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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 45-51

Spiritual wellbeing and depression for pregnant mothers in Covid-19 crisis


1 Department of Occupational Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission04-Sep-2020
Date of Decision22-Apr-2021
Date of Acceptance06-Jul-2021
Date of Web Publication06-Jul-2021

Correspondence Address:
Mahsa Nazari
Yazd, Bahonar Square, The Central Building of Yazd Shahid Sadoughi University of Medical Sciences, Yazd
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ed.ed_28_20

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  Abstract 


Background: Women with high-risk pregnancies experience changes in their personal, family, and social lives that can affect their quality of life and depression. Pregnancy, along with other predisposing factors, can cause or exacerbate depression. Eventually, 15% of depressed people commit suicide. The purpose of this research was to see how COVID-19 affected the condition of pregnancy (high risk or normal), as well as well-being and depressive symptoms in pregnant women.
Methods: This is an analytical case–control analysis that included 500 pregnant women (250 in the case group and 250 in the control group) who were pregnant during the COVID-19 timeframe for health care during pregnancy. The samples were chosen at random and then grouped into two categories based on the definitions of high-risk pregnancy and normal pregnancy: normal pregnancy (control group) and high-risk pregnancy (case group). A three-part questionnaire with demographic features, the Paloutzian and Ellison Religious Well-Being Questionnaire, and the Depression, Anxiety, and Stress Scale-42 Depression Inventory were used to gather data.
Results: According to the findings of this report, the mean score of religious well-being of pregnant mothers with high-risk pregnancies was lower than that of pregnant women with average pregnancies, as were the mean scores of depression. The distinction between a normal pregnancy and a high-risk pregnancy is important. Furthermore, the Pearson correlation coefficient test revealed a strong association between psychological well-being and depression in all types of mothers with high-risk and average pregnancies (r = −0.7) (P = 0.001).
Conclusion: Pregnant women with high-risk pregnancies have less psychological well-being than pregnant women with regular pregnancies. Furthermore, these mothers have a greater risk of depression than pregnant women with normal pregnancies.

Keywords: Coronavirus, Depression, Anxiety, and Stress Scale, depression, pregnancy, pregnant women, psychological health


How to cite this article:
Alimoradi H, Nazari M, Nodoushan RJ, Ajdani A. Spiritual wellbeing and depression for pregnant mothers in Covid-19 crisis. Environ Dis 2021;6:45-51

How to cite this URL:
Alimoradi H, Nazari M, Nodoushan RJ, Ajdani A. Spiritual wellbeing and depression for pregnant mothers in Covid-19 crisis. Environ Dis [serial online] 2021 [cited 2022 Nov 30];6:45-51. Available from: http://www.environmentmed.org/text.asp?2021/6/2/45/320787




  Introduction Top


The cause of respiratory syndrome infection in the world was believed to be a different genetic virus from the coronavirus family named SARS-CoV-2, which was totally unheard of as COVID-19 viral infection.[1] COVID-19 is impacted by external disease of SARS-COV-2 and has infected over 50 million people worldwide.[2] Per the research, respiratory communicable diseases may trigger pneumonia in pregnant women, resulting in premature membrane rupture, preterm birth, intrauterine mortalities, birth retardation, and even neonatal mortality, which are possible outcomes.[3]

Depression has been a common issue over people's mental health condition over the past century.[4] Depression and signs of health arise in two ways: (1) anxiety illness is an illness and (2) physical disorders. The severity of the signs of depression ranges from moderate to extreme. Depression is one of the special complications of pregnancy, because a woman has a complicated emotional state when she gets pregnant due to physical changes or anxiety illness.[5] Mental health problems are common during delivery linked to negative outcomes for mothers such as preeclampsia, low birth weight, depression, and increased nausea and vomiting.[6] Pregnancy is one of the most crucial times in a woman's life. While it is a pleasant memory for the majority of women, it is also a difficult time with mental and emotional improvements.[7] Many metabolic, hormonal, and anatomical modifications arise in a woman's body during this period.[8] In reality, women have little control of the changes that arise in their bodies, and these are the first adjustments that leave women physically and psychologically unstable.[9],[10]

Pregnancy in some women is so stressful that it triggers a mental illness, which may be a recurrence or exacerbation of an existing mental disorder, or a sign of the onset of a new disorder.[11] The rate of depression during pregnancy is based on diagnostic criteria, and the study population varies from 10% to 30%.[12] Cunningham quotes Liselott et al; the psychosis of a normal pregnancy doubles the risk of depression in women who have high-risk pregnancies because of concerns about the future of the fetus.[13] Many changes occur during pregnancy in the dimensions of physical, emotional, and social well-being, as well as overall, the psychological health of pregnant women. Psychological health during pregnancy can be measured. This assessment is significant in maternal and child care planning and recognizing the need for these caregivers for government policymakers and health-care associations.[14]


