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Prevalence and associated factors of prenatal depression in pregnant Korean women during the COVID-19 pandemic: a cross-sectional study

  • Mi-Eun Kim (Department of Nursing Science, Jeonju University) ;
  • Ha-Neul Jung (Department of Nursing Science, Jeonju University)
  • Received : 2022.12.31
  • Accepted : 2023.11.22
  • Published : 2023.12.31

Abstract

Purpose: This study investigated the effects of prenatal education characteristics, pandemic-related pregnancy stress, and health behaviors during pregnancy on prenatal depression in pregnant women during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The participants were 180 pregnant Korean women, recruited from internet communities for pregnancy preparation, childbirth, and childcare, from July 5 to 15, 2022. The collected data were analyzed using the t-test, analysis of variance, the Mann-Whitney U-test, the Kruskal-Wallis test, and multiple regression analysis. Results: The scores for pandemic-related pregnancy stress (24.50±6.37) and health behaviors during pregnancy (67.07±9.20) were high. Nearly half of the participants (n=89, 49.4%) presented with prenatal depression, with scores of 10 or greater. Prenatal depression had a positive correlation with gestational age (r=.18, p=.019) and pandemic-related pregnancy stress (r=.27, p<.001), and a negative correlation with health behaviors during pregnancy (r=-.42, p<.001). The factors associated with prenatal depression were pandemic-related pregnancy stress (t=4.70, p<.001), marital satisfaction (dissatisfied) (t=3.66, p<.001), pregnancy healthcare practice behaviors (t=-3.31, p=.001), family type (weekend couple) (t=2.84, p=.005), and gestational age (t=2.32, p=.022). The explanatory power of these variables was 38.2%. Conclusion: Since participants had a high level of prenatal depression during the pandemic, and infectious diseases such as COVID-19 may recur, strategies should be developed to improve pregnant women's mental health with consideration of the unique variables that are relevant in a pandemic. It is also necessary to develop efficient online prenatal education programs that can be implemented even in special circumstances such as social distancing, and to evaluate their effectiveness.

Keywords

Acknowledgement

This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2021R1G1A1095497).

