Parental Postnatal Depression in the Time of the COVID-19 Pandemic: A Systematic Review of Its Effects on the Parent-Child Relationship and the Child's Developmental Outcomes.

The international literature has shown that maternal and paternal postnatal depression (PND) is one of the most common mental illnesses in the perinatal period, with significant consequences for parent-infant relationships and infant development. The COVID-19 pandemic has increased the rates of prevalence of PND, exacerbating the mental health risk for new families. This systematic review aims to examine the effect of maternal and paternal PND on parent-infant relationships and children's development in the first 36 months after childbirth during the COVID-19 outbreak. Eligible studies were identified using the following databases: Medline, CINAHL, SCOPUS, PsycINFO, PsycARTICLES, ScienceDirect, and Web of Science. Of the 1252 studies considered, 10 studies met the inclusion criteria. Results showed that maternal PND significantly affected the quality of the early mother-infant relationship and the infant's motor, self-regulation, and socio-emotional development. In addition, the detrimental impact of maternal PND on the quality of early mother-infant relationships seems to become stronger as COVID-19 concerns increase. No studies included fathers. These findings strengthened the importance of planning targeted prevention and treatment strategies to prevent PND and its short- and long-term consequences, especially in the case of stressful and traumatic events. They also suggested the urgent need for further exploration of fathers.

[Traumatic motherhood in Covid-19 times]. / Maternités traumatiques en temps de Covid-19.

In the context of maternal vital emergency due to Covid-19, dire situations of birth questioned the health practitioners of a neonatal intensive care unit. How can mothers take care of their baby when their own life has been threatened ? The analysis of two clinical cases underlines the importance of talking for these mothers who have been through disastrous experiences, which could lead to a post-traumatic stress disorder. Restoring a connection to outside reality thanks to psychological care in the acute post-trauma period helps these mothers take care of their child.

Virtual Training on Stress Management for the Mothers of Children with Disabilities in the United Arab Emirates.

Parenting children with disabilities has consistently been reported to be associated with stress, and even more so among mothers who are primary caregivers. In non-Western contexts such as the United Arab Emirates (UAE), there is a dearth of research on maternal mental health in relation to raising children with disabilities and related mitigation strategies. During the COVID-19 pandemic (2020-2021), the Federal Government of the UAE used the Save the Child's Stress Checklist to assess the stress levels of 635 mothers who were raising children with disabilities in the northern part of the country. In the pre-test, an estimated 6% (36/635) of the mothers were found to be experiencing high levels of stress. Consequently, virtual stress management training was conducted, and 12 of the 36 mothers completed the full training. Wilcoxon's ranked test showed a reduction in their total, physical, emotional and cognitive stress at the end of the training. This study demonstrates the pressing need for ongoing training programmes to improve the mental health of mothers of children with disabilities in the UAE and similar contexts.

Trends in maternal mental health during the COVID-19 pandemic-evidence from Zambia.

The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns and the risk of psychiatric illness worldwide. To date, relatively little is known about the impact of the pandemic on vulnerable groups such as women and children in low-resourced settings who generally have limited access to mental health care. We explore two rounds of data collected as part of an ongoing trial of early childhood development to assess mental health distress among mothers of children under 5-years-old living in two rural areas of Zambia during the COVID-19 pandemic. We examined the prevalence of mental health distress among a cohort of 1105 mothers using the World Health Organization's Self-Reporting Questionnaire (SRQ-20) before the onset of the COVID-19 pandemic in August 2019 and after the first two infection waves in October-November 2021. Our primary outcome was mental health distress, defined as SRQ-20 score above 7. We analyzed social, economic and family level characteristics as factors modifying to the COVID-19 induced changes in the mental health status. At baseline, 22.5% of women were in mental health distress. The odds of mental health distress among women increased marginally over the first two waves of the pandemic (aOR1.22, CI 0.99-1.49). Women under age 30, with lower educational background, with less than three children, and those living in Eastern Province (compared to Southern Province) of Zambia, were found to be at highest risk of mental health deterioration during the pandemic. Our findings suggest that the prevalence of mental health distress is high in this population and has further worsened during COVID-19 pandemic. Public health interventions targeting mothers' mental health in low resource settings may want to particularly focus on young mothers with limited educational attainment.

