key: cord-0713689-ce4113hi authors: Naghizadeh, Somayyeh; Mirghafourvand, Mojgan title: Relationship of Fear of COVID-19 and Pregnancy-related Quality of Life during the COVID-19 Pandemic date: 2021-05-17 journal: Arch Psychiatr Nurs DOI: 10.1016/j.apnu.2021.05.006 sha: ca5e2f5516e1d0638e00aa6d9ee962c25168bb71 doc_id: 713689 cord_uid: ce4113hi Aim The aim of this study was to determine the relationship between fear of COVID-19 and quality of life in Iranian pregnant women during the COVID-19 pandemic. METHODS: This cross-sectional study was carried out on 250 Iranian pregnant women. Data was collected through questionnaires including demographic and obstetric characteristics, fear of COVID-19 and quality of life. An adjusted general linear model was used to determine the relationship between variables. RESULTS: There was a negatively significant relationship between fear of COVID-19 and quality of life (P <0.001). Based on the adjusted general linear model, it was expected that if COVID-19 fear score increased, the quality of life score would decrease significantly (B=-0.21, 95%CI: -0.34 to -0.09, P=0.001). CONCLUSION: This study indicated a reverse correlation between fears of COVID-19 and quality of life. Therefore, developing appropriate interventions in order to overcome the fear caused by COVID-19 are recommended to improve pregnant women’s quality of life. The present is a horrible time, where many cities and countries are suffering from pandemic (Amin, 2020) . The COVID-19 pandemic appeared firstly on December 12, 2019 in Wuhan, Hubei Province, China (Hui, Azhar, Madani, Drosten, & Zumla, 2020) . Due to wide spread of COVID-19, World Health Organization (WHO) has recognized it as a pandemic (Satici, Gocet-Tekin, Deniz, & Satici, 2020) . The recent COVID-19 pandemic situation is very serious and stressful around the world (Wang et al., 2020) . The prevalence of COVID-19 and its epidemic nature has resulted widespread concern, fear and anxiety (Ahorsu et al., 2020) . Therefore, one of the psychological aspects of COVID-19 pandemic is fear (Pakpour, & Griffiths, 2020; Pakpour, & Griffiths, 2020) and understanding the effect of such aspect on the individuals' mental health is very important (Xiang et al., 2020) . Fear and horror resulted from COVID-19 may lead to defamation and social exclusion experience in the positively diagnosed and treated patients as well as their family and all other people in contact with it. Furthermore, it can increase the risk of mental health problems such as adjustment disorder and depression (Zhang, Wu, Zhao, & Zhang, 2020; Amin, 2020) . Fear is a defensive mechanism of the creatures with adaptability power which is essential for survival. However, while being chronic or disappropriate, it will be harmful and may be considered as a key component to result a variety of mental disorders (Garcia, 2017; Shin, Liberzon, & Liberzon, 2010) . For as much as the countries of the world have to work to reduce the transmission of COVID-19 and achieve a comprehensive goal, i.e. having Pregnant women are considered as a unique vulnerable group in any prevalence of infectious disease, due to physiological changes, increased susceptibility to infections as well as mechanical and safety dysfunctions (Dashraath et al., 2020) . Physiological changes during pregnancy including decreased Functional Residual Capacity (FRC), elevated diaphragm and changes in cellular immunity lead to increased susceptibility to viral infections and consequently more crucial results (Dashraath et al., 2020; Alzamora et al., 2020) . Conditions including severe stress, emergencies, conflicts and natural disasters may increase the risks of mental illness during pregnancy period. Hence, it is acceptable that pregnant women are vulnerable to mental and psychological health problems during COVID-19 epidemic (Thapa, Mainali, Schwank, & Acharya, 2020) . Pregnant mothers' concerns and fears about their health and infants due to prevalence of such disease are increasing (Mirzadeh & Khedmat, 2020) . On the other hand, as it brings about considerable changes in the mental and psychological health status, it will also cause to reduce social performance, vitality and life quality of pregnant women (Papastathi et al., 2016; Nik-Azin et al., 2013) . As defined by WHO, the quality of life includes the people's understanding of their situation in life in terms of the culture, the value system of the country where they are living as well as their goals, expectations, standards, and priorities which are quiet individual and cannot be observed by others. It is based on the people's understanding of different aspects of their life (World Health Organization, 1997) . Ahorsu et al. demonstrated in their investigation that there is a negatively significant relationship between pregnant women's fear of COVID-19 followed by a quarantine as well as increasing level of fear, stress and mental damages in the people of society. Also, we noted that such fear in pregnant women is an addition threat to physical, mental and psychological health of mothers and their fetus and finally for the society's health and took into account the lack of efficient studies on the quality of life during pregnancy and the related effective factors within this pandemic. This is a descriptive-analytical cross-sectional study carried out within prevalence of COVID-19 period from June to August 2020, on pregnant women attended in the obstetrics clinic of 29-Bahman Hospital in Tabriz-Iran. The study inclusion criteria was determined as the individuals who desire to participate, having Iranian nationality, living in Tabriz, having literacy for reading and writing, being women with 12-week or longer pregnancy, having single pregnancy, having no disease / disorder or medical, obstetric and underlying risk factors as well as the lack of stressful accidents during the last 6 months, such as the death of a loved one and divorce. The exclusion criteria was considered as the failure to fill the questionnaire completely, death of the fetus, major anomalies in the fetus, massive bleeding, Fetal growth disorders such as Intrauterine growth restriction (IUGR), macrosomia, having blood pressure of 140/90 mmHG or higher at the time of attending in clinic, any medical and obstetric disorder in mother (hypertension induced in the pregnancy, hypertension before pregnancy, overt diabetes, gestational diabetes, ….). After obtaining the ethics committee's permission (code: IR,TBZMED.REC.1399.332 in 29/6/2020), this study was conducted in a social security affiliated