The prevalence of perinatal anxiety and depressive symptoms have been speculated to increase during an infectious disease outbreak but remains unknown in the context of the COVID-19 situation. Therefore, this review aimed to examine the prevalence of antenatal and postnatal anxiety and depressive symptoms among pregnant women and postpartum mothers during the COVID-19 period.
Methods:
Six electronic databases were systematically searched for articles from November 2019 to December 2020. Twenty-six observational studies and brief reports were included in the meta-analysis.
Results:
Overall, the prevalence of anxiety was greater than depression in both antenatal and postnatal periods, and the prevalence of depression was higher in the antenatal period than the postnatal period. The pooled prevalence for antenatal anxiety symptoms, antenatal depressive symptoms and postnatal depressive symptoms were 40% (95% confidence intervals (CI): 0.27–0.52), 27% (95% CI: 0.20–0.33) and 17% (95% CI: 0.10–0.24), respectively. Europe (56%, 95% CI: 0.28–0.85) had significantly higher prevalence of antenatal anxiety than Asia (16%, 95% CI: 0.09–0.23).
Conclusions:
The heightened prevalence of perinatal psychological disorders served as an impetus for healthcare professionals and policy makers to ramp up their support and mitigation strategies for pregnant women and mothers in times of health crisis.
TopalidouAThomsonGDowneS. COVID-19 and maternal mental health: Are we getting the balance right?MedRxiv2020. [preprint] DOI: 10.1101/2020.03.30.20047969.
3.
BiaggiAConroySPawlbyS, et al. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord2016;191:62-77. 2015/11/18. DOI: 10.1016/j.jad.2015.11.014.
4.
FisherJMelloMCdPatelV, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: A systematic review. Bull World Health Organ2012;90:139-49.
5.
CraskeMGSteinMB.Anxiety. The Lancet2016;388:3048-59. DOI: 10.1016/S0140-6736(16)30381-6.
LeeDTSahotaDLeungTN, et al. Psychological responses of pregnant women to an infectious outbreak: A case-control study of the 2003 SARS outbreak in Hong Kong. J Psychosomat Res2006;61:707-13. DOI: 10.1016/j.jpsychores.2006.08.005.
8.
WangYDiYYeJ, et al. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med2021;26(1):13–22. DOI: 10.1080/13548506.2020.1746817.
9.
RenS-YGaoR-DChenY-L.Fear can be more harmful than the severe acute respiratory syndrome coronavirus 2 in controlling the corona virus disease 2019 epidemic. World J Clin Cases2020;8:652-7. DOI: 10.12998/wjcc.v8.i4.652.
10.
DadiAFMillerERBisetegnTA, et al. Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review. BMC Public Health2020;20:173. DOI: 10.1186/s12889-020-8293-9.
GrigoriadisSGravesLPeerM, et al. A systematic review and meta-analysis of the effects of antenatal anxiety on postpartum outcomes. Arch Womens Ment Health2019;22:543-56. 2018/12/14. DOI: 10.1007/s00737-018-0930-2.
13.
SlomianJHonvoGEmontsP, et al. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. Womens Health (Lond)2019;15:1745506519844044-1745506519844044. DOI: 10.1177/1745506519844044.
14.
BrooksSKWestonDGreenbergN.Psychological impact of infectious disease outbreaks on pregnant women: Rapid evidence review. Public Health (Lond)2020;189:26-36. DOI: 10.1016/j.puhe.2020.09.006.
15.
HessamiKRomanelliCChiurazziM, et al. COVID-19 pandemic and maternal mental health: A systematic review and meta-analysis. J Matern-Fetal Neonatal Med2020:1-8.
16.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med2009;6:e1000097. DOI: 10.1371/journal.pmed.1000097.
17.
FerrariAJCharlsonFJNormanRE, et al. The epidemiological modelling of major depressive disorder: Application for the Global Burden of Disease Study 2010. PloS One2013;8:e69637. DOI: 10.1371/journal.pone.0069637.
18.
HigginsJPTThompsonSGDeeksJJ, et al. Measuring inconsistency in meta-analyses. BMJ (Clin Res Ed)2003;327:557-60. DOI: 10.1136/bmj.327.7414.557.
19.
DeeksJJHigginsJPAltmanDG, et al. Analysing data and undertaking meta-analyses. In: HigginsJPTThomasJChandlerJ, et al, (eds) Cochrane Handbook Syst Rev Interv. Chichester: John Wiley & Sons, Ltd; 2019:241–84.
