ArticlePDF Available

Abstract and Figures

The present study explored and compared the link between resilience and pregnancy-related stress, perceived stress, and anxiety, employing two structural equation models. One model focused on pregnant women before the outbreak of the pandemic, and the other on pregnancies throughout the pandemic. For this purpose, a total sample of 690 women during their pregnancy were collected: the Pre-Pandemic Group (P-PG) was composed of 341 pregnant women evaluated prior to the pandemic; and 349 pregnant women assessed at the time of the pandemic constituted the Pandemic Group (PG). The resilience, pregnancy-related stress, perceived stress, and anxiety symptomatology of the women were assessed. For both samples, resilience was found to lower levels of pregnancy-specific stress, as well as general perceived stress, and anxiety symptomatology. Furthermore, pregnancy-specific stress and perceived stress showed a covariance relationship and, that these, in turn, increased the anxiety. Moreover, the PG showed greater levels of pregnancy-specific stress, anxiety, somatisa-tions, and obsessions-compulsions, while the P-PG presented higher perceived stress levels.
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Current Psychology
https://doi.org/10.1007/s12144-022-03305-6
Resilience, stress andanxiety inpregnancy beforeandthroughoutthe
pandemic: astructural equation modelling approach
JoseA.Puertas‑Gonzalez1,2· CarolinaMariño‑Narvaez1· BorjaRomero‑Gonzalez3· RaquelVilar‑López1,2·
MariaIsabelPeralta‑Ramirez1,2
Accepted: 2 June 2022
© The Author(s) 2022
Abstract
The present study explored and compared the link between resilience and pregnancy-related stress, perceived stress, and
anxiety, employing two structural equation models. One model focused on pregnant women before the outbreak of the
pandemic, and the other on pregnancies throughout the pandemic. For this purpose, a total sample of 690 women during
their pregnancy were collected: the Pre-Pandemic Group (P-PG) was composed of 341 pregnant women evaluated prior to
the pandemic; and 349 pregnant women assessed at the time of the pandemic constituted the Pandemic Group (PG). The
resilience, pregnancy-related stress, perceived stress, and anxiety symptomatology of the women were assessed. For both
samples, resilience was found to lower levels of pregnancy-specific stress, as well as general perceived stress, and anxiety
symptomatology. Furthermore, pregnancy-specific stress and perceived stress showed a covariance relationship and, that
these, in turn, increased the anxiety. Moreover, the PG showed greater levels of pregnancy-specific stress, anxiety, somatisa-
tions, and obsessions-compulsions, while the P-PG presented higher perceived stress levels.
Keywords SEM· Pandemic· COVID-19· Pregnancy· Resilience· Stress· Anxiety
Introduction
Due to COVID-19, a worldwide pandemic was announced
to start in the month of March 2020 (WHO, 2020). Because
of the health threat, economic ramifications, and disruption
of everyday routines, the COVID-19 has had an enormous
impact on individuals and can be considered a worldwide
stressor. In addition to the death toll, the pandemic has
caused widespread agitation and concern among the general
population, due to fears of contagion and its consequences,
bringing about a rise in various psychopathological symp-
toms such as anxiety (Wang etal., 2020).
A particularly vulnerable population group is pregnant
women. Indeed, their levels of pregnancy-specific stress, as
well as general stress and anxiety were found to have increased
(Boekhorst etal., 2021; Lebel etal., 2020; Medina-Jimenez
etal., 2020; Romero-Gonzalez etal., 2021). Pregnancy-related
stress along with general stress has a strong comorbidity
during pregnancy (Alderdice etal., 2012; Romero-Gonzalez
etal., 2020a), and were also shown to be predictors of
psychopathological symptomatology, including anxiety, at
various times during pregnancy, before and at the time of
the pandemic (Moyer etal., 2020; Peñacoba-Puente etal.,
2016; Romero-Gonzalez etal., 2020a). This symptomatology,
when suffered persistently throughout pregnancy, raises the
probability of developing postpartum depression, as well as
the risk of preeclampsia and hypertension, miscarriages, the
need for instrumented deliveries, preterm births, low birth
weight and low scores on the Apgar test (Accortt etal., 2015;
Bayrampour etal., 2016; Caparros-Gonzalez etal., 2017;
Coussons-Read, 2013; Qu etal., 2017; Rondó etal., 2003;
Romero-Gonzalez etal., 2019; Stein etal., 2014). Moreover,
those symptoms could impact on the mother's state of mind
and on the development of the foetus because they can lead
to alterations regarding physical activity, nutrition and sleep
* Borja Romero-Gonzalez
borja.romero@uva.es
1 Mind, Brain andBehaviour Research Center (CIMCYC),
Granada, Spain
2 Personality, Assessment andPsychological Treatment
Department, Faculty ofPsychology, University ofGranada,
Granada, Spain
3 Psychology Department, Faculty ofEducation, University
ofValladolid, Campus Duques de Soria, Soria, Spain
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
(Coussons-Read, 2013). Furthermore, offspring of women
that experience large amounts of stress at the time of their
pregnancy have a greater likelihood of developing both
cognitive and behavioural deficits, and an increased likelihood
of suffering from mental health problems further on in life
(Glover, 2014; MacKinnon etal., 2018; Van den Bergh etal.,
2018,2020).
Given such negative consequences, resilience acts as
an important buffer against psychological distress both
in the population in general (Oken etal., 2015), and
in women during their pregnancy (García-León etal.,
2019). Resilience indeed represents an individual’s
set of personal resources allowing them to optimally
face stressors and difficulties (Fletcher & Sarkar, 2013;
Newman, 2005). Thus, several investigations have
discovered a negative association between resilience and
anxiety during pregnancy (Lubián López etal., 2021),
and between resilience towards stress and anxiety in
other populations at the time of the pandemic (Braun-
Lewensohn etal., 2021; Satici etal., 2020: Wang etal.,
2021). Additionally, previous researches carried out before
the pandemic have proven the protective role of resilience
regarding these variables in the perinatal stage (Armans
etal., 2020; García-León etal., 2019).
Nevertheless, to date no study has analysed and compared
resilience's position as a buffer for psychological stress and
anxiety in pregnant women at two different moments in time:
before society faced a devastating event such as the COVID-
19 pandemic, and when it erupted. Hence, the purpose of
this investigation was to explore and compare the link of
resilience to general perceived stress, pregnancy-specific
stress and anxiety, and to study the relationships of these
variables, using two structural equation models. The first
model focused on pregnant women before the pandemic,
and the second on women that were pregnant at the time of
the COVID-19.
The first hypothesis of the structural equation models is
that resilience negatively influences pregnancy-related stress,
and also perceived stress and anxiety symptomatology.
A second hypothesis is that pregnancy-related stress and
perceived stress present a correlation and these, in turn, posi-
tively influence anxiety symptomatology.
Finally, if the hypothesised models present a good fit, the
variables included in the samples will be compared to check
whetherthere are differences between the two groups.
Methods
Participants
The sample was composed of 690 pregnant women, which
were split into two different subgroups: Pre-Pandemic Group
(P-PG), formed by 341 (49.4%) pregnant women evaluated
before the COVID-19 pandemic (mean age = 33.35, SD = 4.53),
and Pandemic Group (PG), made up of 349 (49.6%) pregnant
women assessed throughout the pandemic (mean age = 33.9,
SD = 4.15).
All participants included in the research were briefed on
the procedure and objectives and participated on a voluntary
basis. The following were the conditions for participating in
the study: knowing how to write and read properly in Span-
ish; being at least 18years old; and being pregnant. On the
other hand, the exclusion criterion was active treatment with
psychopharmaceuticals.
The present research was approved by the ethics commit-
tee of the University of Granada (reference 881; and refer-
ence 1518/CEIH/2020).
Instruments
Obstetric and socio-demographic variables were gathered
and, in parallel, the subsequent psychological assessment
tools were applied:
The Connor-Davidson Resilience Scale (CD-RISC) (Connor
& Davidson, 2003) in the Spanish abbreviated form (Notario-
Pacheco etal., 2011): it was employed to estimate the level
of resilience. It measures the ability to deal with different
life circumstances such as diseases, changes, stress, failures,
personal difficulties and feelings of grief. It is responded on
a Likert scale with 5 alternatives from 0 = "almost never" to
4 = "almost always", and is composed as a set of 10 items.
