The Prevalence of Psychological Symptoms in Pregnant Healthcare Workers (HCWs) and Pregnant Non-HCWs During the Early Stage of COVID-19 Pandemic in Chongqing, China

Factors associated with depression during pregnancy in women receiving high- and low-risk prenatal care: a predictive model

Introduction

Depression during pregnancy can put strain on pregnant women's interpersonal relationships, the formation of emotional bonds with the fetus, and the adaptation to the new routine and social role post-pregnancy. Some studies have associated socioeconomic factors, emotional factors, interpersonal relationships, perceived social support, gestational risk, and the occurrence of certain diseases during pregnancy with higher risk of depression.

Objectives

This study aimed to investigate the prevalence of depression during pregnancy and associated factors in low- and high-risk prenatal patients at a Brazilian university hospital.

Methods

This study presents a retrospective and prospective cross-sectional design. A total of 684 prenatal psychological analysis records from a Brazilian tertiary university service were retrospectively evaluated to assess depression through the PRIME-MD questionnaire between 2002-2017. Between 2017 and 2018, 76 patients treated at the same service were prospectively evaluated with the aforementioned instrument. Medical records were accessed to obtain labor and birth data. Multivariate analyses assessed the association between sociodemographic, gestational or obstetric, and health variables and the presence of depression during pregnancy.

Results

A total of 760 pregnant women were included in the study, with a depression prevalence of 20.66% (n = 157). At the time of assessment, 48 (21.05%) women from the low-risk pregnancy group and 109 (20.49%) from the high-risk pregnancy group were depressed. The mean age was 30.01 ± 6.55 years in the group with depression and 29.81 ± 6.50 years in the group without depression. In the univariate analysis, there was an association of risk for depression with absence of paid work, absence of a partner, low family income and diagnosis of epilepsy, being a protective factor the presence of diabetes during pregnancy. However, in the multivariate analysis, a lower family income, not having a partner at the time of the assessment, and the prevalence of epilepsy were independently associated with an increased risk of depression during pregnancy.

Conclusion

This study showed that 1 in 5 women had depression during pregnancy, with no association with obstetric risk, but those women living in unfavorable economic conditions, without a partner, and having epilepsy were at increased risk of depression.

Prevalence of obsessive-compulsive disorders (OCD) symptoms among health care workers in COVID-19 pandemic: a systematic review and meta-analysis

BACKGROUND

Obsessive Compulsive Disorder (OCD) symptoms, are among the serious mental health challenges that Health Care Workers (HCWs) faced during the COVID-19 pandemic. As these symptoms reduce the mental well-being and effectiveness of HCWs which are followed by poor health outcomes for patients, the aim of this systematic review and meta-analysis was to determine the prevalence of OCD symptoms among HCWs worldwide.

METHODS

PubMed, Google Scholar, Cochrane, Scopus, Web of Science, ProQuest, Emerald, and ERIC databases were searched using related keywords till the end of October 2021. Observational studies about the prevalence of OCD symptoms among healthcare workers during the COVID-19 pandemic were screened and evaluated. In order to assess the quality of studies, the Newcastle-Ottawa scale (NOS) checklist was used. The effect measure was the prevalence rate with a 95% confidence interval (CI).

RESULTS

A total of 7864 individuals from 11 studies were included. The range of OCD symptoms prevalence across these studies was from 0.07 to 0.47. Due to the high heterogeneity between the studies (I2 = 98.6%, P < 0.01), the random effects model was used. The pooled prevalence was 0.29 (95% CI: 0.22-0.38) based on logit transformed CI.

CONCLUSIONS

The pooled prevalence of OCD symptoms was 29% among the HCWs during the COVID-19 pandemic. This prevalence was higher than the general population according to the pre-pandemic literature, but lower than the recent reports amid the pandemic. Psychosocial interventions are suggested to be designed and implemented in such conditions.

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.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association between psychological symptoms and illegal driving behaviors in a sample of Chinese private car drivers

BACKGROUND

Findings on the associations between psychological symptoms and driving behaviors in private car drivers are inadequate.

METHOD

The study consisted of 3,115 private car drivers in Yulin, China. The measurements included socio-demographic data, traffic violations, accidents, and Symptom Checklist-90 (SCL-90). In addition, an ordered logistic regression model was employed to examine the association between each psychological symptom and risky driving behaviors.

RESULTS

The overall prevalence rate of any self-reported psychological symptom was 10.24%, with 9.22% for males and 11.49% for females. Among them, obsessive-compulsive, interpersonal sensitivity, additional items, hostility, and depression were the five most common psychological symptoms, with prevalence rates of 7.90, 6.29, 6.00, 5.91, and 5.62%, respectively. Any psychological symptom factor was associated with a higher risk of traffic violations and accidents. However, the intensity of the correlations varied, with obsessive-compulsive symptoms the strongest in general traffic violations and anxiety symptoms in traffic accidents. All psychological symptoms except phobic anxiety and paranoid ideation contributed to a higher risk of failing the driver's license test.

CONCLUSIONS

The prevalence rate of psychological symptoms was high in private car drivers. This study calls for an urgent need to establish a pilot tertiary prevention strategy to reduce risky driving behaviors through psychological symptom screening and interventions among private car drivers.

Psychotic-like experiences and associated socio-demographic factors among pregnant women in each trimester in China

OBJECTIVE

Psychotic-like experiences (PLEs) are quite common in the general populations without a clinical diagnosis, but pregnant women have been neglected in earlier literature. This study aimed to investigate the prevalence and correlates of PLEs among pregnant women without previous psychiatric history in each trimester.

METHOD

A total of 950 pregnant women participated in a cross-sectional survey, with social and demographic information collected. The Positive Subscale of Community Assessment of Psychic Experiences (CAPE) was used to measure PLEs, and the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the Edinburgh Postnatal Depression Scale (EPDS) were used to examine anxious and depressive symptoms, respectively. Logistic regression analyses were conducted to investigate the risk factors for pregnant women with PLEs.

RESULTS

In our study, 37.2% of the pregnant women in this sample experienced at least one episode of PLEs, while 4.3% reported "often" having PLEs. More pregnant women experienced PLEs, delusional experiences, and hallucinatory experiences in the first two trimesters than in the third trimester. Factors associated with a higher risk for more frequent PLEs include: rural setting, unplanned pregnancy, parity 1, and EPDS scores. High positive correlations were shown between frequency scores among experiences of PLEs and GAD-7 scores, EPDS scores.

CONCLUSION

Episodes of PLEs are common in Chinese pregnant women; however, only a small proportion has persistent PLEs. It is vital to pay attention to women with psychosis risk in pregnancy.