References

  1. Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016;191:62-77. https://doi.org/10.1016/j.jad.2015.11.014
  2. Berthelot N, Lemieux R, Garon-Bissonnette J, Drouin-Maziade C, Martel E, Maziade M. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand. 2020;99(7):848-855. https://doi.org/10.1111/aogs.13925
  3. Zhao T, Zuo H, Campbell SM, Jhangri GS, Dobson KS, Li JY, et al. The impacts of prenatal mental health issues on birth outcomes during the COVID-19 pandemic: a scoping review. Int J Environ Res Public Health. 2022;19(13):7670. https://doi.org/10.3390/ijerph19137670
  4. Filippetti ML, Clarke ADF, Rigato S. The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support. BMC Pregnancy Childbirth. 2022;22 (1):68. https://doi.org/10.1186/s12884-022-04387-7
  5. Ding X, Liang M, Wu Y, Zhao T, Qu G, Zhang J, et al. The impact of prenatal stressful life events on adverse birth outcomes: a systematic review and meta-analysis. J Affect Disord. 2021;287:406-416. https://doi.org/10.1016/j.jad.2021.03.083
  6. King LS, Feddoes DE, Kirshenbaum JS, Humphreys KL, Gotlib IH. Pregnancy during the pandemic: the impact of COVID-19-related stress on risk for prenatal depression. Psychol Med. 2023;53(1):170-180. https://doi.org/10.1017/S003329172100132X
  7. Chen J, Cross WM, Plummer V, Lam L, Sun M, Qin C, et al. The risk factors of antenatal depression: a cross-sectional survey. J Clin Nurs. 2019;28(19-20):3599-3609. https://doi.org/10.1111/jocn.14955
  8. Omidvar S, Faramarzi M, Hajian-Tilak K, Nasiri Amiri F. Associations of psychosocial factors with pregnancy healthy life styles. PLoS One. 2018;13(1):e0191723. https://doi.org/10.1371/journal.pone.0191723
  9. Kim EG, Park SK, Nho JH. Associated factors of depression in pregnant women in Korea based on the 2019 Korean Community Health Survey: a cross-sectional study. Korean J Women Health Nurs. 2022;28(1):38-45. https://doi.org/10.4069/kjwhn.2022.02.03.1
  10. Yirmiya K, Yakirevich-Amir N, Preis H, Lotan A, Atzil S, Reuveni I. Women's depressive symptoms during the COVID-19 pandemic: the role of pregnancy. Int J Environ Res Public Health. 2021;18(8):4298. https://doi.org/10.3390/ijerph18084298
  11. Shorey S, Loh DNL, Chan V, Chua C, Choolani MA. Parents' perceptions of antenatal educational programs: a meta-synthesis. Midwifery. 2022;113:103432. https://doi.org/10.1016/j.midw.2022.103432
  12. Cankaya S, Simsek B. Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: a prospective randomized controlled study. Clin Nurs Res. 2021;30(6):818-829. https://doi.org/10.1177/1054773820916984
  13. Chen YL, Tseng CH, Cheong ML, Lien YJ, Wang SH, Chang CM, et al. Associations between antenatal education program and mental health outcomes in Taiwan: a population-based cohort study. Psychiatry Res. 2023;322:115128. https://doi.org/10.1016/j.psychres.2023.115128
  14. Artieta-Pinedo I, Paz-Pascual C, Grandes G, Espinosa M. Framework for the establishment of a feasible, tailored and effective perinatal education programme. BMC Pregnancy Childbirth. 2017;17(1):58. https://doi.org/10.1186/s12884-017-1234-7
  15. Zhang Y, Ma ZF. Psychological responses and lifestyle changes among pregnant women with respect to the early stages of COVID-19 pandemic. Int J Soc Psychiatry. 2021;67(4):344-350. https://doi.org/10.1177/0020764020952116
  16. Seok DB, Ju HO. Impact of the COVID-19 pandemic on depression during pregnancy: a cross-sectional study. Korean J Women Health Nurs. 2023;29(1):44-54. https://doi.org/10.4069/kjwhn.2023.02.21.2
  17. Ministry of Health and Welfare (MOHW), Korea. Announcement of the results of the National Mental Health Survey on COVID-19 in the second quarter of 2022 [Internet]. Sejong: MOHW; 2022 [cited 2022 Dec 10]. https://www.mohw.go.kr/board.es?mid= a10503010100&bid= 0027&cg_code=
  18. Kang DI, Park E. Do taegyo practices, self-esteem, and social support affect maternal-fetal attachment in high-risk pregnant women? A cross-sectional survey. Korean J Women Health Nurs. 2022;28(4):338-347. https://doi.org/10.4069/kjwhn.2022.12.16
  19. Han K, Kim M, Park JM. The Edinburgh Postnatal Depression Scale, Korean version: reliability and validity. J Korean Soc Biol Ther Psychiatry. 2004;10(2):201-207.
  20. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786. https://doi.org/10.1192/bjp.150.6.782
  21. Kim YK, Hur JW, Kim KH, Oh KS, Shin YC. Clinical application of Korean version of Edinburgh Postnatal Depression Scale. J Korean Neuropsych Assoc. 2008;47(1):36-44. https://doi.org/10.4306/jknpa.2012.51.1.36
