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Introduction: Depression and anxiety affect one in seven women during the perinatal period, and are associated with increased risk of preterm delivery, reduced mother-infant bonding, and delays in cognitive/emotional development of the infant. With this survey we aimed to rapidly assess the influence of the COVID-19 pandemic and subsequent physical distancing/isolation measures on the mental health and physical activity of pregnant and postpartum women. Methods: Between April 14 and May 8, 2020, we recruited women who were pregnant or within the first year after delivery to participate in an online survey. This included questionnaires on self-reported levels of depression/depressive symptoms (Edinburgh Postnatal Depression Survey; EPDS), anxiety (State-Trait Anxiety Inventory; STAI-State), and physical activity. Current and pre-pandemic values were assessed for each. Results: Of 900 eligible women, 520 (58%) were pregnant and 380 (42%) were in the first year after delivery. Sixty-four percent of women reported reduced physical activity with the onset of isolation measures, while 15% increased, and 21% had no change to their physical activity. An EPDS score >13 (indicative of depression) was self-identified in 15% of respondents pre-pandemic and in 40.7% currently (mean ± SD; 7.5 ± 4.9 vs. 11.2 ± 6.3, respectively; p < 0.01, moderate effect). Moderate to high anxiety (STAI-state score >40) was identified in 29% of women before the pandemic (mean STAI = 34.5 ± 11.4) vs. 72% of women currently (mean STAI = 48.1 ± 13.6; p < 0.01, large effect). However, women engaging in at least 150 min of moderate intensity physical activity (meeting current guidelines) during the pandemic had significantly lower scores for both anxiety and depression than those who did not (p < 0.01, large and small effect, respectively). Discussion: This rapid response survey identifies a substantial increase in the likelihood of maternal depression and anxiety during the COVID-19 pandemic. This highlights the strong need for heightened assessment and treatment of maternal mental health. However, these data also suggest that physical activity, which has previously been shown to reduce depression and depressive symptoms in pregnancy, may be associated with better mental health during the pandemic.
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ORIGINAL RESEARCH
published: 19 June 2020
doi: 10.3389/fgwh.2020.00001
Frontiers in Global Women’s Health | www.frontiersin.org 1June 2020 | Volume 1 | Article 1
Edited by:
Caroline Gurvich,
Monash University, Australia
Reviewed by:
Anne Elizabeth Buist,
The University of Melbourne, Australia
Anne Sved Williams,
Women’s and Children’s Health
Network, Australia
Sonia Shenoy,
Manipal Academy of Higher
Education, India
*Correspondence:
Margie H. Davenport
mdavenpo@ualberta.ca
Specialty section:
This article was submitted to
Women’s Mental Health,
a section of the journal
Frontiers in Global Women’s Health
Received: 11 May 2020
Accepted: 27 May 2020
Published: 19 June 2020
Citation:
Davenport MH, Meyer S, Meah VL,
Strynadka MC and Khurana R (2020)
Moms Are Not OK: COVID-19 and
Maternal Mental Health.
Front. Glob. Womens Health 1:1.
doi: 10.3389/fgwh.2020.00001
Moms Are Not OK: COVID-19 and
Maternal Mental Health
Margie H. Davenport 1
*, Sarah Meyer 1, Victoria L. Meah 1, Morgan C. Strynadka 1and
Rshmi Khurana 2
1Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, Women and Children’s
Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada, 2Faculty of Medicine and
Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, AB, Canada
Introduction: Depression and anxiety affect one in seven women during the perinatal
period, and are associated with increased risk of preterm delivery, reduced mother-infant
bonding, and delays in cognitive/emotional development of the infant. With this survey
we aimed to rapidly assess the influence of the COVID-19 pandemic and subsequent
physical distancing/isolation measures on the mental health and physical activity of
pregnant and postpartum women.
Methods: Between April 14 and May 8, 2020, we recruited women who were pregnant
or within the first year after delivery to participate in an online survey. This included
questionnaires on self-reported levels of depression/depressive symptoms (Edinburgh
Postnatal Depression Survey; EPDS), anxiety (State-Trait Anxiety Inventory; STAI-State),
and physical activity. Current and pre-pandemic values were assessed for each.
Results: Of 900 eligible women, 520 (58%) were pregnant and 380 (42%) were in the first
year after delivery. Sixty-four percent of women reported reduced physical activity with
the onset of isolation measures, while 15% increased, and 21% had no change to their
physical activity. An EPDS score >13 (indicative of depression) was self-identified in 15%
of respondents pre-pandemic and in 40.7% currently (mean ±SD; 7.5 ±4.9 vs. 11.2 ±
6.3, respectively; p<0.01, moderate effect). Moderate to high anxiety (STAI-state score
>40) was identified in 29% of women before the pandemic (mean STAI =34.5 ±11.4)
vs. 72% of women currently (mean STAI =48.1 ±13.6; p<0.01, large effect). However,
women engaging in at least 150 min of moderate intensity physical activity (meeting
current guidelines) during the pandemic had significantly lower scores for both anxiety
and depression than those who did not (p<0.01, large and small effect, respectively).
Discussion: This rapid response survey identifies a substantial increase in the likelihood
of maternal depression and anxiety during the COVID-19 pandemic. This highlights
the strong need for heightened assessment and treatment of maternal mental health.
However, these data also suggest that physical activity, which has previously been shown
to reduce depression and depressive symptoms in pregnancy, may be associated with
better mental health during the pandemic.
Keywords: COVID-19, pregnancy, postpartum, mental health, physical activity
Davenport et al. COVID-19 and Maternal Mental Health
INTRODUCTION
Since COVID-19 was first recognized in late 2019, the virus has
rapidly spread throughout the world. In an effort to mitigate
the devastating effects of this virus, varying levels of “stay at
home” orders have been implemented in most countries around
the world. This has resulted in the closure of schools, daycares,
workplaces, and non-essential services. The impact of the
physical (and social) isolation on mental health is anticipated to
be high, and may disproportionately affect high risk populations.