The Cronbach’s alpha was 0.88 in this research.
The Perceived Stress Scale (PSS) (Cohen etal., 1983;
Spanish validation by Remor, 2006): this instrument reports
on perceived general stress in the past month. PSS provides
scores between 0 and 56 (greater ratings indicate greater
perceived stress) and it is made up of 14 items scored on
a 5-point Likert scale (“very often”, “often”, “once in a
while”, “almost never”, “never”). Its Cronbach’s alpha was
0.73 in this research.
The Prenatal Distress Questionnaire (PDQ) (Yali &
Lobel, 1999; Spanish validation by Caparros-Gonzalez
etal., 2019): the PDQ consists of a scale of 12 items for
evaluating pregnancy-related stress (g., worries regarding
health problems, childbirth, body symptoms, corporal
alterations and/or the baby's general health). The answers of
this instrument are provided through a Likert-type scale from
0 = “not at all” to 4 = ” very much”. Its Cronbach’s alpha was
0.77 in this study.
The Symptom Checklist-90-Revised (SCL-90-R) (Derogatis,
1994; Spanish validation by Caparrós-Caparrós etal., 2007):
were applied to measure the level of anxiety symptoms.
Specifically, the scales in this instrument assessing anxiety
disorders are the obsessions and compulsions dimension,
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
the anxiety dimension and the phobic anxiety dimension.
These use a Likert scale with 5 answer alternatives from
0 = “never” to 4 = ” extremely”. In addition, we added the
somatisation scale because of their link with anxiety and the
other measures included in the models. Thus, some studies
have shown that COVID-19 has enhanced somatisations
along anxiety in the population as a whole (Wang etal.,
2020), while other pre-pandemic research focusing on
pregnant women found correlations between resilience
and stress with somatisations and anxiety (García-León
etal., 2019; Scharlau etal., 2018). The 4 dimensions had
an acceptable reliability, the Cronbach’s alpha ranging from
0.75 to 0.84 for all four dimensions in this study.
Procedure
The two groups of participants in this research were enlisted
at the San Cecilio University Hospital and at the Góngora and
Mirasierra health centres in Granada, Spain. When potential
participants went to their appointment with the midwife for
their pregnancy follow-up, they were provided with study infor-
mation and were offered the possibility to participate in the
research. Subsequently, the contact information of the women
that agreed to their participation in the research were collected
and the survey questionnaires were submitted to them online.
The questionnaires were all done through Google Forms. At
that time, they were also asked to inform us of any potential
persons interested in participating to include them in the study.
The P-PG participants were recruited and evaluated
between late 2017 and early 2020, as they formed part of
an earlier research study entitled Gestastress. In addition
to the recruitment through their medical practitioners,
PG members were also captured through several social
media networks of pregnant women (via internet forums,
WhatsApp and Facebook) and assessed between March 2020
and March 2021 at the time of the pandemic. Other studies
have used two groups from different years to evaluate the
worldwide pandemic disease's impact on prenatal mental
health (Puertas-Gonzalez, etal., 2021; Zanardo etal., 2020).
Data analysis
First, the two groups were compared to examine if they
were evenly homogeneous in relation to primary sociode-
mographic and obstetrical characteristics. For continuous
variables, t-test was applied while the Chi-square test was
performed in order to analyse qualitative variables.
Subsequently, with the aim of checking whether the latent
variable presented an adequate goodness-of-fit for constitu-
ent factors (anxiety, phobic anxiety, somatisation and obses-
sive–compulsive) in both groups, preliminary confirmatory
factor analyses (CFA) were carried out. The factor load
for each factor was set to at least 0.50, in order to ensure
a good fit (Hair etal., 1998). Additionally, before carrying
out the Structural Equation Modelling (SEM), zero-order
correlations between all variables in the models were also
calculated.
Then, the SEM was performed with the Maximum Likeli-
hood Estimator (ML), considering the appropriate statisti-
cal requirements to be met to guarantee a good model fit.
Thus, for both models, cut-off points for the comparative
fit index (CFI) and the Tucker-Lewis index (TLI) were set
at > 0.95. While for the standardised root mean square resid-
ual (SRMR) was set at < 0.08 and for the root mean square
error of approximation (RMSEA) was also set at < 0.08 (Hu
& Bentler, 1999).
Finally, both groups were compared in relation to the
psychological variables measured. In addition, for continu-
ous variables in which statically significant discrepancies
were identified, the effect size was calculated on the basis of
Cohen’s d, and then interpreted according to values proposed
by Cohen (1988): large effect size (≥ 0.80); median effect
size (≥ 0.50); and small effect size (≥ 0.20).
For the CFA and SEM analysis, the software R 4.0.1 (R
Core Team, 2020) was used, implementing the “lavaan”
package (Rosseel, 2012).
Results
Sample description
Of the 341 participants who formed the P-PG, 20 (5.9%)
were in their first trimester of pregnancy (weeks 1–12), 175
(51.3%) in their second trimester (weeks 13–26), and 146
(42.8%) in their third trimester (weeks 27–40). In turn, of
the 349 participants in the PG group, 32 (9.3%) were in their
first trimester of pregnancy, 167 (47.9%) in their second tri-
mester, and 150 (43%) in their third trimester. No significant
differences were found regarding the P-PG and PG for the
primary socio-demographic and obstetric variables. These
results are set out in Table1.
Confirmatory factor analysis results
For each group, a CFA analysis was conducted to check
whether the latent variable of anxious symptomatology
showed adequate goodness of adjustment in terms of the
all factors that comprise it (anxiety, phobic anxiety, soma-
tisation and obsessive–compulsive). In relation to P-PG,
the CFA showed an acceptable fit for anxiety symptoma-
tology: χ2 = 6.032 with 2 degrees of freedom (p = 0.049);
CFI = 0.99; TLI = 0.96; RMSEA = 0.07 (90% CI: 0.04,
0.15; p = 0.195); SRMR = 0.02. With regard to PG a good
fit was also obtained: χ2 = 1.215 with 2 degrees of freedom
(p = 0.545); CFI = 1.00; TLI = 1.01; RMSEA = 0.01 (90%
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
CI: 0.01, 0.09; p = 0.763); SRMR = 0.01. In both groups with
standardized factor loadings for the four variables > 0.50.
Therefore, the latent variable of anxiety symptomatology
met the criteria for inclusion in the models for both groups.
Moreover, all observable variables were also subjected to
zero-order correlations (Fig.1).
Structural equation modelling results
In relation to the P-PG, the SEM model proposed presented
a good adjustment: χ2 = 20.020 with 11 degrees of free-
dom (p = 0.045); CFI = 0.99; TLI = 0.98; RMSEA = 0.05
(90% CI: 0.01, 0.08); SRMR = 0.03. Resilience variable
was shown to be negatively associated with anxiety symp-
toms (β = -0.29; SE = 0.07; p = 0.001). Further more, anxi-
ety symptoms were positively influenced by perceived stress
(β = 0.15; SE = 0.06; p = 0.003) and pregnancy-specific stress
(β = 0.29; SE = 0.07; p = 0.001). In turn, resilience negatively
influenced perceived stress (β = -0.16; SE = 0.06; p = 0.004)
and pregnancy-specific stress in the SEM (β = -0.33;
SE = 0.05; p = 0.001). Moreover, the perceived stress and the
pregnancy-specific stress presented a significant correlation
(φ = 0.13; SE = 0.05; p = 0.017). Finally, resilience indirectly
negatively influenced anxiety symptomatology through
perceived stress (β = -0.05; SE = 0.02; p = 0.012), as well
as through pregnancy-specific stress (β = -0.10; SE = 0.03;
p = 0.001). Thus, this model explained 28% of the variance,
through R2, of anxious symptomatology in pregnancy prior
the COVID-19 (Table2 and Fig.2).
