symptoms characteristic of mental disorders, cognitive disorders and the quality of social functioning, as well as the structure of the relationship between physical activity and psychosocial functioning of 226 women and 226 men during the COVID-19 epidemic in Eastern Poland. The research was conducted using the IPAQ-SF Questionnaire, GHQ-28 Questionnaires, TUS Test-6/9 version, the original SFS Scale and a self-developed sociodemographic survey. The collected data indicate that women as compared to men show lower levels of weekly physical activity, walking, moderate activity, vigorous activity and quality of functioning in family relationships, but higher severity of mental health disorders, somatic symptoms, functional disorders, depressive symptoms, cognitive disorders, perceptual work disorders, attention deficits and higher quality of functioning in work relationships. On the other hand, the structural model indicates that physical activity, interacting with mental health disorders and cognitive disorders, is positively associated with the social functioning of the respondents, and gender is the moderator of the occurring dependencies. This suggests that physical activity adapted to the condition of health may be an important component of gender-individualized psychopreventive interventions.

Experiences, concerns, and needs of pregnant and postpartum women during the Covid-19 pandemic in Cyprus: a cross-sectional study

BACKGROUND

The current COVID-19 pandemic is a unique stressor with potentially challenging and negative consequences on the experiences of pregnant and postpartum women. International literature highlights the pandemic's negative impact on women's perinatal experiences. This is the first study in the scientific literature reporting on the impact of the COVID-19 pandemic, on the perinatal experiences of a large sample of women living in Cyprus.

AIM

To examine the impact of the COVID-19 pandemic on the experiences, concerns and needs of pregnant and postpartum women in Cyprus.

METHOD

The cross-sectional study was conducted from July 2020 to January 2021. A total of 695 women, 355 pregnant and 340 postpartum women (with infants up to 6 months of age), residing in Cyprus were surveyed.

RESULTS

The great majority of the participants (80.9%) perceived the impact of the COVID-19 pandemic on their life as negative. The greatest sources of stress were identified and quantified for their impact on the participants. Our findings indicate that 74.1% of the pregnant women were concerned about changes due to COVID-19 measures impacting the presence of their family at the time of delivery, 57.2% about their newborn's health, and 43.1% about changes related to perinatal care. Postpartum women's concerns were mainly related to the welfare and health of their child (70.3%), whilst half of them (49.1%) expressed concerns about how they were going to care for their baby because of pandemic-related changes. Qualitative data revealed emerging themes as the basis of the pregnant and postpartum women's concerns and needs.

CONCLUSIONS

The COVID-19 pandemic and the associated imposed measures and restrictions had adverse effects on pregnant and postpartum women's perinatal experiences in Cyprus. The women's concerns emphasized the need for the development of specialized, evidenced-based support systems which are essential particularly in pandemic-like situations, when pregnant and postpartum women are more vulnerable to isolation.

The relationship between perceived stress, uncertainty emotions and hopelessness regarding pandemics in pregnant women

The objective of this study was to determine the emotional reactions of pregnant women towards the pandemic and to increase awareness of healthcare professionals on this subject. In this descriptive, cross-sectional, and correlational study, an online questionnaire was applied to 375 pregnant women (n = 375). Data were collected with pregnant information form, Intolerance of Uncertainty Scale and Beck Hopelessness Scale. The mean age of the pregnant women was 29.495 ± 4.301, and the mean gestational week was 27.469 ± 7.971. Pregnant women's levels of perceived stress and intolerance to uncertainty were high. There was a moderate positive correlation between stress and uncertainty levels of the women who stated that they experienced mild hopelessness. It is recommended to identify risky groups and provide the necessary psychological support by health professionals during the pandemic.