Depression and anxiety affect one in seven women during
the perinatal period, and are associated with increased risk of
preterm delivery, reduced mother-infant bonding, and delays
in cognitive/emotional development of the infant, which may
persist into childhood (14). Prevention and treatment is critical
yet it is estimated that 50% of women who are depressed
remain undiagnosed during and following pregnancy (5). A
cross-sectional study of 100 pregnant women from Italy found
a moderate-to-severe psychological impact of the COVID-
19 pandemic and highlighted the need for intervention to
improve the mental health of this population (6). Furthermore,
the COVID-19 pandemic is anticipated to decrease access to
diagnosis and psychological or pharmacological treatment; this
is likely exacerbating poor mental health (7). Even in the absence
of clinical depression or anxiety, identifying therapies to reduce
sub-clinical symptoms is important.
Obstetrical guidelines around the world recommend that all
pregnant women without contraindication be physically active
throughout pregnancy (811). This derives many health benefits
including a 67% reduction in the odds of prenatal depression
(odds ratio 0.33, 95% CI 0.21–0.53, I2=0%) (12), as well as
postpartum depressive symptoms (standardized mean difference
0.34, 95% CI 0.50 to 0.19, I2=0%) (13). With this survey,
we aimed to assess the influence of the COVID-19 pandemic and
subsequent physical distancing/isolation measures on the mental
health and physical activity of pregnant and postpartum women.
MATERIALS AND METHODS
This study was conducted in accordance with the Declaration
of Helsinki, and was approved by the Ethics Committee at
the University of Alberta (University of Alberta ethics protocol
PRO00099671). Between April 14–May 8, 2020, we recruited
women who were pregnant or within the first year after
delivery to participate in an online survey. The survey was
posted online via social media platforms (Twitter, Facebook, and
Instagram) and shared publicly to facilitate snowball sampling.
Participants were informed of the purpose, risks, and benefits
of the survey, were told they could withdraw from the survey
at any time, for any reason, and provided electronic informed
consent. Women answered questions on demographics including
their year of birth, level of education, and personal health
history. They responded to questions regarding symptoms,
testing, and diagnosis of COVID-19, and current physical
distancing/isolation measures including current work status.
Participants completed validated standard questionnaires of self-
reported levels of depression/depressive symptoms (Edinburgh
Postnatal Depression Survey; EPDS) and anxiety (State-Trait
Anxiety Inventory; STAI-State). Self-reported physical activity
was also collected. All measured were assessed for both current
and pre-pandemic values.
The Edinburgh Postnatal Depression Scale (EPDS) is a self-
reported screening questionnaire consisting of 10 questions
which was initially used in the postnatal period; however, it is
also commonly used during pregnancy (14). Clinical diagnosis
of depression can only be determined by a trained health
professional; however, a score of >13 on the EPDS is associated
with a likely diagnosis of depression. The State-Trait Anxiety
Inventory (STAI) is a commonly used self-report questionnaire
to screen for the presence and severity of state (i.e., right now)
and trait (how prone a person is to anxiety) anxiety (used with
permission) (15). The STAI consists of 40 questions with equal
numbers assessing both the state and trait subscales. A score of 40
or higher has been identified as the threshold to identify clinically
significant symptoms of anxiety (16).
Physical activity was self-reported in two ways. First,
participants provided an overall assessment of their achievement
of 150 min of moderate intensity physical activity each week
(i.e., current recommendations for pregnant and postpartum
women). Secondly, participants reported on physical activity
during the week. Volume of physical activity was determined as
per previously published methods (12,17). The intensity of each
activity was assigned a metabolic equivalents (METs) score using
the Compendium, and multiplied by the frequency and duration
of the activities (18).
All data were checked for accuracy, and invalid data were
removed. Pre-pandemic versus current mental health and
physical activity metrics were compared using paired t-tests or
Kruskal-Wallis-H tests as appropriate according to the normality
of their distribution. Effect size was determined using Cohen’s
d. Women were stratified based on physical activity pattern
during the pandemic to assess its influence on mental health
using ANOVA. Post-hoc comparisons were assessed using Dunns
Method. Statistical significance was defined as p<0.05 and
analyzed using SigmaStat (Systat Software Inc., USA).
RESULTS
Of 900 eligible women, 520 (58%) were pregnant and 380 (42%)
were in the first year after delivery. One invalid record was
removed. Participant’s median age was 33 years (range 17–49
years; n=862), 75.5% lived in cities (n=651), and 69% (n=595)
lived in a single family home with an average of one child (range
0–5) living with them in the household. Most women were from
North America (n=779), were Caucasian (n=736, Table 1),
and had some postsecondary education (n=520). At the time of
the survey, 2.8% and 6.7% of women had a pre-existing clinical
diagnosis of depression and anxiety, respectively (Table 1). Forty
seven women had experienced symptoms of COVID-19, 13
of whom were tested and all had negative results. Ninety-
three percent of women were currently engaged in physical
distancing measures with 83% of women in self-isolation or
isolation at home. Sixty-four percent of women reported reduced
Frontiers in Global Women’s Health | www.frontiersin.org 2June 2020 | Volume 1 | Article 1
Davenport et al. COVID-19 and Maternal Mental Health
physical activity with the onset of isolation measures, while 15%
increased and 21% had no change to their physical activity. The
number of women meeting current prenatal physical activity
recommendations prior to and during the pandemic are shown
in Table 2.