With respect to the PG, the SEM model also presented
a good fit: χ2 = 31.574 with 11 degrees of freedom
(p = 0.001); CFI = 0.98; TLI = 0.96; RMSEA = 0.07 (90%
CI: 0.05, 0.10; p = 0.093); SRMR = 0.03. Anxiety symptoms
were negatively influenced by resilience (β = -0.18;
SE = 0.08; p = 0.023) and positively influenced by perceived
stress (β = 0.51; SE = 0.09; p = 0.001) and pregnancy-specific
stress (β = 0.24; SE = 0.08; p = 0.001). Moreover, resilience
presented a negative influence on the perceived stress
Table 1 Analysis of obstetric
and socio-demographic
variables
P-PG Pre-Pandemic Group, PG Pandemic Group
P-PG (n = 341)
M(SD)
PG (n = 349)
M(SD) t p
Age of participants 33.35 (4.53) 33.96 (4.15) 1.836 .067
P-PG (n = 341)
n(%)
PG (n = 349)
n(%) χ2p
Socio-demographic characteristic
Current partner No 8 (2.3%) 14 (4%) 1.550 .213
Yes 333 (97.7%) 335 (96%)
Nationality Spanish 293 (85.9%) 305 (87.4%) 1.364 .505
Inmigrant 48 (14.1%) 44 (12.6%)
Education level Primary school 5 (1.5%) 2 (0.6%) 3.892 .143
Secondary school 95 (27.9%) 80 (22.9%)
University 240 (70.6%) 267 (76.5%)
Obstetric information
Trimester of pregnancy 20 (5.9%) 32 (9.2%) 2.918 .232
175 (51.3%) 167 (47.9%)
146 (42.8%) 150 (43%)
Pregnancy method Spontaneous 298 (87.4%) 309 (88.5%) .215 .643
Fertility treatment 43 (12.6%) 40 (11.5%)
Previous miscarriages 0 202 (59.6%) 228 (65.3%) 8.921 .063
1 76 (22.3%) 84 (24.1%)
2 40 (11.7%) 25 (7.2%)
3 13 (3.8%) 6 (1.7%)
≥ 4 10 (2.9%) 6 (1.7%)
Previous children 0 192 (56.3%) 207 (59.3%) 5.521 .063
1 118 (34.6)% 126 (36.1%)
≥ 2 31 (9.1%) 16 (4.6%)
Primiparous No 179 (52.5%) 160 (45.8%) 3.049 .081
Yes 162 (47.5%) 189 (54.2%)
Risk pregnancy No 274 (80.4%) 274 (84.2%) 1.792 .181
Yes 67 (19.6%) 55 (15.8%)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
variable (β = -0.55; SE = 0.04; p = 0.001) and pregnancy-
specific stress (β = -0.38; SE = 0.05; p = 0.001). The latter
in turn showed a significant correlation (φ = 0.38; SE = 0.04;
p = 0.001). Finally, resilience negatively influenced
anxiety symptomatology indirectly for perceived stress
(β = -0.06; SE = 0.04; p = 0.026) and pregnancy-specific
stress (β = -0.05; SE = 0.03; p = 0.030). Overall, this model
explained 54% of the variance, through R2, of the anxious
symptoms in pregnancy at the time of the pandemic (Table2
and Fig.3).
Differences inresilience, anxiety symptomatology
andstress betweengroups
The comparative analysis between groups using Student's t
showed statistically significant differences regarding the SCL-
90-R dimensions: obsession-compulsion [t (688) = 2,589;
p = 0.010; d = 0.20], anxiety [t (679) = 3.059; p = 0.002;
d = 0.23] and somatisations [t (688) = 2.676; p = 0.008;
d = 0.20]. In addition, statistically significant differences were
found for pregnancy-specific stress [t (681) = 5,323; p = 0.001;
Fig. 1 Zero-ordered correlations for all observable variables in the
models of both groups. Note: Significant correlations at p < .05 are
highlighted in red (negative) or blue (positive); CD-RISC = Con-
nor Davidson Resilience Scale; PSS = Perceived Stress Scale;
PDQ = Pregnancy Distress Questionnaire.; ANX = SCL-90-R Anxi-
ety Dimension; OBS = SCL-90-R Obsession-Compulsion Dimension;
SOM = SCL-90-R Somatization Dimension; PHO = SCL -90-R Pho-
bic Anxiety Dimension
Table 2 Results of structural equation modelling
SE standard error, CD-RISC The Connor-Davidson Resilience Scale, PDQ The Pregnancy Distress Questionnaire, PSS The Perceived Stress Scale
* = ≤ .05; ** = p ≤ .01
Model β/ φ SE pχ2 df CFI TLI RMSEA SRMR R2
Model 1: Pre-Pandemic Group 20.020 11 0.99 0.98 0.05 0.03 0.28
CD-RISC PDQ -0.33 0.05 .001**
CD-RISC PSS -0.16 0.06 .004**
CD-RISC Anxiety -0.29 0.07 .001**
PDQ PSS 0.13 0.05 .017*
PDQ Anxiety 0.29 0.07 .001**
PSS Anxiety 0.15 0.06 .003**
CD-RISC PDQ Anxiety -0.10 0.03 .001**
CD-RISC PSS Anxiety -0.05 0.02 .012*
Model 2: Pandemic Group 31.574 11 0.98 0.96 0.07 0.03 0.54
CD-RISC PDQ -0.38 0.05 .001**
CD-RISC PSS -0.55 0.04 .001**
CD-RISC Anxiety -0.18 0.08 .023*
PDQ PSS 0.38 0.04 .001**
PDQ Anxiety 0.24 0.08 .001**
PSS Anxiety 0.51 0.09 .001**
CD-RISC PDQ Anxiety -0.05 0.03 .030*
CD-RISC PSS Anxiety -0.06 0.04 .026*
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
d = 0.41] and perceived stress [t (504) = -4.808; p = 0.001;
d = 0.36]. PG scored higher in all the above variables except
for perceived stress, where it scored lower than the P-PG.
However, there were no significant differences regarding P-PG
and PG on either the resilience variable or the phobic anxiety.
These results are set out in Table3.
Discussion
The objective of this study was to examine and compare
the association between pregnancy-related stress, anxi-
ety and resilience in pregnant women. For this aim, two
structural equation models were carried out, one with par-
ticipants prior to the pandemic and the other with women
whose pregnancies occurred during the pandemic. Two
hypotheses were raised. According to the first, resilience
would negatively influence perceived stress and preg-
nancy-related stress as well as anxiety symptomatology
in both groups. The second hypothesis was that, in turn,
perceived stress and pregnancy-specific stress would show
a positive relationship with anxiety symptomatology, and
the latter would present a covariance relationship. This
hypothesis was fulfilled, since all the relationships pro-
posed at the beginning were found in both groups, based
on the two structural equations models.
Fig. 2 Structural equation
model with standardized path
coefficients predicting anxiety
symptomatology in the Pre-
Pandemic Group. The statistical
values of the latent variable
anxiety symptomatology cor-
respond to the standardized
factor loadings of the indicators.
Note: *** p < .001; ** p < .01;
* p < .05
Fig. 3 Structural equation
model with standardized path
coefficients predicting anxiety
symptomatology in the Pan-
demic Group. The statistical
values of the latent variable
anxiety symptomatology cor-
respond to the standardized
factor loadings of the indicators.