Prenatal Mental Representations in Italian First-Time Mothers Before and During the COVID-19 Pandemic: A Study with Interviews on Maternal Representations During Pregnancy.

INTRODUCTION: Psychosocial risks increase the levels of not-integrated/ambivalent and restricted/disengaged representations during pregnancy, but no study has specifically analysed the impact of the COVID-19 pandemic on maternal representation styles. OBJECTIVES: (1) to compare maternal representation styles in primiparous women who became pregnant before and during the COVID-19 pandemic and (2) to analyse the content of representation styles during the COVID-19 pandemic. METHODS: A total of 37 Italian pregnant women were recruited from 2019 to 2021. The sample was divided into two groups: the pre-COVID-19 group (22 women, mean age = 33.14 years; SD = 3.78) and the COVID-19 group (15 women, mean age = 35.9 years; SD = 4.6). Interviews on maternal representations during pregnancy were administered and analysed for style and content. RESULTS: Women during the COVID-19 pandemic reported more restricted/disengaged and less integrated/balanced representation styles than women pre-COVID-19. Content analysis showed that the COVID-19 pandemic led women to focus more on concrete aspects of pregnancy in lieu of emotional aspects, thus leading them to develop more restricted/disengaged representation styles. CONCLUSIONS FOR PRACTICE: In future pandemics pregnant women should be supported in focusing their attention to emotions, sensations and fantasies about themselves as mothers and their children.

Psychosocial work stress and parent-child bonding during the COVID-19 pandemic: clarifying the role of parental symptoms of depression and aggressiveness.

BACKGROUND: Parental work stress and impaired mental health seem to have intensified during the current COVID-19 pandemic. Both can have a negative impact on parent-child bonding: psychosocial work stress in the course of a spillover effect from work to family and symptoms of impaired mental health as part of a crossover effect from parent to child. This potentially affects the child's development in the long term. METHOD: This cross-sectional study examined the relationship between psychosocial work stress and parent-child bonding during the early COVID-19 pandemic (May-June 2020). Symptoms of depression and aggressiveness were considered as mediators of this relationship. The sample consisted of employees in Eastern Germany (n = 380; 42.9% mothers, 57.1% fathers), aged 24-55 years, with children aged 0-36 months. RESULTS: In the total sample, an association was only found after adjusting for potential confounders, indicating that higher psychosocial work stress is associated with weaker bonding between the parent and child (ß = 0.148, p = .017, 95% CI [0.566, 5.614]). The separate analyses for mothers and fathers did not reveal a statistically significant relationship between psychosocial work stress and parent-child bonding. In the total sample, the higher the psychosocial work stress was, the higher were the parental symptoms of depression (ß = 0.372, p < .001, 95% CI [3.417, 5.696]) and aggressiveness ß = 0.254, p < .001, 95% CI [1.008, 3.208]). The mental health symptoms in turn were related to weaker parent-child bonding (symptoms of depression ß = 0.320, p < .001, 95% CI [0.345, 0.749]; symptoms of aggressiveness ß = 0.394, p < .001, 95% CI [0.697, 1.287]). The results furthermore suggested that parental mental health symptoms mediate the association between psychosocial work stress and parent-child bonding (symptoms of depression, ab = 2.491, 95% CI [1.472, 3.577] and of aggressiveness, ab = 2.091, 95% CI [1.147, 3.279]). The mediation effect was also found in the separate analyses for the mothers and fathers. DISCUSSION: The results of this study during the early COVID-19 pandemic in Germany highlight the importance of prevention as well as intervention measures in relation to psychosocial work stress that may play a debilitating role in the context of family relationships. In addition, the results suggest that both employers and employees should be made aware of the importance of psychosocial work stress, as it can have a negative impact on mental health, which in turn may have a major influence on family relationships.

The effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy during COVID-19 pandemic: a ramdomized controlled trial.

