Background: The coronavirus disease (COVID-19) pandemic has impacted perinatal women’s mental health.
However, protective factors associated with depression among pregnant Japanese women during the
pandemic have not been reported. Purpose: The present study investigated the risk and protective factors associated with
depression and anxiety among pregnant women during
the COVID-19 pandemic. Methods: An online questionnaire was administered to 157 pregnant women between October 2022 and May 2023 at two general
hospitals in Japan. The Japanese versions of the Patient Health Questionnaire-9
(PHQ-9) and General Anxiety Disorder-7 (GAD-7) were used to assess symptoms of
depression and anxiety. The χ2 test or Fisher’s exact test and multivariate logistic regression model were used to examine
factors associated with depression and anxiety among pregnant women. Results: Overall, 47.1% and 35.7% of the pregnant women reported depressive and anxiety
symptoms, respectively.A “history of mental illness” was a risk factor for
depression and anxiety among pregnant women during the COVID-19 pandemic.
Additionally, unmarried status was a risk factor for anxiety among pregnant women, whereas outdoor and indoor
exercises were protective factors against depression and anxiety, respectively. Conclusions: Exercise may have protected pregnant women from depression and anxiety during
the COVID-19 pandemic. Encouraging exercise may help maintain the mental health
of pregnant women who do not have exercise restrictions.
References
[1]
World Health Organization (WHO) (2020) Novel Coronavirus Infection (COVID-19): Pregnancy and Childbirth.
https://extranet.who.int/kobe_centre/ja/covid/qa/q27_pregnancy
[2]
López-Morales, H., Del-Valle, M.V., Andrés, M.L., Gelpi Trudo, R., Canet-Juric, L. and Urquijo, S. (2021) Longitudinal Study of Prenatal Depression and Anxiety during the COVID-19 Pandemic. Archives of Women’s Mental Health, 24, 1027-1036.
https://doi.org/10.1007/s00737-021-01152-1
[3]
Tomfohr-Madsen, L.M., Racine, N., Giesbrecht, G.F., Lebel, C. and Madigan, S. (2021) Depression and Anxiety in Pregnancy during COVID-19: A Rapid Review and Meta-Analysis. Psychiatry Research, 300, Article ID: 113912.
https://doi.org/10.1016/j.psychres.2021.113912
[4]
Sun, F., Zhu, J., Tao, H., Ma, Y. and Jin, W. (2021) A Systematic Review Involving 11,187 Participants Evaluating the Impact of COVID-19 on Anxiety and Depression in Pregnant Women. Journal of Psychosomatic Obstetrics and Gynaecology, 42, 91-99. https://doi.org/10.1080/0167482X.2020.1857360
[5]
Fan, S., Guan, J., Cao, L., Wang, M., Zhao, H., Chen, L. and Yan, L. (2021) Psychological Effects Caused by COVID-19 Pandemic on Pregnant Women: A Systematic Review with Meta-Analysis. Asian Journal of Psychiatry, 56, Article ID: 102533.
https://doi.org/10.1016/j.ajp.2020.102533
[6]
Manaka, M., Sasano, N., Chikazawa, S. and Sasaki, A. (2023) Review of the Depression Rate among Pregnant Women during the COVID-19 Pandemic. Health, 15, 33-47. https://doi.org/10.4236/health.2023.151003
[7]
Okagbue, H.I., Adamu, P.I., Bishop, S.A., Oguntunde, P.E., Opanuga, A.A. and Akhmetshin, E.M. (2019) Systematic Review of Prevalence of Antepartum Depression during the Trimesters of Pregnancy. Open Access Macedonian Journal of Medical Sciences, 7, 1555-1560. https://doi.org/10.3889/oamjms.2019.270
[8]
Manaka, M., Sasano, N., Chikazawa, S. and Sasaki, A. (2023) Review of Factors Associated with Depression among Pregnant Women during the COVID-19 Pandemic. Health, 15, 161-176. https://doi.org/10.4236/health.2023.152013
[9]
Kornfield, S.L., White, L.K., Waller, R., Njoroge, W., Barzilay, R., Chaiyachati, B.H., et al. (2021) Risk and Resilience Factors Influencing Postpartum Depression and Mother-Infant Bonding during COVID-19: Study Examines Postpartum Depression and Mother-Infant Bonding during the COVID-19 Pandemic. Health Affairs, 40, 1566-1574. https://doi.org/10.1377/hlthaff.2021.00803
[10]
Kroenke, K., Spitzer, R.L. and Williams, J.B. (2001) The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16, 606-613.