Note: *** p < .001; ** p < .01;
* p < .05
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
In relation to the information provided by the structural
equations model of pregnant womenduring the pandemic,
resilience was found to present a negative relationship with
anxiety during pregnancy. These findings support those pre-
sented by Lubián López etal. (2021), in which they found
the same negative relationship in pregnant women. In addi-
tion, it is worth mentioning that our results are in line with
those of other authors who used structural equations mod-
els during the pandemic in other populations. Thus, they
are consistent with the results of Wang etal., 2021, which
found a direct negative relationship of resilience to stress
and anxiety in a sample of medical personnel in a hospital
in Wuhan, Hubei Province's provincial capital (China)—
the location of the first outbreak of COVID-19. They also
support the results of Rodríguez-Hidalgo etal. (2020), who
showed a direct relationship between stress and anxious
symptoms in university students throughout the COVID-
19, again through a structural equation model. Therefore,
the results demonstrate how resilience plays a protective role
in pregnant women in times of crisis in the face of stress,
pregnancy worries and anxiety symptomatology during
the pandemic. This may be because resilience is defined
as the psychological resources that allow a person to cope
optimally with changes and adversities (Fletcher & Sarkar,
2013; Newman, 2005), and resilient people would present
more adaptive coping. In turn, a deficit in personal resources
for coping with adversity would lead to greater levels of
psychological distress, leading to a sub-optimal adaptation
to changes arising from the pandemic, such as lockdowns
or mobility restrictions. These results imply that resilience
can prevent the long-term negative effects of psychological
stress and long-term anxiety, such as postpartum depression
or the baby’s low birth weight (Caparros-Gonzalez etal.,
2017; Coussons-Read, 2013; Rondó etal., 2003).
With respect to the results provided by the model of
pregnant womenbefore the pandemic, our findings also
globally support previous studies showing how resilience
can diminish stress as well as anxiety in the perinatal
stage (García-León etal., 2019). Thus, our findings are in
line with those provided by structural equation models in
other studies. For example, they support those found by
Armans etal. (2020), who showed that resilience negatively
influenced pregnancy-specific stress, or those found by
Peñacoba-Puente etal. (2016), which demonstrated how
pregnancy worries had an impact on anxiety symptoms
before the pandemic. The results provided by this model
showed that resilience also acts as abuffering factor in
relation to stress, pregnancy worries and anxious symptoms
in women during their pregnancy before the COVID-
19, and not only in times of crisis or great adversity.
Therefore, resilience is also a protector against daily
stress during pregnancy, e.g., attending follow-up medical
appointments, psychosocial changes such as sick leave,
delegating responsibilities regarding household tasks, etc.
Nevertheless, this is the first study conducted with pregnant
women before and at the time of the pandemic, and the first
to investigate the connection between these factors using
two structural equation models.
The results that showed an increased symptomatology
of anxiety and pregnancy-related stress during the COVID-
19 are in agreement with the studies that found such an
increase in pregnancy throughout the pandemic (Boekhorst
etal., 2021; Hessami etal., 2020; Lebel etal., 2020; Wu
etal., 2020). The increase in anxiety, as well as the increase
in prenatal worries, may be due to different factors arising
from the pandemic, such as: fear of the disease's spread and
possible negative effects on health and foetus; fear of losing
loved ones; financial worries and the loss of direct social
contacts due to the restrictions aimed at controlling conta-
gion (Wang etal., 2020).
Nevertheless, in our study, we found that pregnant women
before the pandemic reported greater levels of perceived
stress compared to pregnant women during the pandemic.
These results are contrary to those of Medina-Jimenez etal.
(2020), who had previously found increased stress in women
who were pregnant throughout the pandemic in Mexico. It
Table 3 Comparison of means
of psychological variables by
Student's t-test
P-PG Pre-Pandemic Group, PG Pandemic Group, CD-RISC The Connor-Davidson Resilience Scale,
PDQ The Pregnancy Distress Questionnaire, PSS The Perceived Stress Scale
* = ≤ .05; ** = p ≤ .01
P-PG (n = 341)
M(SD)
PG (n = 349)
M(SD) t p Cohen´s d
CD-RISC 28.14 (5.87) 27.58 (6.55) -1.194 .233 0.09
PSS 26.45 (4.40) 23.83 (9.16) -4.808 .001** 0.36
PDQ 14.54 (6.18) 17.22 (6.99) 5.323 .001** 0.41
SCL-90-R Anxiety 62.79 (29.28) 69.32 (26.71) 3.059 .002** 0.23
SCL-90-R Phobic anxiety 57.10 (35.99) 60.51 (34.74) 1.267 .206 0.10
SCL-90-R Obsession-compulsion 68.06 (26.90) 73.23 (25.55) 2.589 .010** 0.20
SCL-90–R Somatisation 61.44 (25.05) 66.52 (24.88) 2.676 .008* 0.20
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
is worth noting, however, that the present study has sub-
stantial differences with this latter one: the earlier investi-
gation did not involve a control group before the pandemic
and the present work was conducted in Spain, where the
restrictions and lockdowns to stop the contagion were dif-
ferent. In addition, in the current investigation, the sample
was recruited over a longer period during the pandemic. The
causes for the lower levels of perceived stress in pregnancies
throughout the pandemic may be multifactorial. One reason
for this decrease in stress may be the increase in time stayed
at home during periods of lockdown and the reduction of
daily stressors such as: visits to the supermarket and other
stores during the week; activities and/or presential courses;
presential work; events and/or social commitments, etc. On
the other hand, the promotion of teleworking and the flex-
ible hours that often result from it may also have contributed
to reducing the stress levels perceived by women pregnant
during the pandemic.
In general terms, resilience, pregnancy-specific stress,
and general stress better predicted the anxiety symptoma-
tology appearing in the wake of the pandemic. These results
may be due to differences with respect to these variables
between groups, as pregnant women at the time of the pan-
demic showed greater levels of pregnancy-specific stress,
anxiety, somatisation, obsessions-compulsions and similar
levels of resilience. Before the pandemic, however, the preg-
nant women showed greater levels of perceived stress. These
differences resulted not only in a stronger relationship in
the pandemic group between resilience and perceived stress,
but also between perceived stress and anxiety symptoms.
This could indicate that in the pre-pandemic group, there
could be other factors influencing perceived stress levels
that would not be influencing the pandemic group, e.g.
work stress, less time with a partner, less free time, etc. On
the other hand, the raised levels of anxiety in the pandemic
group could be a reflection of the increased pregnancy-spe-
cific stress found; as it has a stronger relationship with it
compared to the pre-pandemic group, and could be due to
pandemic-related concerns, such as fear of contagion and
disruption of the gestational process. Thus, while exhibiting
the same levels of resilience, variations in perceived stress
and pregnancy-related stress show that they are influenced
by different contextual factors in the two groups, reflecting
different relationships with resilience itself, as well as with
anxious symptoms.
A first conclusion is that resilience, stress and pregnancy
worries better explained anxiety symptoms during the
pandemic than before the pandemic. In addition, resilience
played an important buffer role against general stress,
pregnancy-related worries and anxiety symptomatology
at both moments in time. Second, the pandemic may
have increased pregnant women’s levels of anxiety and
pregnancy-specific stress because of infection fear and the
possible negative implications for them and their babies, in
addition to uncertainties regarding the future. On the other
hand, throughout the pandemic, women in the gestational
period had lower levels of perceived stress, possibly due
to reduced daily stress resulting from lockdowns and
restrictions and increased hours at home. Based on all
the above, this study has significant clinical implications:
it is necessary to promote tools that have been shown to
be effective at increasing resilience and reducing stress
in pregnant women, thus preventing increases in anxiety
symptoms in crisis situations (Puertas-Gonzalez etal., 2021;
Romero-Gonzalez etal., 2020b).
Strengths
A notable strength of this work was the inclusion of
two samples from two different temporal and contextual
moments (before and at the time of the pandemic).
Limitations
Despite the findings, there are some limitations to this
research. Firstly, as the instruments used for the assessment
were sent online to the participants and therefore there was
no control by a researcher at the time of completion, we
cannot ensure that all questionnaires have been completed
by pregnant women. However, as participants were not paid
or rewarded for completing the questionnaire, and as it was a
long questionnaire with a duration of 30–40minutes, it was
assumed that the people who completed the questionnaire
were pregnant women. Secondly, no participant follow up
was conducted to verify whether the results persisted over
other periods, for example, during the postpartum period, so
we propose this for future research.
Finally, given that we have demonstrated relationships
between resilience and stress and anxiety in pregnancy, both
in crisis situations and in normal life contexts, it would be
highly interesting for future studies to test whether these
relationships are the same for each trimester of pregnancy,
as this would have implications for planning a specific
psychological intervention for this population.
