Maternal Prenatal Somatization, Postnatal Depression, and Offspring Temperament During the COVID-19 Pandemic (preprint)

Background. Researchers have begun to examine the psychological toll of the ongoing global COVID-19 pandemic. Data are now emerging indicating that there may be long-term adverse effects of the pandemic on new mothers and on children born during this period. Methods. In a longitudinal study of maternal mental health and child emotional development during the pandemic, we conducted online assessments of a cohort of women at two time points: when they were pregnant at the beginning of the surge of the pandemic in the United States (N=725), and approximately one year postpartum (N=296), examining prenatal and postnatal maternal mental health symptoms and infant temperament. Results. Prenatal maternal symptoms of somatization, the number of people in the household with COVID-19 symptoms, and postnatal maternal depressive symptoms all were positively associated with infant negative affect. Further, postnatal maternal depressive symptoms mediated the relation between prenatal maternal symptoms of somatization and infant negative affect. Conclusions. These findings have important implications for our understanding of the persistence of mental health symptoms in potentially vulnerable groups and of the emotional development of children who were in utero during the COVID-19 pandemic.

COVID-19 Impacts on Perinatal Care and Maternal Mental Health: A Geotemporal Analysis of Healthcare Disruptions and Emotional Well-Being Across the United States (preprint)

Background: Adequate perinatal care is essential for maternal and infant health. The novel coronavirus (COVID-19) pandemic is potentially the largest natural disruption to perinatal care in recent history, but these disruptions have yet to be characterized in a rigorous and systematic manner. Our goal was to document COVID-19 induced disruptions to perinatal care across the United States (US) using analyses sensitive to the temporal and geographical variability of the pandemic, and to examine the impact of these healthcare disruptions on maternal mental health.Methods: We performed an observational cross-sectional study of 1,922 postpartum and 3,868 pregnant individuals during the 2020 COVID-19 pandemic. Perinatal individuals were recruited from 15 academic institutions across the US, resulting in a geographically diverse sample. We conducted (1) descriptive analyses on the prevalence and timing of perinatal care disruptions, (2) group difference analyses to compare perinatal care disruptions depending on when and where individuals gave birth, (3) cross correlations to assess the temporal linkage between perinatal care disruptions and COVID-19 infection rates, and (4) hierarchical linear regressions to evaluate the impact of prenatal care and birth protocol disruptions on maternal psychological health.Findings: The COVID-19 pandemic significantly altered perinatal care across the US, both through restriction of in-person support and by shifting the focus of care. These changes occurred unevenly over time and across geographic locations. Changes in COVID-19 infection rates explained 65 to 78% of the variance in perinatal care disruptions from August 2019 to August 2020. Moreover, disruptions to perinatal care were robustly associated with heightened psychological distress in mothers, even after controlling for mental health history, number of pregnancy complications, and general stress about the COVID-19 pandemic.Interpretation: Our analyses reveal widespread disruptions to perinatal care across the US that fluctuated depending on where and when individuals gave birth, demonstrating reactivity and elasticity of the US healthcare system. In addition to influencing health outcomes, disruptions to perinatal care may also exacerbate mental health concerns during the COVID-19 pandemic.Funding Information: This research was supported by the NYU COVID-19 Research Catalyst rant, R34DA050287-S1, R34DA050287-S2, R34DA050254-01S2, R01MH126468, R01MH125870, the Nathaniel Wharton Fund, the Columbia University Population Research Center, R34DA050255, R34DA050255-01S2, the Fralin Biomedical Research Institute at VTC, the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1TR003015 and KL2TR003016, the University of Utah Center for Clinical and Translational Science COVID-19 Research Award, Virginia Commonwealth University School of Nursing Internal Grants Program, Sarah P. Farrell Legacy Research Endowment-Virginia Commonwealth University, 5R03HD096141-02, R01HD085990, R34DA050283-01S2, the USC Center for the Changing Family, the Stanford Institute for Research in the Social Sciences, R34DA050291, R01MH119070, R01MH117177, R34 DA050272-01S1, R01 MH113883, R01 DA046224, R21 MH111978, and R21 HD090493, R37 MH10149, UH3OD023279, and National Center for Advancing Translational Sciences (NCATS) Grant UL1TR001881Declaration of Interests: The authors report no conflicts of interest.Ethics Approval Statement: This study has received Institutional Review Board approval from theNYU Langone Health IRB as well as the local IRBs at each data collection site. All data was collected in accordance with the Helsinki Declaration.

Testing a Developmental Model of Parental Warmth, Amygdala–Subgenual Anterior Cingulate Cortex Connectivity, and Depressive Symptoms in Adolescents During the COVID-19 Pandemic (preprint)