https://doi.org/10.1046/j.1525-1497.2001.016009606.x
[11]
Muramatsu, K. (2014) An Up-to-Date Letter in the Japanese Version of PHQ, PHQ-9, PHQ-15. Graduate School of Clinical Psychology, Niigata Seiryo University, 7, 35-39. (In Japanese) https://cir.nii.ac.jp/crid/1372823123423019009
[12]
Muramatsu, K., Miyaoka, H., Kamijima, K., Muramatsu, K., Tanaka, Y., Hosaka, M., et al. (2018) Performance of the Japanese Version of the Patient Health Questionnaire-9 (J-PHQ-9) for Depression in Primary Care. General Hospital Psychiatry, 52, 64-69. https://doi.org/10.1016/j.genhosppsych.2018.03.007
[13]
Spitzer, R.L., Kroenke, K., Williams, J.B. and Lowe, B. (2006) A Brief Measure for Assessing Generalised Anxiety Disorder: The GAD-7. Archives of Internal Medicine, 166, 1092-1097. ttps://doi.org/10.1001/archinte.166.10.1092
[14]
Muramatsu, K. (2009) Validation and Utility of a Japanese Version of the GAD-7. Japanese Journal of Psychosomatic Medicine, 51, 79.
https://cir.nii.ac.jp/crid/1370009142655196420
[15]
Muramatsu, K., Miyaoka, H., Kamijima, K., Muramatsu, Y., Fuse, K., Yoshimine, F., et al. (2010) Validation and Utility of a Japanese Version of the GAD-7. Japanese Society of Psychosomatic Medicine, 50, 166. (In Japanese)
[16]
Mei, H., Li, N., Li, J., Zhang, D., Cao, Z., Zhou, Y., et al. (2021) Depression, Anxiety, and Stress Symptoms in Pregnant Women before and during the COVID-19 Pandemic. Journal of Psychosomatic Research, 149, Article ID: 110586.
https://doi.org/10.1016/j.jpsychores.2021.110586
[17]
Lin, W., Wu, B., Chen, B., Lai, G., Huang, S., Li, S., et al. (2021) Sleep Conditions Associated with Anxiety and Depression Symptoms among Pregnant Women during the COVID-19 Epidemic in Shenzhen. Journal of Affective Disorders, 281, 567-573. https://doi.org/10.1016/j.jad.2020.11.114
[18]
Lin, W., Wu, B., Chen, B., Zhong, C., Huang, W., Yuan, S., et al. (2021) Associations of COVID-19 Related Experiences with Maternal Anxiety and Depression: Implications for Mental Health Management of Pregnant Women in the Post-Pandemic Era. Psychiatry Research, 304, Article ID: 114115.
https://doi.org/10.1016/j.psychres.2021.114115
[19]
Yang, X., Song, B., Wu, A, Mo, P.K., Di, J., Wang, Q., et al. (2021) Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine that Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study. Journal of Medical Internet Research, 23, e24495.
https://doi.org/10.2196/24495
[20]
Mo, P.K.H., Fong, V.W.I., Song, B., Di, J., Wang, Q. and Wang, L. (2021) Association of Perceived Threat, Negative Emotions, and Self-Efficacy with Mental Health and Personal Protective Behaviour among Chinese Pregnant Women during the COVID-19 Pandemic: Cross-Sectional Survey Study. Journal of Medical Internet Research, 23, e24053. https://doi.org/10.2196/24053
[21]
Zhou, Y., Shi, H., Liu, Z., Peng, S., Wang, R., Qi, L., et al. (2020) The Prevalence of Psychiatric Symptoms of Pregnant and Non-Pregnant Women during the COVID-19 Epidemic. Translational Psychiatry, 10, Article No. 319.
https://doi.org/10.1038/s41398-020-01006-x
[22]
Wu, F., Lin, W., Liu, P., Zhang, M., Huang, S., Chen, C., et al. (2021) Prevalence and Contributory Factors of Anxiety and Depression among Pregnant Women in the Post-Pandemic Era of COVID-19 in Shenzhen, China. Journal of Affective Disorders, 291, 243-251. https://doi.org/10.1016/j.jad.2021.05.014
[23]
Wu, F., Zhou, L., Chen, C., Lin, W., Liu, P., Huang, W., et al. (2022) Association between Intimate Partner Violence and Prenatal Anxiety and Depression in Pregnant Women: A Cross-Sectional Survey during the COVID-19 Epidemic in Shenzhen, China. BMJ Open, 12, e055333. https://doi.org/10.1136/bmjopen-2021-055333
[24]
Luong, T.C., Pham, T.T., Nguyen, M.H., Do, A.Q., Pham, L.V., Nguyen, H.C., et al. (2021) Fear, Anxiety and Depression among Pregnant Women during COVID-19 Pandemic: Impacts of Healthy Eating Behaviour and Health Literacy. Annals of Medicine, 53, 2120-2131. https://doi.org/10.1080/07853890.2021.2001044
[25]
Fan, H.S.L., Choi, E.P.H., Ko, R.W.T., Kwok, J.Y.Y., Wong, J.Y.H., Fong, D.Y.T., et al. (2022) COVID-19 Related Fear and Depression in Pregnant Women and New Mothers. Public Health Nursing, 39, 562-571. https://doi.org/10.1111/phn.13035
[26]
de Pádua Borges, R., de Azevedo Jacob Reichelt, A., de Brito, A., Molino, G.O.G. and Schaan, B.D. (2021) Impact of the COVID-19 Pandemic on Mental Health of Pregnant Women with Diabetes Mellitus and Hypertension. Revista da Associacao Médica Brasileira, 67, 1268-1273. https://doi.org/10.1590/1806-9282.20210504
[27]
Shorey, S.Y., Ng, E.D. and Chee, C.Y. (2021) Anxiety and Depressive Symptoms in Perinatal Women during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Scandinavian Journal of Public Health, 49, 730-740.