Acknowledgements Thank you to every pregnant woman who
participated in the study and thanks to Alvaro Lozano-Ruiz for his
advice on the design of the models.This study is part of the Doctoral
Thesis of Mr. Jose A. Puertas-Gonzalez.
Author Contributions JAP-G: Conceptualisation, methodology,
data collecting, formal analysis, writing the original draft, review
and editing the manuscript. CM-N: Methodology, data collecting.
BR-G: Data collecting, review and revise the manuscript. RV-L:
Conceptualisation, data collecting. MIP-R: Acquisition of funding,
conceptualisation, review and monitoring.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
Funding Open Access funding provided thanks to the CRUE-CSIC
agreement with Springer Nature.
Data Availability The datasets generated during and/or analysed dur-
ing the current study are available from the corresponding author on
reasonable request.
Declarations
Conflict of interest On behalf of all authors, the corresponding author
states that there is no conflict of interest.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
References
Accortt, E. E., Cheadle, A. C. D., & Dunkel Schetter, C. (2015). Prena-
tal depression and adverse birth outcomes: An updated systematic
review. In Maternal and child health journal (Vol. 19, Issue 6).
Springer US. https:// doi. org/ 10. 1007/ s10995- 014- 1637-2
Alderdice, F., Lynn, F., & Lobel, M. (2012). A review and psychomet-
ric evaluation of pregnancy-specific stress measures. Journal of
Psychosomatic Obstetrics & Gynecology, 33(2), 62–77. https://
doi. org/ 10. 3109/ 01674 82X. 2012. 673040
Armans, M., Addante, S., Ciciolla, L., Anderson, M., & Shreffler, K.
M. (2020). Resilience during pregnancy: How early life expe-
riences are associated with pregnancy-specific stress. Adversity
and Resilience Science, 1(4), 295–305. https:// doi. org/ 10. 1007/
s42844- 020- 00017-3
Bayrampour, H., Tomfohr, L., & Tough, S. (2016). Trajectories of peri-
natal depressive and anxiety symptoms in a community cohort.
Journal of Clinical Psychiatry, 77(11), e1467–e1473. https:// doi.
org/ 10. 4088/ JCP. 15m10 176
Boekhorst, M. G. B. M., Muskens, L., Hulsbosch, L. P., Van Deun, K.,
Bergink, V., Pop, V. J. M., & van den Heuvel, M. I. (2021). The
COVID-19 outbreak increases maternal stress during pregnancy, but
not the risk for postpartum depression. Archives of Women’s Mental
Health, 0123456789.https:// doi. org/ 10. 1007/ s00737- 021- 01104-9
Braun-Lewensohn, O., Abu-Kaf, S., & Kalagy, T. (2021). Hope and
resilience during a pandemic among three cultural groups in
Israel: The second wave of Covid-19. Frontiers in Psychology,
12(February), 1–12. https:// doi. org/ 10. 3389/ fpsyg. 2021. 637349
Caparrós-Caparrós, B., Villar-Hoz, E., Juan-Ferrer, J., & Viñas-Poch,
F. (2007). Symptom Check-List-90-R: fiabilidad, datos norma-
tivos y estructura factorial en estudiantes universitarios. In ©
International Journal of Clinical and Health Psychology (Vol. 7).
Caparros-Gonzalez, R. A., Romero-Gonzalez, B., Strivens-Vilchez, H.,
Gonzalez-Perez, R., Martinez-Augustin, O., & Peralta-Ramirez, M.
I. (2017). Hair cortisol levels, psychological stress and psychopatho-
logical symptoms as predictors of postpartum depression. PLoS ONE,
12(8), e0182817. https:// doi. org/ 10. 1371/ journ al. pone. 01828 17
Caparros-Gonzalez, R. A., Perra, O., Alderdice, F., Lynn, F., Lobel,
M., García-García, I., & Peralta-Ramírez, M. I. (2019). Psycho-
metric validation of the Prenatal Distress Questionnaire (PDQ) in
pregnant women in Spain. Women and Health, 59(8), 937–952.
https:// doi. org/ 10. 1080/ 03630 242. 2019. 15841 43
Cohen, J. (1988). 2.2. The Effect Size Index: d. In Statistical Power
Analysis for the Behavioral Sciences.Erlbaum.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure
of perceived stress. Journal of Health and Social Behavior, 24(4),
385–396. https:// doi. org/ 10. 2307/ 21364 04
Connor, K. M., & Davidson, J. R. T. (2003). Development of a new
resilience scale: The Connor-Davidson Resilience scale (CD-
RISC). Depression and Anxiety. https:// doi. org/ 10. 1002/ da. 10113
Coussons-Read, M. E. (2013). Effects of prenatal stress on pregnancy
and human development: Mechanisms and pathways. In Obstetric
medicine (Vol. 6, Issue 2, pp. 52–57). Royal Society of Medicine
Press Ltd. https:// doi. org/ 10. 1177/ 17534 95X12 473751
Derogatis, L. R. (1994). Symptom Checklist-90-R (SCL-90-R): Admin-
istration, scoring, and procedures manual (3rd ed.). NCS Pearson.
Fletcher, D., & Sarkar, M. (2013). Psychological resilience: A review
and critique of definitions, concepts, and theory. European Psy-
chologist, 18(1), 12–23. https:// doi. org/ 10. 1027/ 1016- 9040/ a0001
24
García-León, M. Á., Caparrós-González, R. A., Romero-González,
B., González-Perez, R., & Peralta-Ramírez, I. (2019). Resil-
ience as a protective factor in pregnancy and puerperium: Its
relationship with the psychological state, and with hair cortisol
concentrations. Midwifery. https:// doi. org/ 10. 1016/j. midw. 2019.
05. 006
Glover, V. (2014). Maternal depression, anxiety and stress during
pregnancy and child outcome; What needs to be done. Best
Practice and Research: Clinical Obstetrics and Gynaecology,
28(1), 25–35. https:// doi. org/ 10. 1016/j. bpobg yn. 2013. 08. 017
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham,
R. L. (1998).Multivariate data analysis(Vol. 5, No. 3, pp.
207–219). Prentice hall.
Hessami, K., Romanelli, C., Chiurazzi, M., & Cozzolino, M. (2020).
COVID-19 pandemic and maternal mental health: a systematic
review and meta-analysis. Journal of Maternal-Fetal and Neo-
natal Medicine, 1–8.https:// doi. org/ 10. 1080/ 14767 058. 2020.
18431 55
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in
covariance structure analysis: Conventional criteria versus new
alternatives. Structural Equation Modeling: A Multidisciplinary
Journal, 6(1), 1–55.
Lebel, C., MacKinnon, A., Bagshawe, M., Tomfohr-Madsen, L.,
& Giesbrecht, G. (2020). Elevated depression and anxiety
symptoms among pregnant individuals during the COVID-19
pandemic. Journal of Affective Disorders, 277(August), 5–13.
https:// doi. org/ 10. 1016/j. jad. 2020. 07. 126
Lubián López, D. M., Butrón Hinojo, C. A., Arjona Bernal, J. E.,
Fasero Laiz, M., Alcolea Santiago, J., Guerra Vilches, V.,
Casaus Fernández, M., Bueno Moral, A., Olvera Perdigones, A.,
Rodríguez Rodríguez, B., Cuevas Palomino, A., Presa Lorite,
J., Coronado Martín, P., Sánchez-Prieto, M., Sánchez-Borrego,
R., & González-Mesa, E. (2021). Resilience and psychologi-
cal distress in pregnant women during quarantine due to the
COVID-19 outbreak in Spain: A multicentre cross-sectional
online survey. Journal of Psychosomatic Obstetrics and Gyne-
cology, 42(2), 115–122. https:// doi. org/ 10. 1080/ 01674 82X.