Background: Neurobiological measures may serve as predictive markers of risk for and resilience to depressive symptoms during the COVID-19 pandemic. We tested a developmental model linking variation in amygdala–subgenual anterior cingulate cortex (sgACC) resting-state connectivity both to earlier experiences in the family environment and to subsequent vulnerability to depressive symptoms during the pandemic. Methods: We used data from a longitudinal study that included three waves (N=214 adolescents; ages 9-15 years at Time 1 (T1), 11-17 years at Time 2 (T2), and 12-19 years during the pandemic at Time 3 [T3]). We assessed parental warmth (T1), depressive symptoms (T1 to T3), and functional connectivity between the sgACC and basolateral (BLA) and centromedial amygdala (CMA) (T1 and T2). We modeled associations among early parental warmth, amygdala–sgACC connectivity, and depressive symptoms before and during the pandemic. Results: Less parental warmth was associated prospectively with stronger BLA–sgACC connectivity approximately two years later (=-.23, p=.021) over and above the effect of BLA–sgACC connectivity at T1. Stronger BLA–sgACC connectivity, in turn, was associated with heightened depressive symptoms, both before (r=.21, p=.031) and during the pandemic (=.22, p=.031; independent of the effect of pre-pandemic symptoms). Conclusion: Adolescents who experience less parental warmth may develop a pattern of BLA–sgACC connectivity that increases their risk for mental health problems during the pandemic. BLA–sgACC connectivity in early to middle adolescence may be a predictive marker of risk for depressive symptoms in general and specifically during periods of heightened stress.

Behavioral coping phenotypes and psychosocial outcomes in a national U.S. sample of pregnant and postpartum women during the COVID-19 pandemic (preprint)

Maternal stress exposure during the COVID-19 pandemic may have transgenerational effects, adversely affecting both the pregnant woman and her offspring. Therefore, there is an urgent need to characterize the coping styles and psychosocial distress of pregnant and postpartum women during the COVID-19 pandemic to help mitigate lasting sequalae on both mothers and infants. Here we use latent profile analysis to examine patterns of behavioral coping strategies associated with risk and resiliency to adverse mental and physical health outcomes. Leveraging a large U.S. sample of perinatal women (N = 2,876 pregnant women, N = 1,536 postpartum women), we identified four behavioral phenotypes of coping strategies: (1) passive-coping, characterized by primarily engaging in high levels of screen time, social media use, and eating comfort foods; (2) active-coping, characterized by primarily engaging in high levels of self-care, social support, and limiting media exposure; (3) low-coping, characterized by low levels of all coping strategies; (4) high-coping, characterized by high levels of both active and passive coping strategies. Critically, we found that passive-coping phenotypes were associated with higher levels of depression and anxiety and worsening stress and energy levels in both pregnant and postpartum women. Supplementing passive coping strategies with high levels of active coping strategies (the high-coping profile) lessened adverse outcomes in postpartum women. These behavioral coping phenotypes highlight potential risk and protective factors for perinatal women, which is critical in helping to identify and treat perinatal women most at risk for experiencing mood and affective disorders resulting from the COVID-19 pandemic.

Pregnancy during the pandemic: The impact of COVID-19-related stress on risk for prenatal depression (preprint)

Pregnant women may be particularly sensitive to negative events (i.e., adversity) related to the COVID-19 pandemic and affective responses to these events (i.e., stress). We examined COVID-19-related stress and adversity in a sample of 725 pregnant women residing in the San Francisco Bay Area in March-May 2020, 343 of whom provided addresses in California that were geocoded and matched by census tract to measures of community-level risk factors. Women who were pregnant during the pandemic had substantially elevated depressive symptoms compared to matched women who were pregnant prior to the pandemic. Several individual- and community-level risk and protective factors were associated with women’s scores on two latent factors of COVID-19-related stress and adversity. Highlighting the role of subjective responses to the pandemic in vulnerability to prenatal depression and factors that influence susceptibility to COVID-19-related stress, these findings inform understanding of the psychosocial sequelae of disease outbreaks among pregnant women.

Heart Rate Variability Moderates the Effects of COVID-19-Related Stress and Family Adversity on Emotional Problems in Adolescents: Testing Models of Differential Susceptibility and Diathesis Stress (preprint)

The COVID-19 pandemic is a unique period of stress and uncertainty that will have significant implications for adolescent mental health. Nevertheless, stress about COVID-19 may be more consequential for some adolescents’ mental health than for others. We examined whether heart rate variability (HRV) indicated differential susceptibility to mental health difficulties associated with COVID-19 stress. Approximately four years prior to the pandemic, we assessed resting HRV and HRV reactivity to a well-validated stress paradigm in 87 adolescents. During the pandemic, these adolescents (ages 13-19) reported on their health-related stress and concerns about COVID-19 and their recent emotional problems. The association between COVID-19 stress and emotional problems was significantly stronger for adolescents who previously exhibited higher resting HRV or higher HRV reactivity. For adolescents who exhibited lower resting HRV or lower HRV reactivity, COVID-19 stress was not associated with emotional problems. Thus, parasympathetic functioning may reflect differential susceptibility to the effects of COVID-19 stress on mental health during the pandemic.

Early Life Stress Predicts Depressive Symptoms in Adolescents During the COVID-19 Pandemic: The Mediating Role of Perceived Stress (preprint)

Background: Exposure to early life stress (ELS) is alarmingly prevalent, and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression. Methods: We tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area (N=100; 43 male; ages 13-20 years) who had been characterized 4-7 years earlier (M=5.27, SD=0.75 years) with respect to exposure to ELS and symptoms of depression. Results: As expected, severity of ELS predicted levels of depressive symptoms during the pandemic (r(98)=0.25, p=.012), which were higher in females than in males (t(98)=-3.36, p=.001). Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic and other COVID-19-related variables. Conclusions: These findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress and isolation in high-risk youth.