BACKGROUND: Successful breastfeeding is related to the psychosocial conditions of the mother. Covid19 pandemic resulted in psychological consequences in women during postpartum period. Maternal anxiety and distress reduce the chances of exclusive breastfeeding. The present study aimed to investigate the effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy (BSE) during COVID-19 pandemic. METHOD: This randomized controlled clinical trial was conducted on 64 breastfeeding mothers referred to health care centers in Tabriz, Iran in 2021. Participants were assigned into the intervention and control groups in a ratio of 1: 1 using block randomization in a block size of 4 and 6. The intervention group participated in six individual 60-90 min sessions. Spielberger State-Trait Anxiety Inventory (STAI), postpartum distress (PMD), and BSE questionnaires were completed before and 4-week after the intervention by the control and intervention groups. Independent t-test and ANCOVA were used to compare the outcomes between two groups. RESULTS: According to the ANCOVA results by controlling the baseline values and after the intervention, the mean score of anxiety in the intervention group was lower than that in the control group [Adjusted Mean Difference (AMD): -13.82, 95%, confidence interval (CI): -12.35 to -15.29, (p < 0.001)]. Further, the mean score of postpartum distress after intervention was lower in the intervention group compared with that in the control group [AMD:5.31 95% CI: -3.00 to -7.37 (p < 0.001)]. After the intervention, the mean score of BSE in the intervention group was significantly higher than that in the control group [AMD: 25.57, 95% CI: 22.85 to 28.29 (p < 0.001)]. CONCLUSION: Stress management counseling can improve postpartum anxiety and distress and BSE and increase breastfeeding. However, more studies are needed for a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N6. Date of registration: 15/09/2021.

COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US.

Importance: The primary outcomes of the COVID-19 pandemic on the mental health of women with children remain largely unknown. Objectives: To identify and describe clusters of mothers of children participating in the Environmental influences on Child Health Outcomes (ECHO) Program that characterize pandemic-associated hardships, coping mechanisms, and behaviors, and to evaluate associations between pandemic-associated hardships, coping strategies, and behavior changes with pandemic-associated traumatic stress symptoms. Design, Setting, and Participants: This multicenter cohort study investigated experiences during the COVID-19 pandemic between April 2020 and August 2021 among maternal caregivers of children participating in the ECHO Program. Data from self-identified mothers of ECHO-enrolled children from 62 US cohorts were included in analyses. Data were analyzed from November 2021 to July 2022. Exposures: The primary exposures were pandemic-associated changes in mothers' health, health care utilization, work and finances, coping strategies, and health-associated behaviors. Exposures were assessed via a self-reported questionnaire designed by ECHO investigators. Main Outcomes and Measures: The primary outcome was the total symptoms score of pandemic-associated traumatic stress (PTS), defined as the number of items endorsed at least sometimes or more frequently, from a 10-item self-report measure. Results: The study surveyed 11 473 mothers (mean [SD] age, 37.8 [7.4] years; 342 American Indian [2.98%], 378 Asian [3.29%], 1701 Black [14.83%], and 7195 White [62.71%]; 2184 with Hispanic/Latina ethnicity [19.04%]) and identified 2 clusters that best characterized their COVID-19 pandemic experiences-one characterized by higher life disruptions (eg, to work and health care), higher social isolation, more coping behaviors to mitigate the outcomes of the pandemic, and more changes to their health behavior routines (high change [1031 mothers]) and the other characterized by lower changes (low change [3061 mothers]). The high change cluster was more socioeconomically advantaged and reported higher PTS (mean [SD] number of symptoms, 3.72 [2.44] vs 2.51 [2.47]). Across both clusters, higher pandemic-associated hardships, coping mechanisms, and behavior changes were associated with higher PTS, and these associations were greater in the low change cluster. Conclusions and Relevance: In this study of more than 11 000 US mothers, associations between socioeconomic factors, stressful life events, and mental health sequelae were complex. Accordingly, programs, policies, and practices targeting mental health during public health crises such as the COVID-19 pandemic should consider the range and configuration of hardships in designing the most effective interventions to mitigate long-term outcomes.

Once upon a Pandemic: 'Online' Therapeutic Groupwork for Infants and Mothers Impacted by Family Violence.

