key: cord-0953558-diz91fz4
authors: Uguz, Faruk; Kirkas, Aysegul; Yalvac, Tugba; Gezginc, Kazim
title: Is there a higher prevalence of mood and anxiety disorders among pregnant women during the COVID-19 pandemic? A comparative study
date: 2022-01-20
journal: J Psychosom Res
DOI: 10.1016/j.jpsychores.2022.110725
sha: a5f6786c02061b4b1bc98a64d9d6948a9af04acf
doc_id: 953558
cord_uid: diz91fz4

Objective This study aimed to compare data on mood and anxiety disorders of pregnant women before and during the COVID-19 pandemic. Methods The study sample included 253 women evaluated on their first postpartum day during the COVID-19 pandemic. Mood and anxiety disorders were determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Data from sample was compared with data from previous study that was completed and published prior to the COVID-19 pandemic. Results The prevalence rate of mood and anxiety disorders during the COVID-19 pandemic was 7.1% and 13.0%, respectively. The most common specific disorder was generalized anxiety disorder (7.1%). Compared to period before the COVID-19 pandemic, the prevalence of mood and anxiety disorders in the current sample was not significantly different. Conclusion Results of this study suggest that pregnant women may have not be under higher risk for mood and anxiety disorders during the COVID-19 pandemic compared to before the pandemic.

It is well known that pregnancy is the most important reproductive life events in women. The presence of a new baby also makes pregnancy highly valuable. Several studies have shown that, mental health problems such as depression and anxiety in the mother can affect not only J o u r n a l P r e -p r o o f Journal Pre-proof herself, but also her baby in the short or long term [1] [2] [3] . On the other hand, pregnancy does not seem to protect women from psychiatric disorders. Studies have suggested that about 20% of pregnant women experience mood or anxiety disorder; this prevalence rate is similar to the non-pregnant female population [4] [5] [6] [7] . Therefore, individual or social stresses may make pregnant as well as non-pregnant women susceptible to mental health issues.

Coronavirus disease 2019 (COVID-19) has become a major public health concern worldwide, especially after its declaration as a pandemic by The World Health Organization. It is expected that global stress due to COVID-19 pandemic can affect mental health of pregnant women. A recent meta-analysis [8] suggested that psychological stress was observed in 70% of pregnant women. There is an important question as to whether the COVID-19 pandemicrelated stress could lead to a higher prevalence of depression and anxiety disorders during pregnancy in the literature. If so, infants who born after the COVID outbreak may more negatively affected from detrimental effects of depression or anxiety disorder compared to before the outbreak. Additionally, these results affect healthy programs of governments, because pregnant women should be supported more psychologically by the professionals during the outbreak. Therefore, investigating mental status in pregnant women after the outbreak is very important. In the past year, many authors have examined this relevance.

Lebel et al. [9] reported elevated anxiety and depression symptoms in pregnant women during the COVID-19 pandemic compared to similar pre-pandemic pregnancy cohorts. In a prospective study of 63 pregnant women, Ayaz et al. [10] found that depressive and anxiety symptom levels were significantly increased after the pandemic compared to before.

However, the available studies conducted on this topic were based on symptom rating scales rather than a structured clinical interview. Moreover, to date, there is not any published study comparatively examining prevalence of mood and anxiety disorders by means of the same method in pregnant women before and after COVID-19 pandemic in the literature. The current study aims to investigate whether COVID-19 pandemic negatively affected the prevalence of specific mood or anxiety disorders during pregnancy by comparing data obtained before pandemic.

The current study was carried out at the same hospital, using the same methodology as a study published prior to the COVID-19 pandemic [4] , which the current data was compared. In The prevalence of current mood and anxiety disorder in the study sample and comparisons with the reference study are presented in Table 1 . Of the 253 women included in the study, 42 (16.6%) had at least one mood or anxiety disorder, 18 (7.1%) had any mood disorder and 33 (13.0%) had any anxiety disorder during their pregnancy irrespective of comorbid conditions. Comorbid diagnoses were established in 12 (4.7%) women and were observed most frequently among anxiety disorders. The most commonly diagnosed specific disorder was generalized anxiety disorder (n=18, 7.1%) followed by major depression (n=14, 5.5%), obsessive-compulsive disorder (n=13, 5.1%) and panic disorder (n=9, 3.6%).