Prospect of potential intrauterine programming impacts associated with COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - 2019 (COVID-19) has led to a worldwide public health concern. In addition to immediate impacts on human health and well-being, COVID-19 can result in unfortunate and long-term health consequences for future generations. In particular, pregnant women and developing fetuses in low-income settings could be prone to a higher risk of undernutrition, often due to an inadequate supply of food and nutrition during a pandemic outbreak like COVID-19. Such situations can subsequently lead to an increased risk of undesirable health consequences, such as non-communicable diseases, including obesity, metabolic syndrome, hypertension, and type 2 diabetes, in individuals born to exposed mothers via fetal programming. Moreover, COVID-19 infection or related stress during pregnancy can induce long-term programming outcomes on neuroendocrinological systems in offspring after birth. However, the long-lasting consequences of the transplacental transmission of COVID-19 in offspring are currently unknown. Here we hypothesize that a COVID-19 pandemic triggers intrauterine programming outcomes in offspring due to multiple maternal factors (e.g., nutrition deficiency, stress, infection, inflammation) during pregnancy. Thus, it is crucial to establish an integrated lifetime health information system for individuals born in or around the COVID-19 pandemic to identify those at risk of adverse pre-and postnatal nutritional programming. This approach will assist in designing specific dietary or other nutritional interventions to minimize the potential undesirable outcomes in those nutritionally programmed individuals.

Prevalence of Stress, Anxiety, and Depression Among Pregnant Women in Jeddah

Objectives: To estimate the prevalence of depression, anxiety, and stress among pregnant women living in Jeddah, Saudi Arabia, and to assess associated risk factors.

Methods: The study, which was a cross-sectional design, was conducted under the supervision of King Abdulaziz University Hospital, a tertiary care center in Jeddah, Saudi Arabia, in May and June of 2021. The sample consisted of 200 pregnant women who completed an online questionnaire that included sociodemographic variables, obstetric information, pregnancy-related depression, stress, and anxiety symptoms, which were evaluated using the Depression Anxiety Stress Scale (DASS-21) and the Perinatal Anxiety Screening Scale (PASS).

Results: DASS-21 scores indicated the prevalence of depression, anxiety, and stress were 37.5%, 54.0%, and 25.0%, respectively. The PASS revealed that 29.5% of participants had minimal anxiety symptoms, 44.5% had mild-to-moderate anxiety symptoms, and 26.0% had severe anxiety symptoms. The three psychological health conditions were significantly associated with family/husband support, history of caesarean section, parity, and abortion.

Conclusions: Pregnant women should be screened routinely for any psychological disturbances, and women who are at high risk for mental illness should receive proper psychological care. Pregnant women, their families, and members of society should receive health-related education in order to prevent prenatal psychological issues as much as possible.

Prevalencia del riesgo de depresión y preocupaciones en mujeres gestantes en el contexto de la pandemia por COVID-19 en Antioquia, Colombia, 2020-2021

Objetivos:

Describir la prevalencia de los síntomas de depresión y las preocupaciones que afectaron a las gestantes durante la pandemia por COVID-19.

Materiales y métodos:

Estudio transversal descriptivo, se incluyeron mujeres gestantes, con acceso a un medio tecnológico (celular, computador o tableta) y conectividad a internet, residentes en Antioquia, Colombia. Se excluyeron mujeres con analfabetismo literario y tecnológico. Se encuestaron, en línea, las condiciones sociodemográficas y clínicas basales y las principales preocupaciones generadas por la pandemia, además se aplicó la Escala de Depresión de Edimburgo (EPDS) para medir el riesgo de depresión. Se usó el software Jamovi para el procesamiento y análisis estadístico.

Resultados:

Se encuestaron 345 mujeres gestantes de 15 a 44 años, se identificó una prevalencia de riesgo de depresión en 30,4 % de las mujeres encuestadas. Se identificó violencia intrafamiliar en el 4,9 % y ausencia de red de apoyo en el 8,4 %. Se encontraron como mayores preocupaciones temor a ser separadas del bebé el día del parto, la posibilidad de no tener acompañante durante el parto, y temor al contagio por los efectos en el bebé in útero o en el recién nacido.

Conclusiones:

Los síntomas de depresión han sido frecuentes en las mujeres gestantes durante la pandemia del COVID-19. Es importante averiguar por factores de estrés y síntomas de depresión en el control prenatal, el parto y el postparto. Se requieren nuevos estudios locales que evalúen otros trastornos de salud mental que se hayan podido incrementar durante la pandemia por COVID-19.

Coronavirus Disease 2019 (COVID-19) Infection-Related Stigma, Depression, Anxiety, and Stress in Iranian Healthcare Workers

Background

Psychological conditions aggravate during outbreaks. Here, we have discussed the existing COVID-19 depression, anxiety, and stress and the resulting stigma and its different aspects in Iranian health care workers and their 1^st-degree relatives.

Methods

In this cross-sectional study, information of our study groups (237 participants including health care workers and their nuclear family members) was collected via two online stigma and depression, anxiety, and stress scale (DASS) questionnaires.

