key: cord-0752839-12firuak authors: Dagklis, Themistoklis; Tsakiridis, Ioannis; Mamopoulos, Apostolos; Athanasiadis, Apostolos; Pearson, Rebecca; Papazisis, Georgios title: The impact of the COVID‐19 lockdown on antenatal mental health in Greece date: 2020-08-22 journal: Psychiatry Clin Neurosci DOI: 10.1111/pcn.13135 sha: 7868e9b1d32833b3d89306de2c450ada2b70d500 doc_id: 752839 cord_uid: 12firuak nan On March 22, a total lockdown was applied in Greece due to COVID-19. In this unprecentended situation, the phychological impact on the population and especially in pregnant women is largely unknown. Research at the time of previous similar epidemics (SARS and MERS) showed that pregnant women were more likely to be psychologically affected. 1, 2 Anxiety is prevalent in pregnancy; in a recent meta-analysis, the prevalence for self-reported anxiety symptoms was 18.2% in the first trimester, 19.1% in the second trimester and 24.6% in the third trimester and the overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2%. 3 Antenatal depression also affects up to 16% of the general pregnant population 4 while epidemiological studies consistently demonstrate high rates of co-morbidity between anxiety and depressive disorders. 5 Since studying antenatal mental health is of particularly importance because of the negative consequences on perinatal outcomes 6 we sought to assess anxiety and depressive symptoms in pregnant women living in the current quarantine conditions in Greece applying the most commonly used instruments for antenatal anxiety and depression, the State-Trait Anxiety Inventory (STAI) and the Edinburg Postnatal Depression Scale (EPDS). [7] [8] [9] All pregnant women that received routine antenatal care in a university clinic, during the six-week period of total lockdown, were asked to complete the STAI and the EPDS questionnaires. State (S)-and Trait (T)-anxiety scores are categorized as <36 (no anxiety), 36-45 (mild anxiety), 46-55 (moderate anxiety), 56-65 (high anxiety) > 65 as very high anxiety. 7 A cut-off score ≥ 46 was used, in order to identify women with anxiety (moderate anxiety cut-off), while the EPDS cut-off score was >13; these were the dependent variables of interest. 7 For S-anxiety, 21.6% of the women were classified as non-anxious, 40.9% with mild anxiety, 27.5% with moderate, 9.7% with high and 0.3% with very high anxiety. Accordingly, for T-Anxiety, 52.4% were identified as non-anxious, 34.6% with mild anxiety, 10.8% with moderate, 1.9% with high and This article is protected by copyright. All rights reserved. 0.3% with very high anxiety. There were significant differences between the corresponding S-and T-Anxiety categories (p<0.001). A moderate association was identified between the S-and T-Anxiety scores (r=0.549; p<0.001). Based on the multivariable analysis, the first week following the lockdown was identified as an independent risk factor for S-Anxiety (OR: 2.425; 95% CI: 1.299-4.529). Moreover, the median S-Anxiety was significantly different among the study weeks (p=0.003, (Figure 1) . When assessing the individual STAI questions in the weeks 1, 3 and 6, we found that women had similar feelings of tense, strained and confused during the whole period. Moreover, in week 6, they started feeling more frightened than before; accordingly, in week 3 they felt more comfortable and relaxed than in week 1, but this was reversed in week 6 (supplementary Table 1 ). Finally, the third trimester of pregnancy was identified as an independent risk factor for anxiety in pregnancy in the multivariable analysis (OR: 1.913; 95% CI: 1.037-3.529). Regarding antenatal depression, 215 women completed the EPDS and 14.9% (n= 32) were identified as depressed. Antenatal depression was associated with S-Anxiety (p=0.015; OR: 2.570; 95% CI: 1.199-5.508) while, according to multivariable logistic regression, smoking was identified as an independent risk factor for antenatal depression during the lockdown (OR: 2.889; 95% CI: 1.028-8.118). Concluding, the mass quarantine has negatively affected the anxiety levels of a large proportion of pregnant women (>50% at the first week of lockdown) in Greece, since they exhibited a significant increase in anxiety during early stages of the lockdown. However, an encouraging aspect was that the anxiety levels after the initial peak during the first week, they then decreased, possibly due to the This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved. The psychological impact of quarantine and how to reduce it: rapid review of the evidence Potential maternal and infant outcomes from coronavirus 2019-NCOV (SARS-CoV-2) infecting pregnant women: Lessons from SARS, MERS, and other human coronavirus infections Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete The prevalence of antenatal and postnatal co-morbid anxiety and depression: A meta-analysis Maternal anxiety during pregnancy and the association with adverse perinatal outcomes: Systematic review and meta-analysis State-Trait Anxiety Inventory for Adults Sampler Set Manual, Instrument and Scoring Guide. Consult Reliability and psychometric properties of the Greek translation of the State-Trait Anxiety Inventory form Y: Preliminary data Screening for Depression During Pregnancy with the Edinburgh Depression Scale (EPDS) This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.