Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset

https://doi.org/10.1016/j.socscimed.2022.115499Get rights and content

Highlights

  • Pregnant women across the Western world experienced high stress at the pandemic onset.

  • Stress predicted anxiety and depressive symptoms above clinical thresholds.

  • Levels of stress and mood disturbances varied across high-income Western countries.

  • Mood disturbances were predicted by a common set of factors across countries.

Abstract

Objective

Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown.

Methods

8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants.

Results

Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries.

Conclusions

Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Keywords

Anxiety
Depression
Pregnancy
Maternal stress
COVID-19 global pandemic
Women's health

Data availability

Data will be made available on request.

Cited by (0)

1

Other than the U.S., co-authors are listed alphabetically by country. Investigators within each country determined authorship order based on degree of contribution.

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