An EPDS score >13 (indicative of depression) was self-
identified in 15% respondents pre-pandemic and in 40.7%
currently (mean ±SD; 7.5 ±4.9 vs. 11.2 ±6.3, respectively; p<
0.01, Cohen’s d0.66; moderate effect). Moderate to high anxiety
(STAI-state score >40) was identified in 29% of women before
the pandemic (mean STAI =34.5 ±11.4) vs. 72% of women
currently (mean STAI =48.1 ±13.6; p<0.01, Cohen’s d1.08;
large effect). However, women engaging in at least 150 min of
moderate intensity physical activity (meeting current guidelines)
during the pandemic had significantly lower scores for both
anxiety (large effect) and depression (small effect) than those who
did not (p<0.01, see Table 3).
DISCUSSION
The findings of this survey illustrated a significant increase in
self-reported levels of depression and anxiety, and substantial
reductions in physical activity in pregnant women from before
to during the COVID-19 pandemic. Depression and anxiety
are well-established to have both acute (e.g., preterm delivery,
attenuated fetal/neonatal growth) and long-term consequences
(e.g., increased risk of future anxiety and depression, cognitive
delays for the offspring) for the psychological and physical health
of both mother and baby (24). Although, clinical diagnosis
and treatment via psychological or pharmacological treatment
remain front line therapies, the COVID-19 pandemic may reduce
access and/or attendance to health care visits which could
increase the risk of maternal/fetal health complications. The
findings of this survey suggest that remaining physically active
could be a helpful tool for pregnant and postpartum women.
Specifically, engaging in at least 150 min of moderate intensity
physical activity each week was associated with lower scores on
screening tools for depression or anxiety. Thus, physical activity
is an accessible measure to blunt the mental health crisis currently
being experienced by pregnant and postpartum women.
Although estimates vary, depression and/or anxiety
affect 14% of pregnant and postpartum women (1). The
consequences of undiagnosed and untreated depression are
serious; nearly 20% of women with postpartum depression
have considered hurting themselves and in the UK, the leading
cause of maternal death in the year following delivery is suicide
(19). Treatment of depression and anxiety is critical to support
the health of both mother and child. However, many women
are reluctant to take antidepressants even when prescribed
(20,21). In non-pregnant populations exercise has been found
to be as effective in treating mild-to-moderate depression as
anti-depressants and psychotherapy (22). Although this has
not been evaluated in pregnant or postpartum women, recent
systematic reviews and meta-analyses of randomized controlled
trials have shown pre- and post-natal exercise reduces the odds
TABLE 1 | Participant characteristics.
Number (% out of 900)
Ethnic background
Caucasian 736 (81.8%)
Mixed Heritage 42 (4.7%)
Asian 36 (4%)
Hispanic or Latina 11 (1.2%)
African American 10 (1.1%)
Indigenous people 9 (1%)
South Asian 9 (1%)
Prefer not to say 58 (5.2%)
Region of residence
Canada 655 (72.8%)
United Kingdom 73 (8.1%)
USA 53 (5.9%)
Australia 10 (1.1%)
India 7 (0.8%)
Brazil 6 (0.7%)
Germany 5 (0.6%)
China 4 (0.4%)
France 3 (0.3%)
Other/prefer not to say 84 (9.3%)
Relationship Status
In a relationship but living together 837 (93%)
Single 21 (2.3%)
In a relationship but living apart 5 (0.6%)
Prefer not to say 37 (4.1%)
Employment status No % due to multiple selections
Student 31
Self-employed 74
Part-time employment 89
Full-time employment 506
Homemaker/full time parent 103
Unemployed before COVID-19 16
Unemployed due to COVID 19 71
Prefer not to say 63
Pregnancy complications
Gestational diabetes 37 (4.1%)
Hypertensive disorders of pregnancy 41 (4.6%)
Placenta previa 16 (1.8%)
Preterm labor 27 (3%)
Intrauterine growth restriction 11 (1.2%)
Multiple pregnancy (twins or higher) 22 (2.4%)
Depression 25 (2.8%)
Anxiety 60 (6.7%)
Prefer not to say 55 (6.1%)
No complications 655 (72.8%)
Pre-existing conditions
Type 1 diabetes 5 (0.6%)
Type 2 diabetes 4 (0.4%)
Cardiovascular disease 6 (0.7%)
Respiratory disease 47 (5.2%)
Frontiers in Global Women’s Health | www.frontiersin.org 3June 2020 | Volume 1 | Article 1
Davenport et al. COVID-19 and Maternal Mental Health
TABLE 2 | Self-reported physical activity pre-pandemic and following the
implementation of governmental recommendations for self-isolation/physical
distancing associated with the COVID-19 pandemic.
Did you meet or exceed 150 min of
moderate intensity physical activity
each week?
N(%)
Total =714
METs per week
Prior to the implementation of physical isolation measures of COVID-19:
Yes, most if not all of the time 205 (28.7%) 1,548 (1,120–2,342)
Yes, sometimes 211 (29.6%) 894 (567–1,372)*
Yes, but rarely 127 (17.8%) 580 (270–1,107)*#
No 171 (23.9%) 180 (0–516)*#†
Following implementation of physical isolation measures of COVID-19
Yes, most if not all of the time 168 (23.5%) 1539 (967–2,301)
Yes, sometimes 195 (27.3%) 1005 (612–1,342)*
Yes, but rarely 136 (19%) 389 (180–767)*#
No 215 (30.1%) 90 (0–393)*#†
METs, metabolic equivalents.
Main effect of group on METs pre-pandemic: H =260.206 with 3 degrees of freedom,
p<0.001, Cohen’s d 1.507, very large.
Main effect of group on METs current: H =342.357 with 3 degrees of freedom, p <0.001,
Cohen’s d 1.914, very large.
*Different from most, if not all of the time, p <0.05.
#Different from sometimes, p <0.05.
Different from rarely, p <0.05.