This case study describes the transition to an 'online' delivery of an evaluated infant mental health group work intervention for infants/mothers impacted by family violence during the COVID 19 pandemic. The imperative to provide early intervention to infants and their mother is outlined. The model and practice principles integral to this intervention are provided and described are four separate groups run online within two different Australian cities. Facilitators of the groups found that they were able to hold the infants and mothers safely in the online space despite the unexpected presence of others in the families' homes. The home-based nature of the work caused by lockdown restrictions revealed a transparency not found in office-based work, whilst simultaneously, evoking some discomfort. The ease with which infants and young children embraced technology worked in favor of using the online space. Playful, restorative, and creative ways of engaging with a highly vulnerable cohort of families were achieved; enhancing relational repair following both family violence and the isolation created by restrictions imposed by lockdowns. Despite an initial hesitancy to move online, the authors discovered meaningful ways through which to engage, treat and provide safe relational repair work with infants and their mothers impacted by family violence.

Mothers' and fathers' stress and severity of depressive symptoms during the COVID-19 pandemic: actor-partner effects with parental negative emotions as a moderator.

BACKGROUND: In the face of the coronavirus disease 2019 (COVID-19) pandemic, families with young children are bombarded with new challenges and stressors. This study examined the additive and interactive effects of parental stress and negative emotions during COVID-19 on parents' severity of depressive symptoms. METHODS: Participants were 221 Chinese families involving maritally intact mothers and fathers of preschool-aged children. DISCUSSION: Path analysis indicated that mothers' parental stress interacted with their negative emotions, such that their stress was related to their severity of depressive symptoms only when negative emotions were high. By comparison, fathers' stress and negative emotions were additively associated with their severity of depressive symptoms. Supporting the cumulative risk model, parental stress during COVID-19 and negative emotions were linked to parents' severity of depressive symptoms additively or interactively, depending on the gender of the parent. These findings inform practitioners about the relevance of parents' stress and negative emotions to their severity of depressive symptoms during the pandemic.

Once upon a Pandemic: 'Online' Therapeutic Groupwork for Infants and Mothers Impacted by Family Violence.

This case study describes the transition to an 'online' delivery of an evaluated infant mental health group work intervention for infants/mothers impacted by family violence during the COVID 19 pandemic. The imperative to provide early intervention to infants and their mother is outlined. The model and practice principles integral to this intervention are provided and described are four separate groups run online within two different Australian cities. Facilitators of the groups found that they were able to hold the infants and mothers safely in the online space despite the unexpected presence of others in the families' homes. The home-based nature of the work caused by lockdown restrictions revealed a transparency not found in office-based work, whilst simultaneously, evoking some discomfort. The ease with which infants and young children embraced technology worked in favor of using the online space. Playful, restorative, and creative ways of engaging with a highly vulnerable cohort of families were achieved; enhancing relational repair following both family violence and the isolation created by restrictions imposed by lockdowns. Despite an initial hesitancy to move online, the authors discovered meaningful ways through which to engage, treat and provide safe relational repair work with infants and their mothers impacted by family violence.

The Influence of Maternal Psychological Manifestations on the Mother-Child Couple during the Early COVID-19 Pandemic in Two Hospitals in Timisoara, Romania.

BACKGROUND AND OBJECTIVES: The postpartum maternal physical and psychological state played a fundamental role in the mother-child relationship at the beginning of the COVID-19 pandemic. The aim of the study is to analyze the influence of maternal psychological manifestations on the mother-child couple through three objectives (briefly expressed): (I) Determination of the main acute and chronic conditions of newborns/infants. (II) Verification of the hypothesis of the existence of a link between the following neonatal variables: gestational age, birth weight, number of days of hospitalization, and specific neonatal therapies (oxygen, surfactant, and blood products' transfusion). (III) Verification of the influence of postpartum maternal psychological status on the mother-child couple through three hypotheses. MATERIALS AND METHODS: This cross-sectional study was conducted in two hospitals in Timișoara, Romania, between 1 March and 1 September 2020, and included 165 mothers and their 175 newborns. Mothers answered the Edinburgh Postnatal Depression Scale, Spielberger's Inventory of State-Trait Anxiety, and the Collins and Read Revised Adult Attachment Scale. RESULTS: (I) The acute and chronic pathology of the infants in the study group was polymorphic. (II) Large correlations were identified between the following infant variables: gestational age with birth weight, and number of hospitalization days with birth weight, gestational age, and use of blood product transfusion (all p < 0.001). (III) (1) State anxiety was the only significant predictor of number of hospitalization days (p = 0.037), number of acute disorders (p = 0.028), and number of infant chronic diseases (p = 0.037). (2) Maternal depressive symptoms were the only predictor of postpartum maternal attachment (p = 0.018). (3) Depressive symptoms, state, and trait anxiety were non-significant in all models studied (all p > 0.05). CONCLUSIONS: Postpartum maternal physical and psychological state plays a fundamental role on the mother-child relationship in the new social and complex family conditions.

Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial.

Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.

Impact of personal and environmental factors affecting exclusive breastfeeding practices in the first six months during the COVID-19 pandemic in Thailand: a mixed-methods approach.

BACKGROUND: Exclusive breastfeeding (EBF) for six months is recommended as one of the most important ways to support child health and survival, particularly during the COVID-19 pandemic. However, breastfeeding women encountered several obstacles during the pandemic. The purpose of this study was to conduct a survey to document breastfeeding practices, EBF rates and associated factors with six month exclusive breastfeeding during the second wave of the coronavirus outbreak in Thailand. METHODS: A mixed-methods design that included a cross-sectional survey (n = 390) and semi-structured in-depth interviews (n = 15) was carried out between August and November 2021. Participants were women aged ≥ 15 years who had given birth within 6-12 months before data collection and delivered in three public hospitals in the top three provinces with the most severe COVID-19 outbreaks. RESULTS: The median duration of EBF was four months (interquartile range, IQR: 1-6 months) and 37.4% of women exclusively breastfed for six months. From binary logistic regression models, several personal factors were associated with exclusive breastfeeding for six months including being a housewife (AOR 2.848; 95% CI 1.512, 5.367), perceived sufficiency of family income (AOR 2.502; 95% CI 1.362, 4.594), working from home/business (AOR 2.071; 95% CI 1.074, 3.995), breastfeeding intention (AOR 1.162; 95% CI 1.116, 1.210), and maternal age (AOR 0.932; 95% CI 0.882, 0.986). From qualitative interviews, women who were able to exclusively breastfed during the outbreak explained five themes that were a protective shield; I have to save money, I could spend all my time with my baby and breastfeed, spousal support is valuable, and opportunity to avoid the obstructed beliefs about exclusive breastfeeding. CONCLUSIONS: Mothers with higher socioeconomic status and who were unemployed/worked from home and had support structures in place were able to successfully EBF during the COVID-19 outbreak. Healthcare providers can better support breastfeeding if they provide informational support and allow family members to participate in breastfeeding programs, especially spouses who provided key emotional and tangible support during pandemic.

Depression in Early Childhood.

According to data from the WHO, the COVID-19 pandemic has created an increase in anxiety and depression around the world. In particular, there has been an increase in Depressive Disorder in childhood: the closure of childcare centers has caused great stress in parents, especially in mothers who have developed more depressive disorders. Maternal depression appears to have created problematic behaviors in preschool children. This phenomenon is explained by several studies that over the years have shown that a good mother-child interaction is essential for the child's psychophysical health and that interactions with depressed mothers have caused depression in children already in early childhood. The purpose of this work is a review of the scientific literature, from 1927 to 2022, on depression in early childhood, from 0 to 5 years of age. Research has been carried out on Medline PubMed, Google Scholar and specialist scientific journals of psychiatry, psychology and child neuropsychiatry, using the following keywords: infant depression, anaclitic depression, hospitalism, early chilhood depression, depressive position, attachement and mother-infant dyad. The depressive illness of the mother, the lack of care, attention and stimulation to the vocalizations of the young child can induce negative reactions in the relationship between mother and child. Early identification and treatment of perinatal depression is critical to ensuring the child's optimal development and future mental health. In addition to maternal depression there are also other factors that can generate depression in the child as well as a prolonged separation from her. The authors' conclusions are that it is essential to train and inform educators and family members on depression in childhood to allow for the recognition of the child's suffering and for it to be examined by the doctor. It is important an early intervention both on the family and on the child to avoid relapses, chronicity and any serious damage.

New Parent Support Needs and Experiences with Pediatric Care During the COVID-19 Pandemic.