  22. Preis H, Mahaffey B, Lobel M. Psychometric properties of the Pandemic-Related Pregnancy Stress Scale (PREPS). J Psychosom Obstet Gynaecol. 2020;41(3):191-197. https://doi.org/10.1080/0167482X.2020.1801625
  23. Kim ME, Heo ML. Evaluating the reliability and validity of the Korean version of the Pandemic-Related Pregnancy Stress Scale. Risk Manag Healthc Policy. 2023;16:655-666. https://doi.org/10.2147/RMHP.S401210
  24. Wang HJ, Park HS, Kim IO. Comparison of prenatal health management state and educational needs for pregnant women with advanced maternal age and under the age of 35. Korean J Women Health Nurs. 2013;19(4):230-241. https://doi. org/10.4069/kjwhn.2013.19.4.230
  25. Wang HJ, Kim IO. Effects of a mobile web-based pregnancy health care educational program for mothers at an advanced maternal age. J Korean Acad Nurs. 2015;45(3):337-346. https://doi.org/10.4040/jkan.2015.45.3.337
  26. Claridge AM, Beeson T, Wojtyna A, Hoxmeier J. Pregnant women's experiences during the COVID-19 pandemic: A mixed method exploration of prenatal depression. Couple Fam Psychol: Res Pract. 2021;10(3):168-178. https://doi.org/10.1037/cfp0000178
  27. Baek SJ, Yun J, Nam J, Seo EY, Kwon SY, Lee CH, et al. Antenatal depressive symptoms and associated risk factors among pregnant women. J Korean Neuropsychiatr Assoc. 2019;58 (4):346-352. https://doi.org/10.4306/jknpa.2019.58.4.346
  28. Kim M, Kim Y. The mediating effect of fatigue on the relationship between pregnancy stress and depression during the third trimester of pregnancy. J East-West Nurs Res. 2018;24 (1):81-89. https://doi.org/10.14370/jewnr.2018.24.1.81
  29. Kim M, Kim Y. Relationships between pregnancy stress, depression, and pregnancy outcome in pregnant women. J Learn-Cent Curric Instr. 2018;18(21):1015-1532. https://doi.org/10.22251/jlcci.2018.18.21.1015
  30. Lopez-Morales H, Del-Valle MV, Andres ML, Gelpi Trudo R, Canet-Juric L, Urquijo S. Longitudinal study on prenatal depression and anxiety during the COVID-19 pandemic. Arch Womens Ment Health. 2021;24(6):1027-1036. https://doi.org/10.1007/s00737-021-01152-1
  31. Nguyen LH, Nguyen LD, Ninh LT, Nguyen HT, Nguyen AD, Dam VAT, et al. COVID-19 and delayed antenatal care impaired pregnant women's quality of life and psychological well-being: what supports should be provided? Evidence from Vietnam. J Affect Disord. 2022;298(Pt A):119-125. https://doi.org/10.1016/j.jad.2021.10.102
  32. Javaid S, Barringer S, Compton SD, Kaselitz E, Muzik M, Moyer CA. The impact of COVID-19 on prenatal care in the United States: qualitative analysis from a survey of 2519 pregnant women. Midwifery. 2021;98:102991. https://doi.org/10.1016/j.midw.2021.102991
  33. Penengo C, Colli C, Garzitto M, Driul L, Sala A, Degano M, et al. Psychometric properties of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and its correlation with anxiety and depression. J Affect Disord. 2021;294:48-53. https://doi.org/10.1016/j.jad.2021.06.076
  34. Ilska M, Kolodziej-Zaleska A, Brandt-Salmeri A, Preis H, Lobel M. Pandemic-related pregnancy stress assessment-Psychometric properties of the Polish PREPS and its relationship with childbirth fear. Midwifery. 2021;96:102940. https://doi.org/10.1016/j.midw.2021.102940
  35. Ilska M, Kolodziej-Zaleska A, Brandt-Salmeri A, Preis H, Lobel M. Pandemic stress and its correlates among pregnant women during the second wave of COVID-19 in Poland. Int J Environ Res Public Health. 2021;18(21):11140. https://doi.org/10.3390/ijerph182111140
  36. Lablanche O, Salle B, Perie MA, Labrune E, Langlois-Jacques C, Fraison E. Psychological effect of COVID-19 pandemic among women undergoing infertility care, a French cohort - PsyCovART Psychological effect of COVID-19: PsyCovART. J Gynecol Obstet Hum Reprod. 2022;51(1):102251. https://doi.org/10.1016/j.jogoh.2021.102251
  37. Li R, Yin T, Fang F, Li Q, Chen J, Wang Y, et al. Potential risks of SARS-CoV-2 infection on reproductive health. Reprod Biomed Online. 2020;41(1):89-95. https://doi.org/10.1016/j.rbmo.2020.04.018
  38. Zhang JY, Cui YX, Zhou YQ, Li YL. Effects of mindfulness-based stress reduction on prenatal stress, anxiety and depression. Psychol Health Med. 2019;24(1):51-58. https://doi.org/10.1080/13548506.2018.1468028
  39. Pasha H, Faramarzi M, Chehrazi M, et al. Health-promotion and health-harming behaviours in pregnant women: role of coping strategies, anxiety, and depression. J Obstet Gynaecol. 2022;42(3):410-415. https://doi.org/10.1080/01443615.2021.1910634