TABLE 3 | Current self-reported adherence to physical activity guidelines of at
least 150 min of moderate to vigorous physical activity each week following the
implementation of governmental recommendations for self-isolation/physical
distancing associated with the COVID-19 pandemic.
Meets or exceeds
physical activity
guidelines
Edinburgh Postnatal
Depression Score (EPDS)
Median (25, 75%)
State-Trait Anxiety
Inventory (STAI-State)
Median (25, 75%)
Yes, most if not all of
the time
8 (4, 14) 43 (32, 52)
Yes, sometimes 10 (5, 14) 47 (36, 56)*
Yes, but rarely 11 (8, 17)* 52 (42, 60)*
No 13 (8, 19)*#53 (42, 62)*#
Main effect of group on EPDS: H =36.900 with 3 degrees of freedom, p <0.001, Cohen’s
d=0.491, small.
Main effect of group on STAI-State: H =47.415 with 3 degrees of freedom p <0.001,
Cohen’s d =0.568, large.
*Different from most, if not all of the time, p <0.05.
#Different from sometimes, p <0.05.
of depression and depressive symptoms. The findings from
the current study also suggest that pregnant or postpartum
women who were able to engage in regular physical activity
during the COVID-19 pandemic may have improved mental
health compared to those who were not. We must also consider
that certain barriers to physical activity may be increased in
conjunction with COVID-19, such as the closure of indoor
recreation centers and outdoor parks/greenspace. However,
activities such as gardening, going for walks, household chores,
and online fitness classes are feasible alternatives to promote
wellness through movement and should be promoted as
reasonable methods for increasing the physical activity of moms.
Due to the rapid development of COVID-19, pre-pandemic
data were obtained through recall and were cross-sectional
in nature, thereby precluding the ability to make causal
inferences. As these data are correlative the underlying reason
for the observed relationships cannot be determined and only
associations could be identified. Indeed, a number of external
factors may influence both likelihood of depression/anxiety
and physical activity participation. These include fear of the
virus, financial stresses, increased domestic workload, lack
of motivation to exercise and social isolation, among many
others. However, previous systematic reviews and meta-analyses
from randomized controlled trials have demonstrated that
rates of depression and depressive symptoms are reduced in
pregnant and postpartum women randomized to an exercise
intervention (compared to no exercise) (12,13) supporting the
observed relationship in the current study. Our approach utilized
established and validated measures of self-reported screening
tools for anxiety, depression, and physical activity to assess the
psychological health of pregnant and postpartum women. These
data were collected via online survey with social media as the
primary avenue for promotion. As such, random sampling did
not occur which may have introduced sampling bias into the
survey. The number of individuals who saw the survey and
chose not to participate could not be determined; however, it is
plausible that women who had a pre-existing interest in physical
activity and/or mental health would be more likely to respond
to the survey. Furthermore, previous research has suggested
that the quality of response may be reduced in online surveys
(23,24). Careless responding occurs when a participant fails to
read or interpret the survey appropriately leading to incorrect
responses. These types of responses can directly influence the
results, thus the findings of this survey should be interpreted
with consideration of these limitations. Our population was
primarily from Canada (with a freely accessible health care
system), Caucasian, were married, living in a single-family home,
and had some post-secondary education. While we did not
capture a more diverse population, the high rates of anxiety and
depression are concerning as this group would not typically be
considered at elevated risk of mental health disorders. Thus,
these data likely under-estimate the true mental health crisis for
pregnant and postpartum women as a result of the COVID-
19 pandemic. Although the change in prevalence and symptom
severity of anxiety and depression from pre-pandemic to current
times may be subject to recall bias, the unexpectedly high rates of
current mental health issues warrant an urgent call to action.
CONCLUSION
This rapid response survey identifies a substantial increase in self-
reported maternal depression and anxiety from pre- to during-
pandemic. These data highlight the strong need for heightened
assessment and treatment of maternal mental health. However,
these data also suggest that remaining active during the pandemic
is associated with a reduced likelihood of anxiety and depression.
These data highlight a potential intervention for all pregnant
and postpartum women to improve or maintain mental health
Frontiers in Global Women’s Health | www.frontiersin.org 4June 2020 | Volume 1 | Article 1
Davenport et al. COVID-19 and Maternal Mental Health
during this extremely stressful period where access to diagnosis
and treatment is more challenging.
DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this
article will be made available by the authors, without
undue reservation.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by Ethics Committee at the University of Alberta
(University of Alberta ethics protocol PRO00099671). The
patients/participants provided their written informed consent to
participate in this study.
AUTHOR CONTRIBUTIONS
MD: had full access to all of the data in the study
and takes responsibility for the integrity of the data, the
accuracy of the data analysis, statistical analysis, and study
supervision. MD and RK: study concept and design. All authors:
acquisition, analysis, or interpretation of data, drafting of the
manuscript, and critical revision of the manuscript for important
intellectual content.
FUNDING
This research has been funded by generous supporters of
the Lois Hole Hospital for Women through the Women
and Children’s Health Research Institute (redcap development,
VLM Postdoctoral Fellowship). MD was funded by a Heart &
Stroke Foundation of Canada (HSFC)/Health Canada Improving
Heart Health for Women Award and National and Alberta
HSFC New Investigator Award. Study data were collected and
managed using REDCap electronic data capture tools hosted
and supported by the Women and Children’s Health Research
Institute at the University of Alberta. The funder had no role in
the design and conduct of the study; collection, management,
analysis, and interpretation of the data; preparation, review,
or approval of the manuscript; and decision to submit the
manuscript for publication.
ACKNOWLEDGMENTS
The authors would like to thank Shana Rimmer for developing
the redcap survey.