20.
CeulemansMHompesTFoulonV.Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic: A call for action. Int J Gynecol Obstet2020;151:146-7. DOI: 10.1002/ijgo.13295.
21.
DagklisTTsakiridisIMamopoulosA, et al. Impact of the COVID-19 lockdown on antenatal mental health in Greece. Psychiatry Clinical Neurosci2020;74:616-17. DOI: 10.1111/pcn.13135.
22.
DongHHuRLuC, et al. Investigation on the mental health status of pregnant women in China during the Pandemic of COVID-19. Arch Gynecol Obstet2021;303(2):463-69. DOI: 10.1007/s00404-020-05805-x.
23.
Effati-DaryaniFZareiSMohammadiA, et al. Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19. BMC Psychol2020;8:99. DOI: 10.1186/s40359-020-00464-8.
24.
LebelCMacKinnonABagshaweM, et al. Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord2020;277:5-13. DOI: 10.1016/j.jad.2020.07.126.
25.
LiuXChenMWangY, et al. Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: A cross-sectional study. BJOG2020;127:1229-40. DOI: 10.1111/1471-0528.16381.
26.
MappaIDistefanoFARizzoG.Effects of coronavirus 19 pandemic on maternal anxiety during pregnancy: A prospective observational study. J Perinat Med2020;48:545-50. DOI: 10.1515/jpm-2020-0182.
27.
PatabendigeMGamageMMWeerasingheM, et al. Psychological impact of the COVID-19 pandemic among pregnant women in Sri Lanka. Int J Gynecol Obstet2020;151:150-3. DOI: 10.1002/ijgo.13335.
28.
SacconeGFlorioAAielloF, et al. Psychological impact of coronavirus disease 2019 in pregnant women. Am J Obstet Gynecol2020;223:293-5. DOI: 10.1016/j.ajog.2020.05.003.
29.
SutHKKucukkayaB.Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study. Perspect Psychiatr Care2020;1-9. DOI: 10.1111/ppc.12627.
30.
YassaMYassaAYirmibeşC, et al. Anxiety levels and obsessive compulsion symptoms of pregnant women during the COVID-19 pandemic. Turkish J Obstet Gynecol2020;17:155-60. DOI: 10.4274/tjod.galenos.2020.91455.
31.
ZhouYShiHLiuZ, et al. The prevalence of psychiatric symptoms of pregnant and non-pregnant women during the COVID-19 epidemic. Transl Psychiatry2020;10:319. DOI: 10.1038/s41398-020-01006-x.
32.
DurankuşFAksuE. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: A preliminary study. J Matern-Fetal Neonatal Med2020:1-7. DOI: 10.1080/14767058.2020.1763946.
33.
MatsushimaMHoriguchiH. The COVID-19 pandemic and mental well-being of pregnant women in Japan: Need for Economic and Social Policy interventions. Disaster Med Public Health Prep2020:1-11. DOI: 10.1017/dmp.2020.334.
34.
SadeSSheinerEWainstockT, et al. Risk for depressive symptoms among hospitalized women in high-risk pregnancy units during the COVID-19 pandemic. J Clin Med2020;9:2449. DOI: 10.3390/jcm9082449.
35.
SilvermanMEMedeirosCBurgosL.Early pregnancy mood before and during COVID-19 community restrictions among women of low socioeconomic status in New York City: A preliminary study. Arch Womens Ment Health2020;23:779-82. DOI: 10.1007/s00737-020-01061-9.
36.
ThayerZMGildnerTE. COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States. Am J Hum Biol2020:e23508. DOI: 10.1002/ajhb.23508.
37.
WuYZhangCLiuH, et al. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. Am J Obstet Gynecol2020;223:240.e241-49. DOI: 10.1016/j.ajog.2020.05.009.
38.
HuiPMaGSetoMT, et al. Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women. Hong Kong Med J2020;27(2):113-7. DOI: 10.12809/hkmj208774.
39.
ParienteGBroderOWSheinerE, et al. Risk for probable post-partum depression among women during the COVID-19 pandemic. Arch Womens Ment Health2020;23:767–73. DOI: 10.1007/s00737-020-01075-3.
40.
SuzukiS. Psychological status of postpartum women under the COVID-19 pandemic in Japan. J Matern-Fetal Neonatal Med2020;1-3. DOI: 10.1080/14767058.2020.1763949.
41.