There was no significant difference between the current study and reference study with regards to age (t=-1.48, P=0.14), number of children (t=0.551, P=0.58), marital status Table 1 ). Statistical analyses indicated that prevalence of any mood or anxiety disorder, any mood disorder, any anxiety disorder, comorbidity between mood and anxiety disorders and specific diagnoses were statistically similar between current sample and the sample in the reference study

To the best our knowledge, this is the first structured psychiatric interview-based comparative study carried out on women who delivered their babies at the same hospital before and during COVID-19 pandemic. Recently, two meta-analyses [8, 12] have suggested that the prevalence rate of depression and anxiety during the COVID-19 pandemic was 30-31% and 34-37%, respectively, although some authors have reported lower these rates (5.3% and 6.8% for depression and anxiety, respectively) [13] . Therefore, the prevalence rate of 7.1% for depression and 13.0% for anxiety disorders found in the current study are markedly lower J o u r n a l P r e -p r o o f than the rates that were reported in most of the previous studies. The most important cause for this discrepancy may be differences in the diagnostic instruments used such as structured clinical interview versus symptom rating scales. A lower prevalence rate can be expected in interview based studies because symptoms determined by rating scales do not show psychiatric diagnoses. In a meta-analysis by Yan et al. [8] , anxiety symptoms were observed in 37% of pregnant women; however, the prevalence rate of mild and severe anxiety were 24% and 7%, respectively. On the other hand, the time period when the assessment carried out and specific characteristics of study populations may also affect the results. In the current study, the participants were assessed within 24 h following birth; other studies have mostly screened the women during their pregnancy. A previous study on depression in a sample of Turkish women that was conducted within 48 h after birth reported that 14.7% of the participants had a score of 12 or higher with the Edinburgh Postpartum Depression Scale [14] .

Wu et al. [15] reported that the prevalence of depression increased from 26% to 29.6% after the declaration of the COVID-19 epidemic. According to a meta-analysis [12] , the prevalence of depression was 1.95 fold higher while that of anxiety was 2.15-fold higher in pregnant women compared to the controls during the pregnancy. In contrast, Zhou et al. [13] reported that pregnancy was associated with a reduced risk of depressive or anxiety symptoms during the COVID-19 epidemic. The results of the current study suggest that the diagnosis of mood and anxiety disorders during pregnancy was not significantly affected during the COVID-19 pandemic. One explanation could be that elevated distress and symptoms of depression or anxiet among pregnant women during the COVID pandemic may not have reached a level of clinical significance that required a diagnosis. Additionally, current evidence suggest that overall, COVID-19 infection in pregnant women was not associated with a worse course of the disease or neonatal outcomes compared to the general population, although the risk of preterm birth was higher in COVID-19 infected pregnant women compared to uninfected pregnant women [12, 16, 18] . Moreover, vertical transmission of infection is very rarely observed [16] . Awareness of these factors from the internet or social media may have reduced the fetus-focused stress among pregnant women, which may be another explanation. Ideally, to evaluate of the same participants before and after COVID outbreak may ensure more robust data. However, the same hospital and methodology may minimize limitation resulted from evaluation times and samples. Despite these limitations, the current study suggests that pregnant women may have similar prevalence rates of mood and anxiety disorders prior to and during the COVID-19 pandemic. Further multicenter and largescale studies may provide more robust data on this subject.

The authors declare no actual or potential conflict of interest whether financial, personal or otherwise related to this manuscript. 

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Table 1. Sociodemographic characteristics and prevalence of mood and anxiety disorders in samples of comparative study and current study Current sample

Age, meanSD, years 28

This research has not been supported by any commercial or non-commercial organization. In addition, the authors have no conflict of interest with any commerical or other associations in connection with submitted paper. The authors have no financial funding source supporting the article