The Construct Structures of Psychological and Behavioral Responses to COVID-19 Pandemic in Pregnant Women

Zonglin He; Joyce Wai-Ting Chiu; Yuchen Lin; Babatunde Akinwunmi; Tak Hap Wong; Casper J P Zhang; Wai-Kit Ming

doi:10.3389/fpsyt.2022.796567

The Construct Structures of Psychological and Behavioral Responses to COVID-19 Pandemic in Pregnant Women

Front Psychiatry. 2022 Jul 12:13:796567. doi: 10.3389/fpsyt.2022.796567. eCollection 2022.

Authors

Zonglin He^{1

2}, Joyce Wai-Ting Chiu^{3

4

5}, Yuchen Lin⁶, Babatunde Akinwunmi^{7

8}, Tak Hap Wong^{9

10}, Casper J P Zhang¹¹, Wai-Kit Ming¹

Affiliations

¹ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong SAR, China.
² Division of Life Science, The Hong Kong University of Science and Technology, Hong Kong, Hong Kong SAR, China.
³ International School, Jinan University, Guangzhou, China.
⁴ Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
⁵ Department of Psychology, University of York, York, United Kingdom.
⁶ Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁷ Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
⁸ Center for Genomic Medicine (CGM), Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, MA, United States.
⁹ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
¹⁰ Department of Obstetrics, Guangdong Women and Children Hospital, Guangzhou, China.
¹¹ School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.

Abstract

Aim: The present study aimed to investigate the construct structure behind the psychosocial response, behavioral response, prenatal depression, and post-traumatic stress disorder (PTSD) in pregnant women during the COVID-19 pandemic in China.

Method: The validated Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), PTSD CheckList (PCL)-6, and two newly established scales for COVID-19-related psychological and behavioral responses were used. Structural equation modeling (SEM) analysis was applied to evaluate the structural relationships of psychological and behavioral responses during the COVID-19 pandemic.

Results: Of the 1,908 mothers who completed the questionnaires, 1,099 met the criteria for perinatal depression, and 287 were positively screened for PTSD, where 264 women exceed the cut-off points for both. Pregnant women with full-time or part-time jobs tended to have the lowest scores of EPDS (10.07 ± 5.11, P < 0.001) and stress levels (23.85 ± 7.96, P = 0.004), yet they were more likely to change their behavior in accordance with the COVID-19 outbreak (13.35 ± 3.42, P = 0.025). The structural model fit the data (χ² = 43.260, p < 0.001) and resulted in satisfactory fit indices (CFI = 0.984, TLI = 0.959, RMSEA = 0.072, and χ²/df = 10.815), all path loadings were significant (p < 0.05). The SEM indicates that the level of QoL was attributable to the occurrence of PND, leading to PTSD, and COVID-19 related behavioral and psychological responses.

Conclusion: The inter-relationships between the COVID-19-related psychosocial and behavioral responses have been assessed, indicating that the pandemic increased the burden of perinatal depression. Psychoeducation, as well as other psychological interventions, may be needed to alleviate the COVID-19-based anxiety and increase their engagement in protective behaviors.

Keywords: COVID-19; perinatal depression; post-traumatic stress disorder; pregnancy; structural equating modeling.