2021. 18964 91
MacKinnon, N., Kingsbury, M., Mahedy, L., Evans, J., & Colman,
I. (2018). The association between prenatal stress and external-
izing symptoms in childhood: Evidence from the avon longitudi-
nal study of parents and children. Biological Psychiatry, 83(2),
100–108. https:// doi. org/ 10. 1016/j. biops ych. 2017. 07. 010
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
Medina-Jimenez, V., Bermudez-Rojas, M., de la, L., Murillo-Bargas,
H., Rivera-Camarillo, A. C., Muñoz-Acosta, J., Ramirez-Abarca,
T. G., Esparza-Valencia, D. M., Angeles-Torres, A. C., Lara-Avila,
L., Hernandez-Muñoz, V. A., Madrigal-Tejeda, F. J., Estudillo-
Jimenez, G. E., Jacobo-Enciso, L. M., Torres-Torres, J., Espino-
y-Sosa, S., Baltazar-Martinez, M., Villanueva-Calleja, J., Nava-
Sanchez, A. E., Mendoza-Carrera, C. E., … Martinez-Portilla, R.
J. (2020). The impact of the COVID-19 pandemic on depression
and stress levels in pregnant women: a national survey during
the COVID-19 pandemic in Mexico. Journal of Maternal-Fetal
and Neonatal Medicine, 1–3.https:// doi. org/ 10. 1080/ 14767 058.
2020. 18516 75
Moyer, C. A., Compton, S. D., Kaselitz, E., & Muzik, M. (2020). Preg-
nancy-related anxiety during COVID-19: A nationwide survey of
2740 pregnant women. Archives of Women’s Mental Health, 23(6),
757–765. https:// doi. org/ 10. 1007/ s00737- 020- 01073-5
Newman, R. (2005). APA’s resilience initiative. Professional Psychol-
ogy: Research and Practice, 36(3), 227–229. https:// doi. org/ 10.
1037/ 0735- 7028. 36.3. 227
Notario-Pacheco, B., Solera-Martínez, M., Serrano-Parra, M. D.,
Bartolomé-Gutiérrez, R., García-Campayo, J., & Martínez-
Vizcaíno, V. (2011). Reliability and validity of the Spanish
version of the 10-item Connor-Davidson Resilience Scale (10-
item CD-RISC) in young adults. Health and Quality of Life
Outcomes, 9(1), 63. https:// doi. org/ 10. 1186/ 1477- 7525-9- 63
Oken, B. S., Chamine, I., & Wakeland, W. (2015). A systems approach
to stress, stressors and resilience in humans. Behavioural Brain
Research, 282, 144–154. https:// doi. org/ 10. 1016/j. bbr. 2014. 12.
047
Peñacoba-Puente, C., Marín-Morales, D., Carmona-Monge, F. J., &
Velasco Furlong, L. (2016). Post-partum depression, personality,
and cognitive-emotional factors: A longitudinal study on Spanish
pregnant women. Health Care for Women International, 37(1),
97–117. https:// doi. org/ 10. 1080/ 07399 332. 2015. 10667 88
Puertas-Gonzalez, J. A., Romero-Gonzalez, B., Mariño-Narvaez,
C., Cruz-Martinez, M., & Peralta-Ramirez, M. I. (2021). La
terapia cognitiva-conductual como amortiguadora de los efectos
psicológicos negativos del confinamiento por la COVID-19 en
mujeres embarazadas. Revista Espanola de Salud Publica, 95.
Qu, F., Wu, Y., Zhu, Y. H., Barry, J., Ding, T., Baio, G., ... & Hardi-
man, P. J. (2017). The association between psychological stress
and miscarriage: a systematic review and meta-analysis. Scientific
reports, 7(1), 1–8.
R Core Team. (2020). R: a language and environment for statistical
computing. https:// www.R- proje ct. org/
Remor, E. (2006). Psychometric properties of a European Spanish
version of the Perceived Stress Scale (PSS). Spanish Journal of
Psychology, 9(1), 86–93. https:// doi. org/ 10. 1017/ S1138 74160
00060 04
Rodríguez-Hidalgo, A. J., Pantaleón, Y., Dios, I., & Falla, D. (2020).
Fear of COVID-19, stress, and anxiety in University Undergrad-
uate Students: A predictive model for depression. Frontiers in
Psychology, 11(November). https:// doi. org/ 10. 3389/ fpsyg. 2020.
591797
Romero-Gonzalez, B., Caparros-Gonzalez, R. A., Gonzalez-Perez, R.,
Coca-Arco, S., & Peralta-Ramirez, M. I. (2019). Hair cortisol lev-
els, psychological stress and psychopathological symptoms prior
to instrumental deliveries. Midwifery, 77, 45–52. https:// doi. org/
10. 1016/j. midw. 2019. 06. 015
Romero-Gonzalez, B., Caparros-Gonzalez, R. A., Gonzalez-Perez, R.,
Garcia-Leon, M. A., Arco-Garcia, L., & Peralta-Ramirez, M. I.
(2020a). “I am pregnant. Am I different?“: Psychopathology, psy-
chological stress and hair cortisol levels among pregnant and non-
pregnant women. Journal of Psychiatric Research, 131, 235–243.
https:// doi. org/ 10. 1016/j. jpsyc hires. 2020. 09. 023
Romero-Gonzalez, B., Puertas-Gonzalez, J. A., Strivens-Vilchez, H.,
Gonzalez-Perez, R., & Peralta-Ramirez, M. I. (2020b). Effects of
cognitive-behavioural therapy for stress management on stress and
hair cortisol levels in pregnant women: A randomised controlled
trial. Journal of Psychosomatic Research, 135(May), 110162.
https:// doi. org/ 10. 1016/j. jpsyc hores. 2020. 110162
Romero-Gonzalez, B., Puertas-Gonzalez, J. A., Mariño-Narvaez, C., &
Peralta-Ramirez, M. I. (2021). Confinement variables by COVID-
19 predictors of anxious and depressive symptoms in pregnant
women. Medicina Clínica (English Edition), 156(4), 172–176.
https:// doi. org/ 10. 1016/j. medcle. 2020. 10. 010
Rondó, P. H. C., Ferreira, R. F., Nogueira, F., Ribeiro, M. C. N.,
Lobert, H., & Artes, R. (2003). Maternal psychological stress
and distress as predictors of low birth weight, prematurity
and intrauterine growth retardation. European Journal of
Clinical Nutrition, 57(2), 266–272. https:// doi. org/ 10. 1038/
sj. ejcn. 16015 26
Rosseel, Y. (2012). Lavaan: An R package for structural equation mod-
eling and more. Version 0.5–12 (BETA). Journal of Statistical
Software, 48(2), 1–36. https:// doi. org/ 10. 18637/ jss. v048. i02
Satici, S. A., Kayis, A. R., Satici, B., Griffiths, M. D., & Can, G.
(2020). Resilience, hope, and subjective happiness among the
turkish population: Fear of COVID-19 as a mediator. Interna-
tional Journal of Mental Health and Addiction, 1–16.https:// doi.
org/ 10. 1007/ s11469- 020- 00443-5
Scharlau, F., Pietzner, D., Vogel, M., Gaudl, A., Ceglarek, U.,
Thiery, J., ... Kiess, W. (2018). Evaluation of hair cortisol and
cortisone change during pregnancy and the association with
self-reported depression, somatization, and stress symptoms.
Stress, 21(1), 43–50.https:// doi. org/ 10. 1080/ 10253 890. 2017.
13925 07
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A.,
McCallum, M., Howard, L. M., & Pariante, C. M. (2014). Effects
of perinatal mental disorders on the fetus and child. The Lancet,
384(9956), 1800–1819. https:// doi. org/ 10. 1016/ S0140- 6736(14)
61277-0
Van Den Bergh, B. R. H., Dahnke, R., & Mennes, M. (2018). Prenatal
stress and the developing brain: Risks for neurodevelopmental
disorders. Development and Psychopathology, 30(3), 743–762.
https:// doi. org/ 10. 1017/ S0954 57941 80003 42
Van den Bergh, B. R. H., van den Heuvel, M. I., Lahti, M., Braeken,
M., de Rooij, S. R., Entringer, S., Hoyer, D., Roseboom, T., Räik-
könen, K., King, S., & Schwab, M. (2020). Prenatal develop-
mental origins of behavior and mental health: The influence of
maternal stress in pregnancy. Neuroscience and Biobehavioral
Reviews, 117(July 2017), 26–64. https:// doi. org/ 10. 1016/j. neubi
orev. 2017. 07. 003
Wang, Y., Di, Y., Ye, J., & Wei, W. (2020). Study on the public psy-
chological states and its related factors during the outbreak of
coronavirus disease 2019 (COVID-19) in some regions of China.