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Conflict of Interest: The authors declare that the research was conducted in the
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Copyright © 2020 Davenport, Meyer, Meah, Strynadka and Khurana. This is an
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Frontiers in Global Women’s Health | www.frontiersin.org 6June 2020 | Volume 1 | Article 1
... Engaging in physical activity has been found to mitigate against anxiety and depression during the pandemic (Davenport et al., 2020). However, in an effort to slow the spread of COVID-19, several countries implemented governmental policies that severely restricted opportunities for adventure recreation as a form of physical activity (Frühauf et al., 2020;Houge Mackenzie & Goodnow, 2020). ...
... Furthermore, certain population segments have been disproportionally impacted by government restrictions. For example, Davenport et al. (2020) found that 72% of women who were pregnant or recent mothers were found to have moderate to high anxiety (compared to 29% of women before the pandemic). In addition, Coughenour et al. (2020) found that, in the United States, Hispanic and senior college students reported more negative depression scores compared to other college students. ...
Article
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Research conducted during the COVID-19 pandemic underscores the value of physical activity and nature for psychological well-being in the general population when people’s mobility and activities are restricted due to government mandates. Since restrictions may thwart the psychological benefits reported from participation in adventure recreation (e.g., rock-climbing, white-water kayaking), it is important to understand the psychological well-being of people who previously benefited from adventure opportunities. Thus, the purpose of this study was to investigate the lived experiences and psychological well-being of adventure recreation participants during COVID-19 restrictions. Design A descriptive phenomenological approach was used. Method Participants were fifteen men, four women, and one non-binary person who engaged in a variety of adventure recreation activities that included ski-mountaineering, free-diving, rock-climbing, white-water kayaking, back-country skiing, skydiving, SCUBA diving, BASE jumping, and mountaineering. Participants had an average of 11.7 years of experience in at least one of their preferred adventure recreation activities. Participants were invited to take part in a visual and audio-recorded semi-structured interview on Zoom. Interviews lasted on average 69.3 minutes. Reflexive thematic analysis was undertaken inductively. Results Overall, participants discussed a range of nuanced impacts that COVID-19 restrictions had on their psychological well-being. Participants discussed how negative affect resulted from restricted opportunities for physical and mental challenges, emotion regulation, connections to nature and people, and excitement. However, participants also benefited from several silver linings, such as reflecting on past adventures, a reduced need to compare themselves socially, and opportunities to spend quality time with others. Participants also explained how ‘adventure-based mindsets’ (e.g., resilience, focusing on controllable elements, humility) were protective strategies they used to limit the ill-being impacts of COVID-19 restrictions. Conclusions This study extends the alternative sport and exercise literature by illustrating how participation in adventure has the potential to enhance participants’ resilience and their ability to maintain psychological well-being across diverse and novel contexts (e.g., the COVID-19 pandemic). Keywords AdventureExtreme sportCOVID-19ResiliencePsychological well-being
... Importantly, we did not observe a significant increase in MDS in the proportion of mothers who experienced the pandemic by the time their infant was 16-months old, or in mothers of young children across the first 7 months of the COVID-19 pandemic. These findings were against our expectations and contradict an emerging literature which suggests increased MDS during the COVID-19 pandemic (Cameron et al., 2020;Davenport et al., 2020;Lebel et al., 2020;Racine et al., 2021;Wu et al., 2020). Although there is currently limited research that specifically investigates the impact of the COVID-19 pandemic on early childhood temperament, our finding of a general lack of pandemic-related impacts is largely in line with research investigating the effects of natural disaster-related stress on infant temperament. ...
... A substantial strength of the current research is the availability of the 10-and 16-month infant data in Study 1 which was collected before the pandemic. This is unlike many during-pandemic studies that rely on participants to provide retrospective reports on psychological variables before the pandemic (Davenport et al., 2020), or that compare data from two different participant populations cross-sectionally (Cameron et al., 2020). Our pre-pandemic data therefore allow us to draw conclusions about the actual impact of the pandemic on MDS and infant temperament in Study 1. ...
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The COVID‐19 pandemic is an unexpected and major global event, with the potential to have many and varied impacts on child development. However, the implications of the pandemic for maternal depressive symptoms, early childhood temperament dimensions, and their associations, remain largely unknown. To investigate this, questionnaires were completed by mothers (N = 175) before and during the pandemic when their child was 10‐ and 16‐months old (Study 1), and by an extended group of mothers with young children (6–48 months; 66 additional mothers) during the first and second national lockdowns in the United Kingdom in 2020 (Study 2). Results indicated that while maternal pandemic‐related stress decreased over the first 6 months of the pandemic, there was an increase in mothers who reported feeling some level of pandemic‐specific depression. Despite this, we did not observe an increase in the severity of global maternal depressive symptoms, or any negative impact of the pandemic on the development of temperament in infancy and early childhood.
... Ceulemans et al. (2020) have conducted a study in Belgium and found that breastfeeding mothers and women's who are pregnant have high anxiety and depression. Davenport et al. (2020) have found similar results, which indicated pregnant women and breastfeeding mothers have increased anxiety (72%) and depressive (40.7%) symptoms during the current COVID-19 outbreak. Liu et al. (2020) have identified some risk factors for the higher anxiety symptoms among pregnant women (i.e.severity of outbreak in the residence area, household income, subjective symptoms, and attitude toward . ...