hospital. The sampling was performed by the Convenience Sampling method by which the researcher attended the obstetrics clinic of the hospital and all women with over 12 months pregnancy and meeting the inclusion criteria, entered into the study. Before starting the study, women were given necessary explanations about the goals and methodology of the study, voluntary participation, privacy, confidentiality and the right to cancel the participation in all stages of data collection. They were assured that their information would be kept confidential with the researcher, and an informed written consent was obtained from the participants. The questionnaires were checked by the investigator as soon as they were filled. In case any sample did not understand the questions, they would be explained by the researcher. The instrument for data collection was a three-part questionnaire including demographic and (2020) and by these people tested for psychometrics in Iran (Ahorsu et al., 2020) . This questionnaire consists of 7 questions stated using 5-point Likert scale in which the answers are "strongly disagree", "disagree", "neither agree nor disagree", "agree" and "strongly agree". The minimum score and the maximum one for each question is 1 and 5, respectively. By summing the scores of each question, we could calculate the total score. The range of scores to be achieved is 7 to 35. The higher score shows greater fear of COVID-19. The Cronbach's alpha coefficient in this study was obtained as 0.91. The collected data were analyzed by SPSS statistical software version 21. Examining the normality of quantitative data using Skewness and Kurtosis, we found all having normal distributions. To describle the fear of COVID-19 and pregnancy-related quality of life, a descriptive statistics including the mean and standard deviation (SD) were used. In bivariate analysis, the Pearson correlation test was applied to demonstrate the relationship between fear J o u r n a l P r e -p r o o f of COVID-19 and pregnancy-related quality of life. In multivariate analysis, the general linear model was used with adjusting the socio-demographic and obstetrics variables. For this, firstly, the relationship of each demographic and obstetric characteristics with the quality of life total score was measured through independent t-test and one-way ANOVA and then, the variables with p<0.05 related to quality of life total score as well as fear variable were included in the adjusted general linear model. No data lost during the data collection process. The mean (SD) of pregnant women's age was 30.57 (5.87) years old. More than half of the participants (%53.2) had high school education. Table 2 ). In this study, the participants had average fear and quality of life. The mean (SD) fear of COVID-19 in our study was 22.29 (7.08). In an investigation carried out by Reznik et al. (2020) in the general population of Russia, the mean fear of COVID-19 was obtained as 17. In this study, pregnancy-related quality of life was at an average level with the mean score calculated as 2.77 (1.04). In an investigation performed by Zarei et al. (2018) , pregnancy-related quality of life was calculated 2.9 (0.3), which is approximately near to what we obtained in our study. In both studies, the quality of life is at an average level. Indeed, COVID-19 is a source of fear, stress and anxiety and as an important factor affects the health, welfare and life quality of the people around the world (Reznik, Gritsenko, Konstantinov, Khamenka, & Isralowitz, 2020) . The results of the study indicated a significant relationship between the family economic status with quality of life of pregnant women, so that women whose family economic status was moderate had better quality of life than those whose family economic status was poor. Therefore, if pregnant mothers, in addition to worrying about COVID-19 disease, also have financial worries, it will probably be effective in reducing their quality of In our study, there was a significant relationship between husband's job and quality of life, so that women whose husbands were laborer had better quality of life than those whose husbands had freelance job. The freelancers were among people hit hardest by the economic challenges of COVID-19 pandemic (Vieira & Lehdonvirta, 2020) , therefore, the financial worries caused by lack of income may have contributed to the poor quality of of life of their wifes. On the other hand, because the laborer have insurance and are paid even during the holidays, these condition may lead to better quality of life of their wifes. The pregnancy itself puts high physical and mental pressures on the individual and if combined with other stressful factors like COVID-19 may lead to fear, stress and anxiety in pregnant women. Therefore, to overcome such fear, it is suggested that pregnant women will be trained for properly management of fear and reduction of its impacts, effective preventive and protective behaviors against COVID-19. Furthermore, they should receive emotional and psychological support from their family, especially their wife. What seems to be important is that this group of women needs greater supports during prevalence of epidemics and disasters. In such period, health system is under high pressures, because COVID-19 has increased the capacity of the hospitals and clinics. However, the health sector can take necessary measures to improve the women's mental health and reduce fear and stress caused by such disease during this period and help decreasing its effects. The governments should develop supportive and training programs to deal with pregnant women's fear and anxiety during COVID-19 prevalence, provide necessary financial and human resources and specify a few strategies to achieve them. One of the limitations of this research was its cross-sectional nature, in that the relationship found between fear of COVID-19 and the quality of life doesn't necessarily J o u r n a l P r e -p r o o f indicate a causal relationship. Convenience sampling is another limitation of this study that reduces the generalizability of the results of the study. There is another limitation as the possibility of response bias due to the nature of research questions that was removed by trying to assure the participants for the privacy of their information and filling the questionnaires without inserting the name. Furthermore, this study was conducted in Tabriz with Azeri people; therefore, its results cannot be generalized to other cities and ethnic groups. 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