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Licensed Unlicensed Requires Authentication Published by De Gruyter March 17, 2021

Antenatal depression and anxiety during the COVID-19 pandemic: a cross-sectional study in pregnant women from routine health care contact in Greece

  • Ioannis Tsakiridis ORCID logo , Themistoklis Dagklis ORCID logo EMAIL logo , Apostolos Mamopoulos , Apostolos Athanasiadis , Rebecca Pearson and Georgios Papazisis



The impact of the COVID-19 pandemic and the public health measures introduced to control it, on mental health, is largely unknown. Research conducted during past epidemics found that pregnant women are more vulnerable psychologically. The aim of this study was to investigate antenatal depressive and anxiety symptoms during this pandemic in Greece.


All women receiving routine antenatal care, during a three-month period, starting one week after the total lockdown in Greece, in a University department, were asked to fill in two questionnaires, the Edinburg Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI).


Overall, 505 women (93.3% of the eligible population) agreed to participate. The prevalence of antenatal depression (EPDS score≥13) in the population of the study was 13.5%. Unplanned pregnancy (OR: 2.447; 95% CI: 1.235–4.846), smoking (OR: 2.268; 95% CI: 1.166–4.411) and antenatal anxiety (OR: 5.074; 95% CI: 2.898–8.883) increased the risk of antenatal depression during the COVID-19 pandemic. State (current)-anxiety affected 34.1% of the participants, whereas Trait (lifetime)-anxiety affected 15.8%. The State-anxiety score (median) was significantly higher than the Trait-anxiety (median) (41 vs. 36; p<0.001), revealing an increase in the levels of anxiety in the pandemic, while there was also a positive linear correlation between the two scales (rho=0.592; p<0.001).


The unprecedented situation of the COVID-19 pandemic has increased anxiety, but not depression levels of pregnant women in Greece. Population level interventions to address adverse effects on anxiety status in the initial phases of similar situations may be helpful in the future.

Corresponding author: Themistoklis Dagklis, MD, PhD, Assistant Professor in Obstetrics and Gynecology, 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Phone +30 2310 992150, Fax: +30 2310 992150, E-mail:
Ioannis Tsakiridis and Themistoklis Dagklis share first authorship.
  1. Research funding: None declared.

  2. Author contributions: Themistoklis Dagklis developed the original idea for the study, coordinated recruitment, interviewed patients, recorded patient data. Ioannis Tsakiridis designed, coordinated, implemented the project, evaluated the results. Apostolos Athanasiadis and Rebecca Pearson participated in the revision. Apostolos Mamopoulos supervised sample extraction and cooperated in results’ analysis. Georgios Papazisis participated in statistical analysis, evaluated the results and also supervised the manuscript development. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The Bioethics Committee of the Aristotle University of Thessaloniki approved the protocol of the study (reference number: 5.172/28.2.2020).


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Received: 2020-10-09
Accepted: 2020-12-27
Published Online: 2021-03-17
Published in Print: 2021-07-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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