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In March 2020, Coronavirus disease (COVID-19) was declared a public health emergency of international concern. Studies have suggested a higher prevalence of mental health problems during this pandemic among the general population in Bangladesh. However, there was no information regarding the mental health problems of pregnant women and breastfeeding mothers. Therefore, the present study aimed to assess pregnant and breastfeeding women's mental health status during the COVID 19 pandemic in Bangladesh. In the present study, data were collected from a sample of 201 pregnant women and 279 breastfeeding mothers via an online survey. The Depression Anxiety Stress Scale -21 (DASS-21) and the Coronavirus Anxiety Scale (CAS) were utilized to assess the mental problems in this study. Results suggested 39.31% had moderate to extremely severe depression symptoms, 43.29% had moderate to extremely severe anxiety symptoms, 28.86% moderate to extremely severe stress symptoms, and 11.42% COVID-19 anxiety symptoms among pregnant women. For the breastfeeding mothers, these ratios were 39.78%, 36.98%, 26.16%, and 12.90%, respectively. Mothers who gave birth for the first time had a higher depression ratio than mothers who had previously delivered babies. These findings suggested the strong need for heightened assessment and treatment of mental health for pregnant women and breastfeeding mothers during the current pandemic.
... The psychological impact caused by this disease has been significantly associated with the trimester of pregnancy in which these women were found. There was more evidence of psychological distress during the second trimester of pregnancy, which also harmed health (work stress, stress at home, apprehension, and helplessness), although pregnant women paid more attention to their mental health and performed relaxation activities [104,105]. A similar result emerged in Italian pregnant women from a recent systematic review on the same subject [106]. ...
Article
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The immune system is highly dynamic and susceptible to many alterations throughout pregnancy. Since December 2019, a pandemic caused by coronavirus disease 19 (COVID-19) has swept the globe. To contain the spread of COVID-19, immediate measures such as quarantine and isolation were implemented. These containment measures have contributed to exacerbate situations of anxiety and stress, especially in pregnant women, who are already particularly anxious about their condition. Alterations in the psychological state of pregnant women are related to alterations in the immune system, which is more vulnerable under stress. COVID-19 could therefore find fertile soil in these individuals and risk more severe forms. Normally a controlled dietary regimen is followed during pregnancy, but the use of particular vitamins and micronutrients can help counteract depressive-anxiety states and stress, can improve the immune system, and provide an additional weapon in the defense against COVID-19 to bring the pregnancy to fruition. This review aims to gather data on the impact of COVID-19 on the immune system and psychological condition of pregnant women and to assess whether some micronutrients can improve their psychophysical symptoms.
Article
This study examined parents’ (N = 10,141, 64% women) reports of their and their childrens’ depression, anxiety, and stress in Brazil, Mexico, Colombia and Argentina. The data come from the COVID‐19 Family Life Study (Ben Brik, 2020) and cohort recruited between April and December 2020. Participants completed online surveys that included the DASS‐21 and the Revised Children's Manifest Anxiety Scale. Our findings indicate that socio‐economically disadvantaged families fared worse in mental health during the early phases of the COVID‐19 pandemic compared with families with more social and economic resources. Mothers reported higher anxiety, depression, and stress compared with fathers. Parents of adolescents and adolescents fared worse than did families with younger children. Parental physical activity was associated with better parent and child mental health of anxiety symptoms. We discuss the need to address the adverse impacts of the COVID‐19 pandemic on mental health in families in Latin America via coordinated mental health and psychosocial support services that are integrated into the pandemic response currently and after the pandemic subsides.
Background: Women in the postpartum period may be particularly vulnerable to the psychological effects of the COVID-19 pandemic. The aim of our study was to evaluate the impact of the coronavirus pandemic on postpartum depression and anxiety levels and the role of the fear of COVID-19 in its development. Methods: Women who delivered at the Bissaya Barreto Maternity Hospital, between 16 March and 16 June 2020 (Group 1: Birth in COVID-19 period, n = 207), recruited in the postpartum period, filled in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale, Perinatal Anxiety Screening Scale, Profile of Mood States, Perseverative Thinking Questionnaire, Dysfunctional Beliefs Towards Maternity Scale, and the Fear of COVID-19 Scale. Levels of depressive and anxious symptomatology, negative affect, negative repetitive thinking, and the dysfunctional beliefs towards motherhood of these women were compared with data from samples of previous studies that included women whose delivery had occurred at the same Maternity Hospital before the COVID-19 pandemic period (Group 2: Birth before the COVID-19 period, n = 212). Results: Based on the cutoff points of the screening scales, the prevalence of clinically relevant depressive and anxious symptoms in Group 1 was 40.1% and 36.2%, respectively. Women in Group 1 had significantly higher levels of anxious and depressive symptoms, negative affect, negative repetitive thinking, and dysfunctional beliefs towards motherhood than women in Group 2 (p < 0.05). Fear of COVID-19 in the postpartum period was a predictor of depressive (ß = 0.262) and anxious (ß = 0.371) symptoms, explaining 6.9% and 13.7% of their variability, respectively (p < 0.001). Conclusion: During the COVID-19 pandemic, women in the postpartum period present greater depressive and anxious symptomatology, as well as increased risk factors.
Article
Background Physical distancing associated with the COVID-19 pandemic may lead to suboptimal maternal mental health, social support after birth, and infant feeding practices. Research Aims To compare breastfeeding prevalence in participants who were pregnant at a time when strict physical distancing measures were imposed in Fortaleza, the capital of Ceará state, Brazil, with the pre-pandemic breastfeeding levels, and to assess the association of breastfeeding prevalence with maternal common mental disorders, and sociodemographic and health predictors. Method A cross-sectional prospective two-group comparison design using two population-based surveys was carried out in Fortaleza before and after the pandemic. Participants ( n = 351) who had a live birth in Fortaleza in July or August 2020, and participants ( n = 222) who had a child younger than 12 months in 2017 were surveyed. Crude and adjusted multinomial logistic regressions with robust variance were used to estimate risk ratios and 95% confidence intervals (CI). Results Similar prevalence of exclusive breastfeeding were observed in 2021 (8.1%) and 2017 (8.5%; p = .790). An increase in predominant (2.2% vs. 13.4%; p < .001) and a decrease in complementary breastfeeding (64.0% vs. 48.4%; p = .037) was observed in 2021, compared to 2017. The prevalence of maternal common mental disorders also increased in 2021 (17.6% vs. 32.5%, p < .001). No statistically significant associations were found between breastfeeding patterns, maternal common mental disorders, and other predictors in 2017 or 2021. Conclusions Participants who delivered during the COVID-19 pandemic delayed solid foods introduction and breastfed predominantly longer than participants during the pre-pandemic period. While common mental disorders significantly increased, they were not associated with differences in breastfeeding.