Results

The DASS questionnaire's mean depression, anxiety, and stress scores were 13.59 ± 5.76, 11.07 ± 4.38, and 15.05 ± 5.86, respectively, in our study population. Marriage status was effective on depression and stress scores. Married participants were having less depression (P = 0.008) but more stressful (P = 0.029) than single ones. Education was found to be effective on anxiety and stress scores. Those with an associate, master, Ph.D., and higher college degrees were significantly less anxious and stressed than those with a diploma or bachelor's degrees (P = 0.032 and 0.016, respectively, for anxiety and stress). Participants with a history of psychiatric conditions showed significantly higher depression, anxiety, and stress rates than those without a past psychiatric condition (P = 0.001). Healthcare workers and their nuclear family members suffer from severe stigma (mean stigma scores were 33.57 and 33.17, respectively).

Conclusions

Healthcare workers and their nuclear family members in Iran suffer from severe COVID-19 related stigma. We also showed that depression, anxiety, and stress are common among Iranian Healthcare workers and their nuclear family members during this pandemic. This study showed that people with preexisting psychiatric conditions need extra mental care during the pandemic.

Investigation of stress, anxiety, and depression levels of Pre-Hospital Emergency Medicine personnel in eastern Iran during the Covid-19 pandemic

Background

Pre-hospital emergency medicine (PHEM) personnel are at risk of developing psychological disorders during the Covid-19 pandemic. This study aimed to investigate depression, anxiety, and stress levels of the Iranian PHEM personnel during the Covid-19 pandemic.

Methods

This descriptive cross-sectional study was performed on 544 PHEM personnel chosen by purposive sampling in North Khorasan, Khorasan-Razavi, South Khorasan, Sistan-Baluchestan, and Kerman provinces in eastern Iran from August to September 2021. Data collection tools included a demographic information questionnaire and the standardized 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed in SPSS 16 using one-way analysis of variance and linear regression.

Results

The mean scores of depression, anxiety, and stress were 8.7 ± 9.2, 7.0 ± 7.8, and 11.6 ± 9.2, respectively. Depression, stress, and anxiety were more prevalent in the age group of 41-55 years, people with master’s and higher degrees, people with a history of underlying diseases, and people with over 10 years of work experience(p < 0.05). Depression and stress also showed a significant relationship with the type of employment. Stress alone was also significantly associated with working less than 35 hours a week and living separately from family(p < 0.05).

Conclusions

PHEM personnel suffer from significant levels of depression, anxiety, and stress during the Covid-19 pandemic. Therefore, in order to improve the mental condition, it is recommended that the work schedule and services provided to these people be designed in such a way that they have more time for rest and communication with their family members. The personnel should also have easier access to the expert team in the fields of counseling and psychiatry.

A comparison of COVID-19 vaccination status among pregnant Israeli Jewish and Arab women and psychological distress among the Arab women

The public debate surrounding the COVID-19 vaccine is especially intense regarding pregnant women, who are concerned with its effects on themselves and their fetus, and a vulnerable at-risk population for psychological distress. We aimed at describing differences in vaccination status between pregnant Jewish and Arab women and understanding factors contributing to psychological distress among Arab women. Pregnant women (n = 860) aged 19-46 completed self-report questionnaires during the national vaccination program (March-April 2021). The questionnaires related to background, COVID-19-related vaccination status and intentions in this regard, COVID-19-related anxiety, and the Mental Health Inventory-Short Form. Data were analyzed using descriptive statistics, t- and chi-square tests, Pearson correlations, and a hierarchical regression. Considerably fewer Jewish women had been infected and more were vaccinated than Arab women. Poorer health, lower economic status, being a mother, not being vaccinated, higher anxiety over economic damage, a family member being infected, delivery, and raising the baby contributed to higher distress. Findings offer novel insights for nurses in their efforts to encourage vaccination, highlighting the need to understand women's concerns during the vulnerable period of pregnancy.

Factors affecting the mental health of pregnant women using UK maternity services during the COVID-19 pandemic: a qualitative interview study

Background

People using maternity services in the United Kingdom (UK) have faced significant changes brought on by the COVID-19 pandemic and social distancing regulations. We focused on the experiences of pregnant women using UK maternity services during the pandemic and the impact of social distancing rules on their mental health and wellbeing.