ZanardoVManghinaVGilibertiL, et al. Psychological impact of COVID-19 quarantine measures in northeastern Italy on mothers in the immediate postpartum period. Int J Gynecol Obstet2020;150(2):184-8. DOI: 10.1002/ijgo.13249.
42.
CameronEEJoyceKMDelaquisCP, et al. Maternal psychological distress & mental health service use during the COVID-19 pandemic. J Affect Disord2020;276:765-74. DOI: 10.1016/j.jad.2020.07.081.
43.
DavenportMHMeyerSMeahVL, et al. Moms are not ok: COVID-19 and maternal mental health. Front Glob Women’s Health2020;1(1):1-6. DOI: 10.3389/fgwh.2020.00001.
44.
FarewellCVJewellJWallsJ, et al. A mixed-methods pilot study of perinatal risk and resilience during COVID-19. J Prim Care Community Health2020;11: 2150132720944074-2150132720944074. DOI: 10.1177/2150132720944074.
45.
ZhengQXJiangXMLinY, et al. The influence of psychological response and security sense on pregnancy stress during the outbreak of coronavirus disease 2019: A mediating model. J Clin Nurs2020;29:4248-57. DOI: 10.1111/jocn.15460.
46.
DennisC-LFalah-HassaniKShiriR.Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. Br J Psychiatry2017;210:315-23. DOI: 10.1192/bjp.bp.116.187179.
47.
LeachLSPoyserCFairweather-SchmidtK.Maternal perinatal anxiety: A review of prevalence and correlates. Clin Psychol (Aust Psychol Soc)2017;21:4-19. DOI: 10.1111/cp.12058.
48.
BayrampourHHeamanMDuncanKA, et al. Predictors of perception of pregnancy risk among nulliparous women. J Obstet Gynecol Neonatal Nurs2013;42:416-27. DOI: 10.1111/1552-6909.12215.
49.
MadhavanprabhakaranGKD’SouzaMSNairyKS.Prevalence of pregnancy anxiety and associated factors. Int J Africa Nurs Sci2015;3:1-7. DOI: 10.1016/j.ijans.2015.06.002.
50.
ReckCZimmerKDubberS, et al. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Womens Ment Health2013;16:363-9. DOI: 10.1007/s00737-013-0344-0.
51.
AdewuyaAOOlaBAAlobaOO, et al. Anxiety disorders among Nigerian women in late pregnancy: A controlled study. Arch Womens Ment Health2006;9:325-8. DOI: 10.1007/s00737-006-0157-5.
52.
UguzFMDGezgincKMDKayhanFMD, et al. Is pregnancy associated with mood and anxiety disorders? A cross-sectional study. Gen Hospital Psychiatry2010;32:213-15. DOI: 10.1016/j.genhosppsych.2009.11.002.
53.
Hahn-HolbrookJCornwell-HinrichsTAnayaI.Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry2017;8:248. DOI: 10.3389/fpsyt.2017.00248.
54.
ShoreySCheeCYINgED, et al. Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. J Psychiatr Res2018;104:235-48. DOI: 10.1016/j.jpsychires.2018.08.001.
55.
InsanNSlackEHeslehurstN, et al. Antenatal depression and anxiety and early pregnancy BMI among White British and South Asian women: Retrospective analysis of data from the Born in Bradford cohort. BMC Pregnancy Childbirth2020;20:1-502. DOI: 10.1186/s12884-020-03097-2.
56.
RedshawMHendersonJ.From antenatal to postnatal depression: Associated factors and mitigating influences. J Women’s Health (Larchmont, NY 2002)2013;22:518-25. DOI: 10.1089/jwh.2012.4152.
57.
ShakeelNEberhard-GranMSletnerL, et al. A prospective cohort study of depression in pregnancy, prevalence and risk factors in a multi-ethnic population. BMC Pregnancy Childbirth2015;15:5-5. DOI: 10.1186/s12884-014-0420-0.
58.
QiuJXiaoZ.Reproductive-related depression in women: A review of two decades of research in China. Asia-Pacific Psychiatry2010;2:19-25. DOI: 10.1111/j.1758-5872.2009.00035.x.
59.
ShiS.An investigation of the prevalence of anxiety or depression and related risk factors in women with pregnancy and postpartum. Chinese Mental Health J2007;21:254.
60.
SchatzDBHsiaoM-CLiuC-Y.Antenatal depression in East Asia: A review of the literature. Psychiatry Investig2012;9:111-18. DOI: 10.4306/pi.2012.9.2.111.
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