Abstract
Objectives
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.
Methods
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).
Results
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).
Conclusions
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.
-
Research funding: None declared.
-
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.
-
Competing interests: Authors state no conflict of interest.
-
Informed consent: Informed consent was obtained from all individuals included in this study.
-
Ethical approval: The Bioethics Committee of the Aristotle University of Thessaloniki approved the protocol of the study (reference number: 5.172/28.2.2020).
References
1. Holmes, EA, O’Connor, RC, Perry, VH, Tracey, I, Wessely, S, Arseneault, L, et al.. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020;7:547–60.10.1016/S2215-0366(20)30168-1Search in Google Scholar
2. Brooks, SK, Webster, RK, Smith, LE, Woodland, L, Wessely, S, Greenberg, N, et al.. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020;395:912–20.10.1016/S0140-6736(20)30460-8Search in Google Scholar
3. Taylor, MR, Agho, KE, Stevens, GJ, Raphael, B. Factors influencing psychological distress during a disease epidemic: data from Australia’s first outbreak of equine influenza. BMC Publ Health 2008;8:347.10.1186/1471-2458-8-347Search in Google Scholar PubMed PubMed Central
4. Liu, X, Kakade, M, Fuller, CJ, Fan, B, Fang, Y, Kong, J, et al.. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr 2012;53:15–23.10.1016/j.comppsych.2011.02.003Search in Google Scholar PubMed PubMed Central
5. Jeong, H, Yim, HW, Song, YJ, Ki, M, Min, JA, Cho, J, et al.. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health 2016;38:e2016048.10.4178/epih.e2016048Search in Google Scholar PubMed PubMed Central
6. Schwartz, DA, Graham, AL. Potential maternal and infant outcomes from (Wuhan) coronavirus 2019-nCoV infecting pregnant women: lessons from SARS, MERS, and other human coronavirus infections. Viruses 2020;12:194. https://doi.org/10.3390/v12020194.Search in Google Scholar
7. Rashidi Fakari, F, Simbar, M. Coronavirus pandemic and worries during pregnancy; a letter to editor. Arch Acad Emerg Med 2020;8:e21.Search in Google Scholar
8. Andersson, L, Sundstrom-Poromaa, I, Bixo, M, Wulff, M, Bondestam, K, aStrom, M. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003;189:148–54.10.1067/mob.2003.336Search in Google Scholar PubMed
9. van de Loo, KFE, Vlenterie, R, Nikkels, SJ, Merkus, P, Roukema, J, Verhaak, CM, et al.. Depression and anxiety during pregnancy: the influence of maternal characteristics. Birth 2018;45:478–89.10.1111/birt.12343Search in Google Scholar PubMed
10. Falah-Hassani, K, Shiri, R, Dennis, CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychol Med 2017;47:2041–53.10.1017/S0033291717000617Search in Google Scholar PubMed
11. Hermon, N, Wainstock, T, Sheiner, E, Golan, A, Walfisch, A. Impact of maternal depression on perinatal outcomes in hospitalized women-a prospective study. Arch Womens Ment Health 2019;22:85–91.10.1007/s00737-018-0883-5Search in Google Scholar PubMed
12. Grigoriadis, S, Graves, L, Peer, M, Mamisashvili, L, Tomlinson, G, Vigod, SN, et al.. Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: systematic review and meta-analysis. J Clin Psychiatry 2018;79.10.4088/JCP.17r12011Search in Google Scholar
13. Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, et al.. Effects of perinatal mental disorders on the fetus and child. Lancet 2014;384:1800–19.10.1016/S0140-6736(14)61277-0Search in Google Scholar
14. Spielberger, C, Gorsuch, R, Lushene, R. State-Trait Anxiety Inventory for adults sampler set manual, instrument and scoring guide. Tampa, Florida: Consult Psychol Press Inc Mind Gard Inc.; 1983.10.1037/t06496-000Search in Google Scholar
15. Dagklis, T, Tsakiridis, I, Mamopoulos, A, Athanasiadis, A, Pearson, R, Papazisis, G. The impact of the COVID-19 lockdown on antenatal mental health in Greece. Psychiatr Clin Neurosci 2020;74:616–7. https://doi.org/10.1111/pcn.13135.Search in Google Scholar
16. Murray, L, Carothers, AD. The validation of the Edinburgh Post-Natal Depression Scale on a community sample. Br J Psychiatry 1990;157:288–90.10.1192/bjp.157.2.288Search in Google Scholar PubMed