Methods

We conducted 23 qualitative semi-structured interviews from June 2020 to August 2021, with women from across the UK who experienced a pregnancy during the pandemic. Nineteen participants in the study carried their pregnancy to term and four had experienced a miscarriage during the pandemic. Interviews took place remotely over video or telephone call, discussing topics such as mental health during pregnancy and use of UK maternity services. We used reflexive thematic analysis to analyse interview transcripts.

Results

We generated six higher order themes: [1] Some pregnancy discomforts alleviated by social distancing measures, [2] The importance of relationships that support coping and adjustment, [3] Missed pregnancy and parenthood experiences, [4] The mental health consequences of birth partner and visitor restrictions, [5] Maternity services under pressure, and [6] Lack of connection with staff. Many participants felt a sense of loss over a pregnancy experience that differed so remarkably to what they had expected because of the pandemic. Supportive relationships were important to help cope with pregnancy and pandemic-related changes; but feelings of isolation were compounded for some participants because opportunities to build social connections through face-to-face parent groups were unavailable. Participants also described feeling alone due to restrictions on their partners being present when accessing UK maternity services.

Conclusions

Our findings highlight some of the changes that may have affected pregnant women’s mental health during the COVID-19 pandemic. Reduced social support and being unable to have a partner or support person present during maternity service use were the greatest concerns reported by participants in this study. Absence of birth partners removed a protective buffer in times of uncertainty and distress. This suggests that the availability of a birth partner or support person must be prioritised wherever possible in times of pandemics to protect the mental health of people experiencing pregnancy and miscarriage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04602-5.

Adverse Mental Health Sequelae of COVID-19 Pandemic in the Pregnant Population and Useful Implications for Clinical Practice

The COVID-19 pandemic has increased risk of disturbances in the functioning of everyday life, directly or indirectly has influenced the risk of mental disorders in the most vulnerable populations, including pregnant women. The aim of this study was to analyze adverse mental health effects in the pregnant population during the COVID-19 pandemic, investigate risk factors for adverse mental health outcomes, identify protective factors, and create practical implications for clinical practice, bearing in mind the need to improve perinatal mental healthcare during such pandemics. Qualitative research was conducted in the electronic databases PubMed and Web of Sciences for the keywords COVID-19, pregnancy, depression, anxiety, and telemedicine for relevant critical articles (n = 3280) published from 2020 until October 2021, outlining the outcomes of control studies, meta-analysis, cross-sectional studies, face-to-face evaluation survey studies, remotely administered survey studies, and observational studies regarding the main topic; all were evaluated. Mental health problems among pregnant women linked to the COVID-19 pandemic, in most cases, show symptoms of depression, anxiety, insomnia, and PTSD and may cause adverse outcomes in pregnancy and fetus and newborn development, even at later stages of life. Therefore, useful implications for clinical practice for improving the adverse mental health outcomes of pregnant women associated with the COVID-19 pandemic are highly desirable. Our research findings support and advocate the need to modify the scope of healthcare provider practice in the event of a disaster, including the COVID-19 pandemic, and may be implemented and adopted by healthcare providers as useful implications for clinical practice.

Machine learning techniques for predicting depression and anxiety in pregnant and postpartum women during the COVID-19 pandemic: a cross-sectional regional study

Background: Maternal depression and anxiety are significant public health concerns that play an important role in the health and well-being of mothers and children. The COVID-19 pandemic, the consequential lockdowns and related safety restrictions worldwide negatively affected the mental health of pregnant and postpartum women. Methods: This regional study aimed to develop a machine learning (ML) model for the prediction of maternal depression and anxiety. The study used a dataset collected from five Arab countries during the COVID-19 pandemic between July to December 2020. The population sample included 3569 women (1939 pregnant and 1630 postpartum) from five countries (Jordan, Palestine, Lebanon, Saudi Arabia, and Bahrain). The performance of seven machine learning algorithms was assessed for the prediction of depression and anxiety symptoms. Results: The Gradient Boosting (GB) and Random Forest (RF) models outperformed other studied ML algorithms with accuracy values of 83.3% and 83.2% for depression, respectively, and values of 82.9% and 81.3% for anxiety, respectively. The Mathew’s Correlation Coefficient was evaluated for the ML models; the Naïve Bayes (NB) and GB models presented the highest performance measures (0.63 and 0.59) for depression and (0.74 and 0.73) for anxiety, respectively. The features’ importance ranking was evaluated, the results showed that stress during pregnancy, family support, financial issues, income, and social support were the most significant values in predicting anxiety and depression. Conclusion: Overall, the study evidenced the power of ML models in predicting maternal depression and anxiety and proved to be an efficient tool for identifying and predicting the associated risk factors that influence maternal mental health. The deployment of machine learning models for screening and early detection of depression and anxiety among pregnant and postpartum women might facilitate the development of health prevention and intervention programs that will enhance maternal and child health in low- and middle-income countries.