Psychology, Health and Medicine. https:// doi. org/ 10. 1080/ 13548
506. 2020. 17468 17
Wang, J., Li, D., Bai, X., Cui, J., Yang, L., Mu, X., & Yang, R. (2021).
The physical and mental health of the medical staff in Wuhan
Huoshenshan Hospital during COVID-19 epidemic: A structural
equation modeling approach. European Journal of Integrative
Medicine, 44(March), 101323. https:// doi. org/ 10. 1016/j. eujim.
2021. 101323
World Health Organization. (2020). Statement on the second meet-
ing of the International Health Regulations (2005) Emergency
Committee regarding the outbreak of novel coronavirus (2019-
nCoV). https:// www. who. int/ news- room/ detail/ 30- 01- 2020-
state ment- on- the- second- meeti ng- of- the- inter natio nal- health-
regul ations- (2005)- emerg ency- commi ttee- regar ding- the- outbr
eak- of- novel- coron avirus- (2019- ncov). Accessed 4 June 2021.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Current Psychology
1 3
Wu, Y., Zhang, C., Liu, H., Duan, C., Li, C., Fan, J., Li, H., Chen, L.,
Xu, H., Li, X., Guo, Y., Wang, Y., Li, X., Li, J., Zhang, T., You,
Y., Li, H., Yang, S., Tao, X., … Huang, H. F. (2020). Perinatal
depressive and anxiety symptoms of pregnant women during the
coronavirus disease 2019 outbreak in China. American Journal
of Obstetrics and Gynecology, 223(2), 240.e1–240.e9.https:// doi.
org/ 10. 1016/j. ajog. 2020. 05. 009
Yali, A. M., & Lobel, M. (1999). Coping and distress in pregnancy: An
investigation of medically high risk women. Journal of Psycho-
somatic Obstetrics & Gynecology, 20(1), 39–52. https:// doi. org/
10. 3109/ 01674 82990 90755 75
Zanardo, V., Manghina, V., Giliberti, L., Vettore, M., Severino, L., &
Straface, G. (2020). Psychological impact of COVID-19 quarantine
measures in northeastern Italy on mothers in the immediate
postpartum period. International Journal of Gynecology and
Obstetrics, 150(2), 184–188. https:// doi. org/ 10. 1002/ ijgo. 13249
Publisher's note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
Article
Full-text available
The COVID-19 pandemic has affected the population's levels of stress and anxiety due to its contagious nature and the uncertainties generated by its novelty. One population that is especially vulnerable to these psychological consequences are pregnant women. This is why the objective of this study was to test the efficacy of an online stress management programme of a cognitive behavioural nature on pregnant women during the COVID-19 pandemic, in Spain. The trial was controlled and randomised, with a total of 207 pregnant women divided into three groups: the Online Cognitive Behavioural Therapy group (o-CBT) (N = 70); the Online Psychological Support group (o-PS) (N = 69); and the Usual Care group (UC) (N = 68). To test the therapy's efficacy, the women's resilience, perceived stress, pregnancy-specific stress and psychopathological symptoms were assessed before and after the intervention. The o-CBT and o-PS consisted of a programme of 8 group sessions (one per week). The results showed that pregnant women who participated in the o-CBT group presented lower rates of pregnancy-specific stress and perceived stress, as well as greater resilience and lower anxiety, depression and obsessions-compulsions symptoms. These data show the efficacy of the treatment programme and thus confirm the importance of implementing these types of interventions during a woman's pregnancy, especially over periods of major stress, such as during a pandemic.
Article
Full-text available
The COVID-19 pandemic affects society and may especially have an impact on mental health of vulnerable groups, such as perinatal women. This prospective cohort study of 669 participating women in the Netherlands compared perinatal symptoms of depression and stress during and before the pandemic. After a pilot in 2018, recruitment started on 7 January 2019. Up until 1 March 2020 (before the pandemic), 401 women completed questionnaires during pregnancy, of whom 250 also completed postpartum assessment. During the pandemic, 268 women filled out at least one questionnaire during pregnancy and 59 postpartum (1 March–14 May 2020). Pregnancy-specific stress increased significantly in women during the pandemic. We found no increase in depressive symptoms during pregnancy nor an increase in incidence of high levels of postpartum depressive symptoms during the pandemic. Clinicians should be aware of the potential for increased stress in pregnant women during the pandemic.
Article
Full-text available
Objective: The pandemic caused by COVID-19, at a psychological level, can cause an increase in levels of stress and anxiety due to the fear of contagion and its consequences. Pregnant women are especially vulnerable to these psychological consequences. Thus, the objective of this study was to verify the efficacy of a cognitive-behavioral stress control program in reducing psychological stress and increasing resilience in pregnant women, which ended at the begining of the confinement due to COVID-19 in Spain. Methods: The study included 22 pregnant women who were randomly divided into two groups: the experimental group (GT) consisted of 11 participants and the control group (GC) also consisted of 11 participants. Participants were recruited from the Hospital Universitario Clínico San Cecilio in the province of Granada (Spain), where the weekly cognitive behavioral intervention was also carried out, which was implemented between January 22 and March 11, 2020. They used the assessment instruments: Pregnancy Distress Questionnaire (PDQ), Perceived Stress Scale (EEP-14), Inventory of Vulnerability to Stress (IVE) and Connor Davidson Resilience Scale (CD-RISC). A mixed ANOVA of repeated measures 2*2 was performed, with the variable between groups having two levels (CG and GT), and the within-subject having two time periods (pre and post). Results: The repeated measures ANOVA analysis showed group*time interaction effects between the therapy group and the control group and the CD-RISC scores (F1,20=10.658; p<0.02). Intrasubject differences in CD-RISC scores were found in the (GT) (t=-2.529; p<0.05), with a moderate effect size. Conclusions: It can be affirmed that cognitive behavioral intervention in pregnant women, administrated prior to confinement in Spain and during the COVID-19 pandemic, has resulted in increased levels of resilience in this population.
Article
Full-text available
Background: The pandemic caused by COVID-19, at a psychological level, can cause an increase in levels of stress and anxiety due to the fear of contagion and its consequences. Pregnant women are especially vulnerable to these psychological consequences. Thus, the objective of this study was to verify the efficacy of a cognitive-be-havioral stress control program in reducing psychological stress and increasing resilience in pregnant women, which ended at the begining of the confinement due to COVID-19 in Spain. Methods: The study included 22 pregnant women who were randomly divided into two groups: the experimental group (GT) consisted of 11 participants and the control group (GC) also consisted of 11 participants. Participants were recruited from the Hospital Universitario Clínico San Cecilio in the province of Granada (Spain), where the weekly cognitive behavioral intervention was also carried out, which was implemented between January 22 and March 11, 2020. They used the assessment instruments: Pregnancy Distress Questionnaire (PDQ), Perceived Stress Scale (EEP-14), Inventory of Vulnerability to Stress (IVE) and Connor Davidson Resilience Scale (CD-RISC). A mixed ANOVA of repeated measures 2*2 was performed, with the variable between groups having two levels (CG and GT), and the within-subject having two time periods (pre and post). Results: The repeated measures ANOVA analysis showed group*time interaction effects between the therapy group and the control group and the CD-RISC scores (F1,20=10.658; p<0.02). Intrasubject differences in CDRISC scores were found in the (GT) (t=-2.529; p<0.05), with a moderate effect size. Conclusions: It can be affirmed that cognitive behavioral intervention in pregnant women, administrated prior to confinement in Spain and during the COVID-19 pandemic, has resulted in increased levels of resilience in this population.
