A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic
Authors: Basu Archana , Kim Hannah Hayoung , Choi Karmel W. , Charron Lily , Kelsall Nora , Basaldua Rebecca , Hernandez-Diaz Sonia , Wyszynski Diego F. , Koenen Karestan C. 
Published: December 2020

Background

Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic.

Methods and Findings

An anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26 2020 and June 13 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies (https://corona.pregistry.com), and advertised predominantly in social media channels and online parenting forums. Participants completed measures on demographic characteristics, COVID-19 exposure and worries, media exposure, COVID-19 prevention behaviors, and mental health symptoms including posttraumatic stress symptoms via the IES-6, anxiety/depression via the PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions of women scored at or above the cut-offs for elevated posttraumatic stress (2,979 [43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information seeking from any source (e.g., social media, news, talking to others) five or more times per day was associated with more than twice the odds of elevated posttraumatic stress and anxiety/depression, in adjusted models. A large majority of women (86%) reported being somewhat or very worried about COVID-19. The most commonly reported worries were related to pregnancy and delivery, including family being unable to visit after delivery (59%), the baby contracting COVID-19 (59%), lack of a support person during delivery (55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries related to children (i.e. inadequate childcare, their infection risk) and missing medical appointments were associated with significantly higher odds of posttraumatic stress, anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to mental health symptoms or loneliness.

Conclusions

Clinically significant posttraumatic stress, anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum women across 64 countries during the COVID-19 pandemic. Excessive information seeking and worries related to children and medical care are associated with clinically significant symptoms, whereas engaging in hygiene-related preventive measures were not. In addition to screening and monitoring mental health symptoms, reinforcing healthy information seeking, addressing worries about access to medical care and the well-being of their children, and strategies to target loneliness (e.g., online support groups) should be part of intervention efforts for perinatal women. Public and mental health interventions need to explicitly address the impact of COVID-19 on both physical and mental health in perinatal women, as prevention of viral exposure itself does not mitigate the mental health impact of the pandemic.