Article
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Objectives The COVID-19 pandemic has brought significant changes to family life, society and essential health and other services. A rapid review of evidence was conducted to examine emerging evidence on the effects of the pandemic on three components of nurturing care, including responsive caregiving, early learning, and safety and security. Design Two academic databases, organisational websites and reference lists were searched for original studies published between 1 January and 25 October 2020. A single reviewer completed the study selection and data extraction with verification by a second reviewer. Interventions We included studies with a complete methodology and reporting on quantitative or qualitative evidence related to nurturing care during the pandemic. Primary and secondary outcome measures Studies reporting on outcomes related to responsive caregiving, early learning, and safety and security were included. Results The search yielded 4410 citations in total, and 112 studies from over 30 countries met our eligibility criteria. The early evidence base is weighted towards studies in high-income countries, studies related to caregiver mental health and those using quantitative survey designs. Studies reveal issues of concern related to increases in parent and caregiver stress and mental health difficulties during the pandemic, which was linked to harsher and less warm or responsive parenting in some studies. A relatively large number of studies examined child safety and security and indicate a reduction in maltreatment referrals. Lastly, studies suggest that fathers’ engagement in caregiving increased during the early phase of the pandemic, children’s outdoor play and physical activity decreased (while screen time increased), and emergency room visits for child injuries decreased. Conclusion The results highlight key evidence gaps (ie, breastfeeding support and opportunities for early learning) and suggest the need for increased support and evidence-based interventions to ensure young children and other caregivers are supported and protected during the pandemic.
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Introduction While the secondary impact of the COVID-19 pandemic on the psychological well-being of pregnant women and parents has become apparent over the past year, the impact of these changes on early social interactions, physical growth and cognitive development of their infants is unknown, as is the way in which a range of COVID-19-related changes have mediated this impact. This study (CoCoPIP) will investigate: (1) how parent’s experiences of the social, medical and financial changes during the pandemic have impacted prenatal and postnatal parental mental health and parent–infant social interaction; and (2) the extent to which these COVID-19-related changes in parental prenatal and postnatal mental health and social interaction are associated with fetal and infant development. Methods and analysis The CoCoPIP study is a national online survey initiated in July 2020. This ongoing study (n=1700 families currently enrolled as of 6 May 2021) involves both quantitative and qualitative data being collected across pregnancy and infancy. It is designed to identify the longitudinal impact of the pandemic from pregnancy to 2 years of age as assessed using a range of parent- and self-report measures, with the aim of identifying if stress-associated moderators (ie, loss of income, COVID-19 illness, access to ante/postnatal support) appear to impact parental mental health, and in turn, infant development. In addition, we aim to document individual differences in social and cognitive development in toddlers who were born during restrictions intended to mitigate COVID-19 spread (eg, social distancing, national lockdowns). Ethics and dissemination Ethical approval was given by the University of Cambridge, Psychology Research Ethics Committee (PRE.2020.077). Findings will be made available via community engagement, public forums (eg, social media,) and to national (eg, NHS England) and local (Cambridge Universities Hospitals NHS Foundation Trust) healthcare partners. Results will be submitted for publication in peer-reviews journals.
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The objective is to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. The outcomes evaluated were maternal, fetal or neonatal morbidity, or fetal mortality during and following pregnancy. Literature was retrieved through searches of MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full Text, Child Development & Adolescent Studies, Education Resources Information Center, SPORTDiscus, ClinicalTrials.gov and the Trip Database from inception up to 6 January 2017. Primary studies of any design were eligible, except case studies. Results were limited to English-language, Spanish-language or French-language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal or neonatal morbidity, or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation methodology. The Guidelines Consensus Panel solicited feedback from end users (obstetric care providers, exercise professionals, researchers, policy organisations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research and Evaluation II instrument. The benefits of prenatal physical activity are moderate and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end users indicated that following these recommendations would be feasible, acceptable and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.
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Objective To examine the influence of prenatal exercise on depression and anxiety during pregnancy and the postpartum period. Design Systematic review with random effects meta-analysis and meta-regression. Data sources Online databases were searched up to 6 January 2017. Study eligibility criteria Studies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcome (prenatal or postnatal depression or anxiety). Results A total of 52 studies (n=131 406) were included. ‘Moderate’ quality evidence from randomised controlled trials (RCTs) revealed that exercise-only interventions, but not exercise+cointerventions, reduced the severity of prenatal depressive symptoms (13 RCTs, n=1076; standardised mean difference: −0.38, 95% CI −0.51 to –0.25, I ² =10%) and the odds of prenatal depression by 67% (5 RCTs, n=683; OR: 0.33, 95% CI 0.21 to 0.53, I ² =0%) compared with no exercise. Prenatal exercise did not alter the odds of postpartum depression or the severity of depressive symptoms, nor anxiety or anxiety symptoms during or following pregnancy. To achieve at least a moderate effect size in the reduction of the severity of prenatal depressive symptoms, pregnant women needed to accumulate at least 644 MET-min/week of exercise (eg, 150 min of moderate intensity exercise, such as brisk walking, water aerobics, stationary cycling, resistance training). Summary/Conclusions Prenatal exercise reduced the odds and severity of prenatal depression.