Article
Full-text available
The aim of this study was to explore the coping resources of hope (Snyder, 1994) and sense of coherence (Antonovsky, 1987), which are rooted in positive-psychology theory, as potential resilience factors that might reduce the emotional distress experienced by adults from three cultural groups in Israel during the chronic-stress situation of a pandemic. The three cultural groups examined were secular Jews, Ultra-Orthodox Jews, and Arabs. We compared these cultural groups during the second wave of the Covid-19 pandemic, just before the Jewish New Year (mid-September 2020) as a second lockdown was announced. Data were gathered from 248 secular Jews, 243 Ultra-Orthodox Jews, and 203 Arabs, who were 18‒70 years old (M = 37.14, SD = 12.62). The participants filled out self-reported questionnaires including the Brief Symptom Inventory as a measure of emotional/psychological distress (i.e., somatization, depression, and anxiety) and questionnaires about sense of coherence and different types of hope (i.e., intrapersonal, interpersonal, and transpersonal) as measures of coping resources and resiliency. Differences were found between the three groups in terms of several variables. The Arab participants reported the highest levels of emotional distress and the lowest levels of interpersonal and transpersonal hope; whereas the Ultra-Orthodox participants revealed the highest levels of sense of coherence and other resilience factors. A structural equation model revealed that, in addition to the sociodemographic factors, only sense of coherence and intrapersonal hope played significant roles in explaining emotional distress, explaining 60% of the reported distress among secular Jews, 41% among Ultra-Orthodox Jews, and 48% among Arabs. We discuss our findings in light of the salutogenic and hope theories. We will also discuss their relevancy to meaning-seeking and self-transcendence theory in the three cultural groups.
Article
Full-text available
Background COVID-19 outbreak has been associated with a wide variety of psychiatric manifestations such as panic, anxiety, and depression. We aim to assess the impact of the COVID − 19 pandemic on the levels of stress and depression of pregnant women in Mexico. Methods A cross-sectional web survey was carried out in pregnant women in 10 states of the Mexican Republic during the COVID-19 pandemic among public and private hospitals. The perception of stress was assessed using the Perceived Stress Scale, while depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale. Results A total of 549 surveys were applied, of which 96.1% (n = 503) were included in the data analysis. The mean participant’s age was 28.1 years old. The mean perceived stress scale score was 24. 33.2% (n = 167) of participants had a score equal to 27 points or more and were considered highly stressed. The mean depression score was 9. A total of 17.5% (n = 88) participants had more than 14 points on the Edinburgh’s depression scale, and were considered depressed. Stress levels were higher at later gestational ages (p = .008). Conclusions COVID-19 pandemic has caused mental health issues in pregnant women reflected by high perceived stress levels and depression.
Article
Full-text available
Psychology deals with not only mental disorders but also psychological strengths within individuals. Psychological strengths will play an important role in struggling with the global novel coronavirus 2019 (COVID-19) pandemic. The present study tested a model concerning the relationship between resilience, hope, and subjective happiness using structural equation modeling to identify the mediating role of fear of COVID-19. A cross-sectional survey was conducted among a convenience sample of 971 Turkish individuals (aged 18 to 74 years) from 75 of 81 cities in Turkey. The survey included the Subjective Happiness Scale, Fear of COVID-19 Scale, Brief Resilience Scale, and the Dispositional Hope Scale, and data were analyzed using structural equation modeling (SEM). The SEM demonstrated an association between resilience–hope and subjective happiness was mediated by fear of COVID-19 (CMIN/df = 2.664, CFI = 0.994, NFI = 0.984, TLI = 0.984, GFI = 0.994, RMSEA = 0.044, SRMR = 0.024, AIC = 81.334, ECVI = 0.084). Resilience had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Hope also had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Consequently, in the fight against COVID-19, individuals who are resistant to stress and have a belief that they can find a way to cope can help prevent the fear of COVID-19 and so enhance good mental health.
Article
Full-text available
High levels of maternal pregnancy–specific stress are associated with an increased risk for adverse birth outcomes as well as anxiety and depression symptoms during and following pregnancy. There is evidence that early childhood experiences play an important role in maternal psychological health and well-being and may be important for shaping maternal vulnerability to pregnancy-specific stress. The current study examined the link between both maternal adverse childhood experiences (ACEs) and protective and compensatory experiences (PACEs) and pregnancy-specific stress and considered the mediating and moderating roles of resilience on these associations. Data came from a high-risk clinic cohort of 138 racially diverse pregnant women (ages 16–38). We found that resilience mediated the associations between PACEs and pregnancy-specific stress and moderated the association between ACEs and pregnancy-specific stress. In particular, high levels of resilience were protective against pregnancy-specific stress at low and moderate levels of ACEs. The findings highlight the importance of early childhood experiences on women’s well-being during pregnancy and demonstrate how both ACEs and PACEs contribute to and are protected by resilience.
Article
Full-text available
The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant women’s anxiety and identify factors most strongly associated with greater changes in anxiety. An anonymous, online, survey of pregnant women (distributed April 3–24, 2020) included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents’ perception of pregnancy anxiety before COVID-19 and a current assessment of pregnancy-related anxiety. The difference between these scores was used as the outcome variable. Data were analyzed using bivariate and multivariate linear regression analyses. Two thousand seven hundred forty pregnant women from 47 states completed the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415), and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-19. More than half of women reported increased stress about food running out (59.2%, N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare (56.3%, N = 1543). More than a third reported increasing stress about conflict between household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress about getting infected with COVID-19. Slightly less than half of respondents (either selves or family members) were healthcare workers (41.4%, N = 1133) or worked in essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant women’s mental health, and factors independent of pregnancy appear to be driving changes in pregnancy-specific anxiety.
Article
Purpose To examine the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women during the confinement due to the COVID-19 outbreak in Spain. Materials and methods Between 15 April and 14 May 2020, a multicentre cross-sectional survey was performed to study depression, anxiety and resilience in a sample of Spanish pregnant women during the lockdown set up by the Government in response to COVID-19 pandemic outbreak. We designed an anonymous online self-administered questionnaire (https://bit.ly/34RRpq1) that included the Spanish validated versions of the Edinburgh Postpartum Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI) and the Connor-Davidson Resilience 10-items Scale (CD-RISC-10). Results A total of 514 pregnant women completed the survey. 72.8% had been confined < 40 days and 27.2% between 41 and 60 days. 182 (35.4%) participants scored over 10, with 21.3% scoring over 13 (75th Percentile) in depressive symptoms rates. We found high trait and anxiety scores, with 223 (43.4%) and 227 (44.2%) pregnant women scoring over the trait and state mean scores. Neither depression, anxiety or resilience levels showed any significant correlation with the length of confinement. We found low CD-RISC-10 scores. Conclusions We found a high prevalence of depression and anxiety symptoms during the quarantine, although we did not find an increased prevalence of psychological distress according to length of home confinement. Resilience correlated negatively with depression and anxiety.
Article
Introduction Early in the epidemic of corona virus disease 2019, the Chinese government recruited a proportion of healthcare workers to support the designated hospital (Huoshenshan Hospital) in Wuhan, China. The majority of front-line medical staff suffered from adverse effects, but their real health status during COVID-19 epidemic was still unknown. The aim of the study was to explore the latent relationship of the physical and mental health of front-line medical staff during this special period. Methods A total of 115 military medical staff were recruited between February 17th and February 29th, 2020 and asked to complete questionnaires assessing socio-demographic and clinical characteristics, self-reported sleep status, fatigue, resilience and anxiety. Results 55 medical staff worked within Intensive Care and 60 worked in Non-intensive Care, the two groups were significantly different in general fatigue, physical fatigue and tenacity (P<0.05). Gender, duration working in Wuhan, current perceived stress level and health status had significant differences in fatigue scores (P<0.05), the current perceived health status (P<0.05) impacted on the resilience and anxiety of participants. The structural equation modeling analysis revealed resilience were negatively associated with fatigue (β=-0.52, P<0.01) and anxiety (β=-0.24, P<0.01), and fatigue had direct association with the physical burden (β=0.65, P<0.01); Fatigue mediated the relationship between resilience and anxiety (β=-0.305, P=0.039) as well as resilience and physical burden (β=-0.276, P=0.02). Conclusion During an explosive pandemic, motivating the effect of protective resilience and taking tailored interventions against fatigue are promising ways to protect the physical and mental health of the front-line medical staff.