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.

Factors Affecting Primiparous Pregnant Women's Prenatal Attachment Levels, Childbirth Self-Efficacy Beliefs, and Labor Worry Levels

This study aimed to identify the factors affecting primiparous pregnant women's prenatal attachment levels, childbirth self-efficacy beliefs, and labor worry levels. This cross-sectional study was conducted with 351 pregnant women. The data were collected by using a Personal Information Form, the Prenatal Attachment Inventory, the Oxford Worries about Labour Scale, and the Childbirth Self-Efficacy Inventory. The mean Prenatal Attachment Inventory, Oxford Worries About Labour Scale and Childbirth Self-Efficacy Inventory scores of the participants were 40.53 ± 10.32, 21.82 ± 6.8, and 201.35 ± 23.21, respectively. The data obtained in the study showed that the care offered in the preconception period affected the participating pregnant women's prenatal attachment, labor worry, and childbirth self-efficacy levels. With individualized preconception care provided by health personnel, not only will awareness be increased but also women will be able to have a more positive pregnancy and labor experience.

Students' negative emotions and their rational and irrational behaviors during COVID-19 outbreak

The pandemic has posed an intense threat to the mental health of younger adults. Despite significant efforts in studying various aspects of COVID-19, there is a dearth of evidence on how negative emotions are associated with behaviors. A comparison across associated factors to different negative emotions by means of a unified model is especially missing from the literature. This study was conducted by using the results of a survey conducted across 2,534 students enrolled in 7 states in the US. Various feelings such as sad, irritable, stress and guilt were analyzed in a unified model by means of seemingly unrelated regression (SUR). Questions were asked related to rationally limiting the spread of virus, and questions related to behaviors that seem to be extreme. Irrational behaviors, such as limiting exercise at home due to COVID-19 could be due to experiencing negative emotions, which distort the meaning of events for the students. That behavior, for instance, was found to be positively associated with various negative feelings. In addition, the results highlighted significant differences across emotions in terms of demographic characteristics such as gender and age, and various precautionary actions that students take, such as limiting outdoor activities or limiting social gathering. For instance, it was highlighted while avoiding a large group of people, in spite of its importance in curbing the spread of virus, is negatively associated with various negative emotions, taking a possible nonconsequential precaution of completely limiting all people outside the immediate family result in a higher level of negative emotions. Also, it was found that having a higher body mass index (BMI), self-rated worse health conditions, and limiting outdoor activities have detrimental effects on the mental health of students.

A machine learning technology to improve the risk of non-invasive prenatal tests

BACKGROUND

Timely and accurate diagnosis of genetic diseases can lead to proper action and prevention of irreparable events.

OBJECTIVE

In this work we propose an integrated genetic-neural network (GNN) to improve the prediction risk of trisomy diseases including Down's syndrome (T21), Edwards' syndrome (T18) and Patau's Syndrome (T13).

METHODS

A dataset including 561 pregnant were created. In this integrated model, the structure and input parameters of the proposed multilayer feedforward network (MFN) were optimized.

RESULTS

The results of execution of the GNN on the testing dataset showed that the developed model can be accurately classify the anomalies from healthy fetus with 97.58% accuracy rate, and 99.44% and 85.65% sensitivity, and specificity, respectively. In the proposed GNN model, the Levenberg Merquident (LM) algorithm, the Radial Basis (Radbas) function from various types of functions were selected by the proposed GA. Moreover, maternal age, Nuchal Translucency (NT), Crown-rump length (CRL), Pregnancy-associated plasma protein A (PAPP-A) were selected by the proposed GA as the most effective factors for classifying the healthfetuses from the cases with fetal disorders.

CONCLUSION

The proposed computerized model increases the diagnostic performance of the physicians especially in the accurate detection of healthy fetus with non - invasive and low - cost treatments.