OBJECTIVES: Despite evidence for heightened psychiatric risk and unique parenting challenges during the COVID-19 pandemic, no research exists on the specific needs of parents of infants and responsiveness of pediatric care to their needs. We aimed to describe the support needs of new parents and explore their experiences with pediatric care. METHODS: In late 2020 we conducted semi-structured interviews with 30 mothers of babies born or due that year. Interviews addressed perinatal experiences during the pandemic, with an emphasis on experiences related to social support. In an iterative, inductive process, thematic analysis was used to analyze the data. RESULTS: This study identifies a set of support needs specific to the context of parenting an infant during the COVID-19 crisis: coping with the compound psychological impacts of the postpartum period and a pandemic; parenting in the absence of expected social support; risk assessment to keep infant and family safe. This study finds that policies implemented by health care providers to reduce risk of COVID-19 transmission came at a cost to new parents and parent-provider relationships. Participants reported mixed experiences with in-person and telehealth pediatric care, including inadequate and/or uncomfortable postpartum mental health screening and breastfeeding support, and identified specific features that constituted responsive care during the pandemic. CONCLUSIONS: Normative changes associated with the postpartum period combined with complex adaptations necessitated by the COVID-19 pandemic presented substantial challenges for families with infants, even relatively privileged families. Providers can incorporate these findings to enhance support for families and promote maternal and child health.

Building Emotional Awareness and Mental Health (BEAM): study protocol for a phase III randomized controlled trial of the BEAM app-based program for mothers of children 18-36 months.

BACKGROUND: The prevalence of maternal depression and anxiety has increased during the COVID-19 pandemic, and pregnant individuals are experiencing concerningly elevated levels of mental health symptoms worldwide. Many individuals may now be at heightened risk of postpartum mental health disorders. There are significant concerns that a cohort of children may be at-risk for impaired self-regulation and mental illness due to elevated exposure to perinatal mental illness. With both an increased prevalence of depression and limited availability of services due to the pandemic, there is an urgent need for accessible eHealth interventions for mothers of young children. The aims of this trial are to evaluate the efficacy of the Building Emotion Awareness and Mental Health (BEAM) app-based program for reducing maternal depression symptoms (primary outcome) and improve anxiety symptoms, parenting stress, family relationships, and mother and child functioning (secondary outcomes) compared to treatment as usual (TAU). METHODS: A two-arm randomized controlled trial (RCT) with repeated measures will be used to evaluate the efficacy of the BEAM intervention compared to TAU among a sample of 140 mothers with children aged 18 to 36 months, who self-report moderate-to-severe symptoms of depression and/or anxiety. Individuals will be recruited online, and those randomized to the treatment group will participate in 10 weeks of psychoeducation modules, an online social support forum, and weekly group teletherapy sessions. Assessments will occur at 18-36 months postpartum (pre-test, T1), immediately after the last week of the BEAM intervention (post-test, T2), and at 3 months after the intervention (follow-up, T3). DISCUSSION: eHealth interventions have the potential to address elevated maternal mental health symptoms, parenting stress, and child functioning concerns during and after the COVID-19 pandemic and to provide accessible programming to mothers who are in need of support. This RCT will build on an open pilot trial of the BEAM program and provide further evaluation of this evidence-based intervention. Findings will increase our understanding of depression in mothers with young children and reveal the potential for long-term improvements in maternal and child health and family well-being. TRIAL REGISTRATION: ClinicalTrials.gov NCT05306626 . Registered on April 1, 2022.

Prenatal hair cortisol concentrations during the COVID-19 outbreak: Associations with maternal psychological stress and infant temperament.