https://doi.org/10.1177/14034948211011793
[28]
Gildner, T.E., Laugier, E.J. and Thayer Z.M. (2020) Exercise Routine Change Is Associated with Prenatal Depression Scores during the COVID-19 Pandemic among Pregnant Women across the United States. PLOS ONE, 15, e0243188.
https://doi.org/10.1371/journal.pone.0243188
[29]
Sut, H.K. and Kucukkaya, B. (2021) Anxiety, Depression, and Related Factors in Pregnant Women during the COVID-19 Pandemic in Turkey: A Web-Based Cross-Sectional Study. Perspectives in Psychiatric Care, 57, 860-868.
https://doi.org/10.1111/ppc.12627
[30]
Lebel, C., MacKinnon, A, Bagshawe, M., Tomfohr-Madsen, L. and Giesbrecht, G. (2020) Elevated Depression and Anxiety Symptoms among Pregnant Individuals during the COVID-19 Pandemic. Journal of Affective Disorders, 277, 5-13.
https://doi.org/10.1016/j.jad.2020.07.126
[31]
Stampini, V., Monzani, A., Caristia, S., Ferrante, G., Gerbino Pedrini, A., et al. (2021) The Perceptions of Italian Pregnant Women and New Mothers about Their Psychological Well-Being, Lifestyle, Delivery, and Neonatal Management Experience during the COVID-19 Pandemic Lockdown: A Web-Based Survey. BMC Pregnancy and Childbirth, 21, Article No. 473.
https://doi.org/10.1186/s12884-021-03904-4
[32]
Hu, W.S., Lu, S., Xu, M.Y., Zhou, M.C., Yuan, Z.M. and Deng, Y.Y. (2021) Behavioural Responses of Pregnant Women to the Early Stage of COVID-19 Pandemic in the Network Era in China: Online Questionnaire Study. Asian Nursing Research, 15, 215-221. https://doi.org/10.1016/j.anr.2021.06.003
[33]
Berthelot, N., Lemieux, R., Garon-Bissonnette, J., Drouin-Maziade, C., Martel, é. and Maziade, M. (2020) Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women during the Coronavirus Disease 2019 Pandemic. Acta Obstetrica et Gynaecologica Scandinavica, 99, 848-855. https://doi.org/10.1111/aogs.13925
[34]
Lequertier, B., McLean, M.A., Kildea, S., King, S., Keedle, H., Gao, Y., et al. (2022) Perinatal Depression in Australian Women during the COVID-19 Pandemic: The Birth in the Time of COVID-19 (BITTOC) Study. International Journal of Environmental Research and Public Health, 19, Article 5062.
https://doi.org/10.3390/ijerph19095062
[35]
Lubian Lopez, D.M., Butrón Hinojo, C.A., Arjona Bernal, J.E., Fasero Laiz, M., Alcolea Santiago, J., Guerra Vilches, V., et al. (2021) Resilience and Psychological Distress in Pregnant Women during Quarantine due to the COVID-19 Outbreak in Spain: A Multicentre Cross-Sectional Online Survey. Journal of Psychosomatic Obstetrics and Gynaecology, 42, 115-122.
https://doi.org/10.1080/0167482X.2021.1896491
[36]
Aba, Y.A., Dulger, O., Sik, B.A. and Ozolcay, O. (2022) Levels and Predictors of Anxiety and Depression in Turkish Pregnant Woman during the COVID-19 Pandemic. Revista Brasileira de Ginecologia e Obstetrícia, 44, 100-108.
https://doi.org/10.1055/s-0041-1741033
[37]
Brik, M., Sandonis, M.A., Fernández, S., Suy, A, Parramon-Puig, G., Maiz, N., Dip, M.E., et al. (2021) Psychological Impact and Social Support in Pregnant Women during Lockdown due to SARS-CoV2 Pandemic: A Cohort Study. Acta Obstetricia et Gynecologica Scandinavica, 100, 1026-1033. https://doi.org/10.1111/aogs.14073
[38]
Biaggi, A., Conroy, S., Pawlby, S. and Pariante, C.M. (2016) Identifying the Women at Risk of Antenatal Anxiety and Depression: A Systematic Review. Journal of Affective Disorders, 191, 62-77. https://doi.org/10.1016/j.jad.2015.11.014
