Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study

Abstract

Background: While there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety.

Methods: Data were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used.

Results: Objective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety.

Limitations: Participants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status.

Conclusions: These findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.

Keywords: Anxiety; COVID-19; Cognitive appraisal; Prenatal maternal stress; Resilience; Tolerance of uncertainty.

Fig. 1

Two-month postpartum anxiety as a function of Objective Hardship or Subjective Distress at different levels of resilience, tolerance of uncertainty, and cognitive appraisal. Note: Each star (*) indicates that the association between objective hardship or subjective distress and postpartum anxiety is significant (p < 0.05) at that level of the moderator. The vertical green lines represent the Johnson-Neyman region of significance: the region where the moderator has a significant association with postpartum anxiety on the objective hardship/subjective distress scale. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)