Impact of the COVID-19 pandemic on women's perinatal mental health and its association with personality traits: An observational study

Abstract

Introduction: The burden of perinatal mental health problems was expected to increase during the COVID-19 pandemic. We prospectively investigated the impact of the COVID-19 pandemic on the mental health of pregnant and postpartum women in Norway and explored associations with their sociodemographic characteristics and personality traits.

Material and methods: Sociodemographic information and the self-reported impact of pandemic on wellbeing of pregnant women was collected using an online survey. To assess women's mental health, two validated questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 item Scale (GAD-7), were used prenatally and postnatally. Personality traits were evaluated using HumanGuide, a web-based ipsative psychological evaluation instrument.

Results: 772 women were included prenatally, of which 526 also responded to the survey 4-6 weeks postnatally. The median age was 29 years, 53.6% of the women were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The median EPDS (6.0; interquartile range [IQR] 3.0-10.0 vs 6.0; IQR: 3.0-10.0) and the median GAD-7 (5.0; IQR 2.0-9.0 vs 5.0; IQR 2.0-9.0) were similar pre-and postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on GAD-7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not significant (P = 0.59 and P = 0.99). Being <25 years of age, being on pre-pregnancy psychotherapy or psychotropic medication, frequent voluntary isolation, perception of maternity care not proceeding normally, avoiding seeking medical assistance due to fear of infection and having negative economic consequences during the COVID19 pandemic significantly increased the risk of both anxiety (GAD-7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk of anxiety, whereas being a healthcare worker had a lower risk. The personality trait factors Power (P = 0.008), Quality (P = 0.008), Stability (P < 0.001) and Contacts (P < 0.001) were significant predictors of depression among pregnant women, whereas the Quality (P = 0.005) and Contacts (P = 0.003) were significant predictors of anxiety.

Conclusions: During the initial phase of the COVID-19 pandemic, the prevalence of depression (EPDS ≥ 13) and anxiety (GAD-7 ≥ 10) was 14.5% and 21.5%, respectively, among Norwegian pregnant women. Certain sociodemographic characteristics and personality traits were significant predictors of depression and anxiety.

Keywords: COVID-19; anxiety; depression; mental health; perinatal mental health; postnatal depression; pregnancy.

FIGURE 1

List of eight factors evaluated by the HumanGuide personality test (first column). The second column represents an example of the scores of different factors demonstrating primary strength (fully colored squares), secondary strength (half‐colored squares) and a factor that is not needed by the individual (white squares). The typical characteristics (attributes) of each factor are described in the corresponding row of the third column. Figure modified from HumanGuide (HG) personality test (https://humanguide.org/en/). with permission from the publisher, Rolf Kenmo (H.E. Humankonsult AB).

FIGURE 2

Chart diagram demonstrating the flow of study participants. EPDS, Edinburgh Postnatal Depression Scale; GAD‐7, Generalized Anxiety Disorder 7.

FIGURE 3

Observed frequencies and distribution of differences between prenatal and postnatal EPDS (A,B) and GAD‐7 scores (C,D). EPDS, Edinburgh Postnatal Depression Scale; GAD‐7, Generalized Anxiety Disorder 7.