BACKGROUND: Maternal psychological stress during pregnancy, including stress resulting from disasters and trauma, has been linked to temperamental difficulties in offspring. Although heightened cortisol concentrations are often hypothesized as an underlying mechanism, evidence supporting this mechanism is not consistent, potentially because of methodological issues and low stress in the population. AIM: To address these issues, this preregistered study investigated the following associations between: 1) prenatal psychological stress and hair cortisol, as a biomarker for chronic stress, during the COVID-19 outbreak (i.e., as a major worldwide psychological stressor), and 2) maternal hair cortisol during the COVID-19 outbreak and later infant temperamental negative affectivity and orienting/regulation. Additionally, we explored whether associations were different for women with low versus high socioeconomic status (SES; maternal education and annual household income) and at different stages of pregnancy. METHOD: Pregnant women (N = 100) filled out online questionnaires during the first COVID-19 lockdown. Six months later, when most mothers were still pregnant or had just given birth, maternal hair samples were collected during home visits. When infants were six months old, mothers reported on their infant's temperament. RESULTS: Although hierarchical regression analyses revealed no associations between prenatal COVID-19 psychological stress and hair cortisol during the COVID-19 outbreak, SES proved to be a moderator in this association. Only pregnant women with higher levels of SES, not lower levels, showed a positive association between work-related and social support-related COVID-19 worries and hair cortisol. Finally, prenatal hair cortisol was not associated with later infant temperamental negative affectivity and orienting/regulation. CONCLUSION: Although the COVID-19 outbreak proved to be a major psychological stressor worldwide, the physiological impact of the crisis might be different for pregnant women with higher SES as compared to lower SES.

Child emotional and behavioral difficulties and parent stress during COVID-19 lockdown in Sri Lankan families.

INTRODUCTION: Understanding parents' and children's mental health issues would help design population-specific intervention programs. The present study explored parents' perceived stress and child emotions and behavior during the COVID-19 lockdown among Sri Lankan families. METHODS: A cross-sectional survey was conducted among Sri Lankan parents of children aged 11 to 17 years. Validated instruments (Perceived Stress Scale-PSS and Strengths and Difficulties Questionnaire-SDQ) evaluated parental stress, child emotions, and hyperactivity/inattention. Multiple linear regression assessed the predictors of mental health issues, including the interaction between age and gender. RESULTS: Three hundred fifty-five parents responded to the survey (mothers:76%). One-third of parents experienced difficulties with their children during the pandemic. Emotions and hyperactivity-inattention problems measured via the SDQ scale were high among 38% of children, while the perceived stress was high in 79.2% of parents. Overall, child emotions and hyperactivity-inattention increased with decreasing age, increasing parent stress, having middle-income compared to high-income, and having a family member/close relative tested positive for COVID-19. Hyperactivity-inattention (29.3%) was more than the emotional problems (22%) among children. The emotional problems were reported more with increasing parent stress, while child hyperactivity-inattention alone was reported more with decreasing age, middle-income compared to high-income families, and increasing parent stress. Also, the interaction effect of age and gender indicated that higher age was related to greater parent-reported hyperactivity-inattention problems in males. CONCLUSIONS: The findings highlight how the COVID-19 crisis and social isolation have contributed to increased parental stress and child emotional and hyperactivity-inattention problems. In addition to cautioning the healthcare workers, socio-culturally appropriate preventive and supportive mental health programs may help deal with further waves of COVID-19 or any other adverse circumstances.

Psychiatric symptoms in children with COVID-19, mothers` psychological resilience and related factors: pandemic hospital inpatient experiences.

BACKGROUND: Information on psychological problems and affecting factors in children hospitalized with the suspicion or diagnosis of COVID-19 is limited. We aimed to screen the psychiatric symptoms of children hospitalized with COVID-19 in Ankara City Children`s Hospital and evaluate the caregivers` depression, anxiety, stress, and resilience levels during hospitalization. METHODS: Among the children and adolescents hospitalized in Ankara City Children`s Hospital between 1 May 2020 and 31 May 2020 due to the diagnosis of COVID-19, those who agreed to participate in the study were included. The Strengths and Difficulties Questionnaire (SDQ), the Depression Anxiety Stress Scale-21 (DASS- 21) scale, and the Brief Resilience Scale (BRS) were used to determine the symptoms. RESULTS: The mean age of study group (n = 49) was 8.7 ± 5.0 years, 59.2% (n = 29) were girls. The mean children`s SDQ-externalizing problems scores were higher in the COVID-19 positive mothers group than the COVID-19 negative mothers` group. The SDQ-total score was positively and strongly correlated with the DASS total score, DASS-depression score, and DASS-anxiety score. BRS scale scores were negatively correlated with the SDQtotal, externalizing, and DASS-21scale scores. CONCLUSIONS: COVID-19 positivity in mothers could be associated with externalizing problems in children. The high resilience of caregivers of inpatients seems to be related to less psychopathology in children. During hospitalization, caregivers` psychological evaluation and psychosocial support may be important for preventive child mental health.