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PurposeQuality of life (QoL) measurement relies upon participants providing meaningful responses, but not all respondents may pay sufficient attention when completing self-reported QoL measures. This study examined the impact of careless responding on the reliability and validity of Internet-based QoL assessments. Methods Internet panelists (n = 2000) completed Patient-Reported Outcomes Measurement Information System (PROMIS®) short-forms (depression, fatigue, pain impact, applied cognitive abilities) and single-item QoL measures (global health, pain intensity) as part of a larger survey that included multiple checks of whether participants paid attention to the items. Latent class analysis was used to identify groups of non-careless and careless responders from the attentiveness checks. Analyses compared psychometric properties of the QoL measures (reliability of PROMIS short-forms, correlations among QoL scores, “known-groups” validity) between non-careless and careless responder groups. Whether person-fit statistics derived from PROMIS measures accurately discriminated careless and non-careless responders was also examined. ResultsAbout 7.4% of participants were classified as careless responders. No substantial differences in the reliability of PROMIS measures between non-careless and careless responder groups were observed. However, careless responding meaningfully and significantly affected the correlations among QoL domains, as well as the magnitude of differences in QoL between medical and disability groups (presence or absence of disability, depression diagnosis, chronic pain diagnosis). Person-fit statistics significantly and moderately distinguished between non-careless and careless responders. Conclusions The results support the importance of identifying and screening out careless responders to ensure high-quality self-report data in Internet-based QoL research.
Article
Perinatal depression is the most common obstetric complication in the United States, with prevalence rates of 15% to 20% among new mothers. Untreated, it can adversly affect the well-being of children and families throught increasing the risk for costly complications during birth and lead to deterioration of core supports, including partner relationships and social networks. Perinatal depression contributes to long-lasting, and even permanent, consequences for the physical and mental health of parents and children, including poor family functioning, increased risk of child abuse and neglect, delayed infant development, perinatal obstetric complications, challenges with breastfeeding, and costly increases in health care use. Perinatal depression can interfere with early parent-infant interaction and attachment, leading to potentially long-term disturbances in the child's physical, emotional, cognitive, and social development. Fortunately, perinatal depression is identifiable and treatable. The US Preventive Services Task Force, Centers for Medicare and Medicaid Services, and many professional organizations recommend routine universal screening for perinatal depression in women to facilitate early evidence-based treatment and referrals, if necessary. Despite significant gains in screening rates from 2004 to 2013, a minority of pediatricians routinely screen for postpartum depression, and many mothers are still not identified or treated. Pediatric primary care clinicians, with a core mission of promoting child and family health, are in an ideal position to implement routine postpartum depression screens at several well-child visits throughout infancy and to provide mental health support through referrals and/or the interdisciplinary services of a pediatric patient-centered medical home model.
Article
Objective: The objective is to provide guidance for pregnant women, and obstetric care and exercise professionals, on prenatal physical activity. Outcomes: The outcomes evaluated were maternal, fetal, or neonatal morbidity or fetal mortality during and following pregnancy. Evidence: Literature was retrieved through searches of Medline, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus and Web of Science Core Collection, CINAHL Plus with Full-text, Child Development & Adolescent Studies, ERIC, Sport Discus, ClinicalTrials.gov, and the Trip Database from database inception up to January 5, 2017. Primary studies of any design were eligible, except case studies. Results were limited to English, Spanish, or French language materials. Articles related to maternal physical activity during pregnancy reporting on maternal, fetal, or neonatal morbidity or fetal mortality were eligible for inclusion. The quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Values: The Guidelines Consensus Panel solicited feedback from end-users (obstetric care providers, exercise professionals, researchers, policy organizations, and pregnant and postpartum women). The development of these guidelines followed the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument. Benefits, harms, and costs: The benefits of prenatal physical activity are moderate, and no harms were identified; therefore, the difference between desirable and undesirable consequences (net benefit) is expected to be moderate. The majority of stakeholders and end-users indicated that following these recommendations would be feasible, acceptable, and equitable. Following these recommendations is likely to require minimal resources from both individual and health systems perspectives.
Article
Objective: To examine the influence of exercise on depressive symptoms and the prevalence of depression in the postpartum period. Data sources: A structured search of MEDLINE, EMBASE, CINAHL, Sport Discus, Ovid's All EBM Reviews, and ClinicalTrials.gov databases was performed with dates from the beginning of the databases until June 16, 2016. The search combined keywords and MeSH-like terms including, but not limited to, "exercise," "postpartum," "depression," and "randomized controlled trial." Methods of study selection: Randomized controlled trials comparing postpartum exercise (structured, planned, repetitive physical activity) with the standard care for which outcomes assessing depressive symptoms or depressive episodes (as defined by trial authors) were assessed. Trials were identified as prevention trials (women from the general postpartum population) or treatment trials (women were classified as having depression by the trial authors). Effect sizes with 95% confidence intervals (CIs) were calculated using Hedges' g method and standardized mean differences in postintervention depression outcomes were pooled using a random-effects model. Tabulation, integration, and results: Across all 16 trials (1,327 women), the pooled standardized mean difference was -0.34 (95% CI -0.50 to -0.19, I=37%), suggesting a small effect of exercise among all postpartum women on depressive symptoms. Among the 10 treatment trials, a moderate effect size of exercise on depressive symptoms was found (standardized mean difference-0.48, 95% CI -0.73 to -0.22, I=42%). In six prevention trials, a small effect (standardized mean difference-0.22, 95% CI -0.36 to -0.08, I=2%) was found. In women with depression preintervention, exercise increased the odds of resolving depression postintervention by 54% (odds ratio 0.46, Mantel-Haenszel method, 95% CI 0.25-0.84, I=0%). The trials included in this meta-analysis were small and some had methodologic limitations. Conclusion: Light-to-moderate intensity aerobic exercise improves mild-to-moderate depressive symptoms and increases the likelihood that mild-to-moderate depression will resolve.