  40. Fathnezhad-Kazemi A, Aslani A, Hajian S. Association between perceived social support and health-promoting lifestyle in pregnant women: a cross-sectional study. J Caring Sci. 2021;10(2):96-102. https://doi.org/10.34172/jcs.2021.018
  41. Matvienko-Sikar K, Pope J, Cremin A, Carr H, Leitao S, Olander EK, et al. Differences in levels of stress, social support, health behaviours, and stress-reduction strategies for women pregnant before and during the COVID-19 pandemic, and based on phases of pandemic restrictions, in Ireland. Women Birth. 2021;34(5):447-454. https://doi.org/10.1016/j.wombi.2020.10.010
  42. Kim TW, Lee JM. The increasing income inequality in times of COVID-19 and its policy implications. Health Welf Policy Forum. 2020;(290):20-33. https://doi.org/10.23062/2020.12.3
  43. Silva-Jose C, Nagpal TS, Coteron J, Barakat R, Mottola MF. The 'new normal' includes online prenatal exercise: exploring pregnant women's experiences during the pandemic and the role of virtual group fitness on maternal mental health. BMC Pregnancy Childbirth. 2022;22(1):251. https://doi.org/10.1186/s12884-022-04587-1
  44. McNeil A, Hicks L, Yalcinoz-Ucan B, Browne DT. Prevalence & correlates of intimate partner violence during COVID-19: a rapid review. J Fam Violence. 2023;38(2):241-261. https://doi.org/10.1007/s10896-022-00386-6
  45. Penengo C, Colli C, Cesco M, Croccia V, Degano M, Ferreghini A, et al. Stress, coping, and psychiatric symptoms in pregnant women in outpatient care during the 2021 second-wave COVID-19 pandemic. Front Psychiatry. 2022;12: 775585. https://doi.org/10.3389/fpsyt.2021.775585
  46. Felsenthal E. deaths-and why its border is black for the second time in history [Internet]. New York: Time; 2020 [cited 2022 Dec 30]. Available from: https://time.com/5887436/time-black-border-coronavirus/
  47. Graupensperger S, Calhoun BH, Patrick ME, Lee CM. Longitudinal effects of COVID-19-related stressors on young adults' mental health and wellbeing. Appl Psychol Health Well Being. 2022;14(3):734-756. https://doi.org/10.1111/aphw.12344
  48. Laskawiec D, Grajek M, Szlacheta P, Korzonek-Szlacheta I. Post-pandemic stress disorder as an effect of the epidemiological situation related to the COVID-19 pandemic. Healthcare (Basel). 2022;10(6):975. https://doi.org/10.3390/healthcare10060975
  49. Huang X, Sun W, Wang R, Wu H, Yu S, Fang X, et al. Present situation and the future development of web-based prenatal education in China: cross-sectional web-based survey. J Med Internet Res. 2022;24(6):e28637. https://doi.org/10.2196/28637
  50. Kim MY, Kim GS, Kim S, Lee HJ. Participation in prenatal education, knowledge and attitude related to delivery, postpartum care, newborn care in nulliparous women. Korean J Women Health Nurs. 2016;22(3):139-150. https://doi.org/10.4069/kjwhn.2016.22.3.139
  51. Min HY, Jeong GH. Advanced aged women's needs for pregnancy and childbirth care. Korean J Women Health Nurs. 2015;21(4):332-341. https://doi.org/10.4069/kjwhn.2015.21.4.332
  52. Kang SJ, Yang MJ. Factors influencing pregnancy stress in pregnant women in Korea: a cross-sectional study. Korean J Women Health Nurs. 2022;28(1):27-37. https://doi.org/10.4069/kjwhn.2022.02.03
  53. Yoon KJ. Changes and tasks in Korea's healthcare system in times of the COVID-19 pandemic. Health Welf Policy Forum. 2020;2020(12):34-49. https://doi.org/10.23062/2020.12.4
  54. Narumoto K, Miyazaki K, Inoue M, Kaneko M, Okada T, Sugimura M. Investigating women's health issues and help-seeking intentions in primary care in Japan: a cross-sectional study. BMC Primary Care. 2022;23(1):1-10. https://doi.org/10.1186/s12875-022-01862-0
  55. Spiby H, Stewart J, Watts K, Hughes AJ, Slade P. The importance of face to face, group antenatal education classes for first time mothers: a qualitative study. Midwifery. 2022;109:103295. https://doi.org/10.1016/j.midw.2022.103295
  56. Choi EJ, Ryu S, Chun H, Kwak W, Choi SK. Personal competence factors associated with better access to digital health. Sejong: Korea Institute for Health and Social Affiars; 2022. p.185.
  57. Ciochon A, Apanasewicz A, Danel DP, Galbarczyk A, Klimek M, Ziomkiewicz A, et al. Antenatal classes in the context of prenatal anxiety and depression during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(9):5073. https://doi.org/10.3390/ijerph19095073