The COVID-19 pandemic impacted maternal mental health differently depending on pregnancy status and trimester of gestation (preprint)

Introduction: We aimed to measure the impact of the COVID-19 pandemic on maternal mental health, stratifying on pregnancy status, trimester of gestation, and pandemic period/wave. Methods: : Pregnant persons and persons who delivered in Canada during the pandemic, >18 years, were recruited, and data were collected using a web-based strategy. The current analysis includes data on persons enrolled between 06/2020-08/2021. Maternal sociodemographic indicators, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7), stress) were self-reported. Maternal mental health in pregnant women (stratified by trimester, and pandemic period/wave at recruitment) was compared with mental health of women who had delivered; determinants of severe depression were identified with multivariate logistic regression models. Results: : 2,574 persons were pregnant and 626 had already delivered at recruitment. Participants who had delivered had significantly higher mean depressive symptom scores compared to those pregnant at recruitment (9.1 (SD, 5.7) vs. 8.4 (SD, 5.3), p=0.009). Among those who were pregnant at recruitment, depressive symptoms were significantly higher in women recruited in their third trimester, and those recruited during the 2 nd wave of the pandemic. Maternal anxiety (aOR 1.51; 95%CI 1.44-1.59) and stress (aOR 1.35; 95%CI 1.24-1.48) were the most significant predictors of severe maternal depression (EDPS˃13) in pregnancy. Conclusion: The COVID-19 pandemic had a significant impact on maternal depression during pregnancy and in the post-partum period. Given that gestational depression/anxiety/stress have been associated with preterm birth and childhood cognitive problems, it is essential to continue following women/children, and develop strategies to reduce COVID-19’s longer-term impact.

Children's Mental and Behavioral Health, Schooling, Sociodemographic and Socioeconomic Characteristics During School Closure in France Due To COVID-19: The SAPRIS Project. (preprint)

Background: COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children’s mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. Methods: We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children’s mental health, children’s health behaviors, schooling, and sociodemographic and socioeconomic characteristics of the children’s families. Results: The sample consisted of 5702 children aged 8 to 9 years, including 50.2% girls. In multivariate logistic regression models, children’s sleeping difficulties were associated with children’s abnormal hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05; 95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34; 95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29; 95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51; 95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06; 95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13; 95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25; 95% CI 2.64-3.99; aOR 2.47; 95% CI 1.48-4.11, respectively). Factors associated with children’s emotional symptoms were the following: being born pre-term (aOR 1.34; 95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72; 95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18; 95% CI 3.27-5.34) and modest income (aOR 1.45; 95% CI 1.07-1.96; aOR 1.36; 95% CI 1.01-1.84). Conclusions: Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.

The Impact of the COVID-19 Lockdown Restrictions on Mental Health Disorders According Student Status (preprint)

The objective was to compare the frequency of depressive symptoms, anxiety and suicidal thoughts in students and non-students enrolled in the same study in France according to key periods of the COVID-19 epidemic. Students were more likely than non-students to having high scores of depressive symptoms and anxiety, particularly during the 1st and 2nd lockdowns. These findings suggest that restrictive measures i.e. lockdown and curfew have an alarmingly stronger negative impact in students than in non-student and underlines the frailty of students’ mental health and that greater attention should be given to this population. 

Depression and Anxiety Symptoms in Young Adults Before and During the Covid-19 Pandemic: Evidence from a Canadian Population-Based Cohort (preprint)

ObjectivesConcerns have been raised that the COVID-19 pandemic could increase risk for adverse mental health outcomes, especially in young adults, a vulnerable age group. We investigated changes in depression and anxiety symptoms (overall and severe) from before to during the pandemic, as well as whether these changes are linked to COVID-19 related stressors and pre-existing vulnerabilities in young adults followed in the context of a population-based cohort. MethodParticipants (n=1039) from the Quebec Longitudinal Study of Child Development reported on their depression and anxiety symptoms and completed a COVID-19 questionnaire during the first wave of the COVID-19 pandemic in the summer of 2020 (age 22 years). Assessments at age 20 (2018) were used to estimate pre-pandemic depression and anxiety symptom severity. ResultsWhile overall levels of depression and anxiety symptoms did not change, there was an increase in rates of severe depression (but not severe anxiety) from before (6.1%) to during (8.2%) the pandemic. Depressive and anxiety symptoms increased from before to during the COVID-19 pandemic among young adults with the lowest levels of symptoms before the pandemic, while they decreased among those with the highest levels of pre-existing symptoms. Youth who were living alone experienced an increase in depressive symptoms. Other COVID-19 related variables (e.g., loss of education/occupation, frequent news-seeking) and pre-existing vulnerabilities (e.g., low SES, low social support) were not associated with changes in depression or anxiety symptoms. ConclusionDepression and anxiety symptoms in young adults from Quebec in Summer 2020 were comparable to symptoms reported in 2018. Most COVID-19 related stressors and pre-existing vulnerabilities were not associated with changes in symptoms. However, the increased rate of severe depression and the increase in depression and anxiety symptoms among young adults with the least mental health symptoms before the COVID-19 pandemic are concerning.

Impact of the COVID-19 Pandemic on Maternal Mental Health During Pregnancy: The CONCEPTION Study – Phase I (preprint)

Background: Mental health regional differences during pregnancy through the COVID-19 pandemic are understudied. The first phase of CONCEPTION cohort aims to compare country-specific mental health status in pregnant women following the start of the pandemic.Methods: Pregnant women, >18 years were recruited, and data collected using a web-based strategy. Although Canadian women were primarily targeted, pregnant women worldwide were eligible. The current analysis includes data on women enrolled between 06/2020-11/2020. Self-reported data included COVID-19 testing/diagnosis, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7)), prenatal care/birth plan changes. We compared maternal mental health stratifying on country/continents of residence; and identified determinants of mental health with multivariable linear regression models.Findings: Of 2,109 pregnant women recruited (mean gestational age, 24·7 weeks (SD 9·7)), 1,932 were from Canada, 48 the United States (US), 73 Europe, 35 Africa, and 21 Asia/Oceania. Among the 226 pregnant women who were tested for SARS-CoV-2, 26 were positive (11·5% test positivity rate); COVID-19 prevalence was 1·2% (26/2,109). Mean depressive symptom scores were lower in Canada (EPDS 8·2, SD 5·2) compared to the US (EPDS 10·5, SD 4·8) and Europe (EPDS 10·4, SD 6·5) (p<0·05). Maternal anxiety, stress, decreased income and access to health care due to the pandemic were independently increasing maternal depression. Mean anxiety symptoms were higher in the US (GAD-7 6·5, SD 4·3) than Canada (GAD-7 4·3, SD 3·8) (p<0·05). Maternal depression, stress, and earlier recruitment during the pandemic were independently associated with increased maternal anxiety.Interpretation: In this first international study on the impact of the COVID-19 pandemic, CONCEPTION has shown significant country/continent-specific variations in depression and anxiety during pregnancy. Given that gestational depression/anxiety have been associated with preterm birth and childhood cognitive problems, strategies are needed to reduce COVID-19’s mental health burden. Funding: Faculty of Pharmacy, Université de Montréal, Canada.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: This study was approved by the CHU Sainte-Justine's Research Ethics Committee, which autorized worldwide recruitment of subjects.