17. Murray, D, Cox, JL. Screening for depression during pregnancy with the Edinburgh Depression Scale (EDDS). J Reprod Infant Psychol 1990;8:99–107.10.1080/02646839008403615Search in Google Scholar
18. Vivilaki, VG, Dafermos, V, Kogevinas, M, Bitsios, P, Lionis, C. The Edinburgh Postnatal Depression Scale: translation and validation for a Greek sample. BMC Publ Health 2009;9:329.10.1186/1471-2458-9-329Search in Google Scholar PubMed PubMed Central
19. Cox, JL, Holden, JM, Sagovsky, R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782–6.10.1192/bjp.150.6.782Search in Google Scholar PubMed
20. Leonardou, A, Zervas, Y, Papageorgiou, C, Marks, M, Tsartsara, E, Antsaklis, A, et al.. Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers. J Reprod Infant Psychol 2009;27:8–39.10.1080/02646830802004909Search in Google Scholar
21. Gibson, J, McKenzie-McHarg, K, Shakespeare, J, Price, J, Gray, R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 2009;119:350–64.10.1111/j.1600-0447.2009.01363.xSearch in Google Scholar PubMed
22. Fountoulakis, KN, Papadopoulou, M, Kleanthous, S, Papadopoulou, A, Bizeli, V, Nimatoudis, I, et al.. Reliability and psychometric properties of the Greek translation of the State-Trait Anxiety Inventory form Y: preliminary data. Ann Gen Psychiatry 2006;5:2.10.1186/1744-859X-5-2Search in Google Scholar PubMed PubMed Central
23. Gunning, M, Denison, F, Stockley, C, Ho, S, Sandhu, H, Reynolds, R. Assessing maternal anxiety in pregnancy with the State-Trait Anxiety Inventory (STAI): issues of validity, location and participation. J Reprod Infant Psychol 2010;28:266–73.10.1080/02646830903487300Search in Google Scholar
24. Barbisch, D, Koenig, KL, Shih, FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep 2015;9:547–53.10.1017/dmp.2015.38Search in Google Scholar PubMed
25. Harville, E, Xiong, X, Buekens, P. Disasters and perinatal health:a systematic review. Obstet Gynecol Surv 2010;65:713–28.10.1097/OGX.0b013e31820eddbeSearch in Google Scholar PubMed PubMed Central
26. Koutra, K, Vassilaki, M, Georgiou, V, Koutis, A, Bitsios, P, Chatzi, L, et al.. Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete, Greece. Soc Psychiatry Psychiatr Epidemiol 2014;49:711–21.10.1007/s00127-013-0758-zSearch in Google Scholar PubMed
27. Lebel, C, MacKinnon, A, Bagshawe, M, Tomfohr-Madsen, L, Giesbrecht, G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord 2020;277:5–13.10.1016/j.jad.2020.07.126Search in Google Scholar PubMed PubMed Central
28. Wu, Y, Zhang, C, Liu, H, Duan, C, Li, C, Fan, J, et al.. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol 2020;223:240 e1–9.10.1016/j.ajog.2020.05.009Search in Google Scholar PubMed PubMed Central
29. Tsakiridis, I, Dagklis, T, Zerva, C, Mamopoulos, A, Athanasiadis, A, Papazisis, G. Depression in pregnant women hospitalized due to intrauterine growth restriction: prevalence and associated factors. Midwifery 2019;70:71–5.10.1016/j.midw.2018.12.008Search in Google Scholar PubMed
30. Dagklis, T, Tsakiridis, I, Chouliara, F, Mamopoulos, A, Rousso, D, Athanasiadis, A, et al.. Antenatal depression among women hospitalized due to threatened preterm labor in a high-risk pregnancy unit in Greece. J Matern Fetal Neonatal Med 2018;31:919–25.10.1080/14767058.2017.1301926Search in Google Scholar PubMed
31. Dagklis, T, Papazisis, G, Tsakiridis, I, Chouliara, F, Mamopoulos, A, Rousso, D. Prevalence of antenatal depression and associated factors among pregnant women hospitalized in a high-risk pregnancy unit in Greece. Soc Psychiatry Psychiatr Epidemiol 2016;51:1025–31.10.1007/s00127-016-1230-7Search in Google Scholar PubMed
32. Tsakiridis, I, Bousi, V, Dagklis, T, Sardeli, C, Nikolopoulou, V, Papazisis, G. Epidemiology of antenatal depression among women with high-risk pregnancies due to obstetric complications: a scoping review. Arch Gynecol Obstet 2019;300:849–59.10.1007/s00404-019-05270-1Search in Google Scholar PubMed
33. Dennis, CL, Falah-Hassani, K, Shiri, R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 2017;210:315–23.10.1192/bjp.bp.116.187179Search in Google Scholar PubMed
34. Mappa, I, Distefano, FA, Rizzo, G. Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: a prospectic observational study. J Perinat Med 2020;48:545–50.10.1515/jpm-2020-0182Search in Google Scholar PubMed
© 2021 Walter de Gruyter GmbH, Berlin/Boston