  Methods Top


Population analysis and layout

In this analysis, a cross-sectional design was used in which we actively recruited 500 pregnant mothers. The concept of the thesis was accepted according to the Ethical Approval of Shahid Sadoughi University of Medical Sciences (Ref No: IR.SSU.REC.1399.134). A detailed analysis was conducted on the main sample to assess sample size, and with 95% conviction and 95% test force, the number of samples of 250 people in each group was determined, and in reality, 250 people were chosen as case group and 250 people as control group. Among the inclusion and exclusion criteria in this study is the selection of pregnant women who are less than 20 years old or older than 35 years, diseases such as diabetes mellitus, kidney stones, heart disease, uterine bleeding (declination-peria), and no history of infertility.

All of the women studied were Iranian and were in the third trimester of pregnancy, at least literate, and did not have a known mental illness or had not received medical treatment for a mental illness in the past year. Mothers selected in this study should not have experienced a traumatic event in the past year, including the death of first-degree relatives, divorce, or a change of job. In this way, the effect of confounding variables on the study variables can be reduced. Case and control groups were selected in terms of basic characteristics such as gestational age, number of children, employment status, spouse employment status and the same income level.

In this study, t and χ2 statistical tests were used to examine the relationship between demographic and dependent variables. Confounding variables that can negatively affect life outcomes and depression in this study include social and economic status, social and family support, relationship with spouse, cooperation and participation in household chores.

In order to select the initial samples, all pregnant women who had referred for pregnancy care that day and at least one of the characteristics of high-risk pregnancy were randomly selected.

After obtaining consent, they participated in the study (case group). After completing the case group samples in each clinic, the same number of control samples (with normal pregnancy) was randomly selected.

The survey population contained pregnant women reported to Isfahan Private and Medical Hospital in 2019 and 2020. A total of 500 women who are pregnant were sent to this hospital in Isfahan for mother and fetus care. The sampling process has been as follows: first, 10 of the 15 hospitals were chosen at random using a simple lottery. The sample size was estimated using a preliminary study with a conviction factor of 95% (=0.05), a test rate of 80% (=0.2), and the correlation coefficient equation. Health-care professionals employed in the clinics wrote and revised questionnaires for people who were unable to read and complete the questionnaire. Not all have been qualified to participate in the survey, and the cost of the sample was deducted for them, which meant that pregnant women were excluded from the study if they had a history of mental disease such as depression or factual illness. Three questionnaires were used in this research to assess personal characteristics (age, level of education, employment, maternal age, and marriages), psychological well-being, stress anxiety, and Depression, Anxiety, and Stress Scale (DASS) depression.

To exclude interfering factors, pregnant women with drug use, a history of heart disease and high-risk births, a history of visiting a psychiatrist or psychologist, and taking prescription or mental illness hospitalization were excluded before completing the questionnaires. A population questionnaire and the Well-Being Anxiety Questionnaire were used to evaluate quantitative data. The questionnaire on demographics contained questions about age, parity, total number of infants, financial status, careers of women and their husbands, as well as the third pregnancy of birth.

Questionnaires

Questionnaire on mental health by Paloutzian and Ellison

An Ellison Standardized Psychological Health Questionnaire consists of 20 queries of Likert scale responses of firmly accept, agree, oppose, disagreement, and completely disagree. The answers to all the questions were numbered and evaluated on a scale of 1 to 5. The cumulative psychological well-being score is the calculation of the three aspects of cognition, behavior, and feelings.[15] It is between 20 and 120. In expressions with a positive verb, the answers “strongly agree” were given a score of 5 and “strongly disagreed” a score of 1. The rest of the expressions were scored in reverse with a negative verb. This questionnaire has also been used by other researchers in Iran and its reliability has been confirmed.[16]

Questionnaire for Stress, Anxiety, and Depression

The DASS (Lavibund, 1995) is a set of sanity scales used to measure negative emotional reactions in depression, nervousness, and discomfort.[17] This scale is used to measure the prevalence of the major signs of depression, anxiety, and tension. To answer the questionnaires, the person must assess the condition of a symptom within the previous week. Since this scale allows for a contrast of symptom progression over times, it can be used to track patient's condition across time.[18]

Anthony et al (1998) developed a questionnaire using factor structure and showed that the presence of three factors including depression, anxiety and stress has the greatest impact on psychometrics. According to the findings of this report, these three variables account for 68% of the overall variance of the measure. In the study, the stress, depression, and anxiety equations were created 9.07, 1.23, and 2.23, respectively, as well as the alpha coefficients for these variables were 0.97, 0.92, and 0.95. Musa and Fadzil (2007) evaluated the quality of this questionnaire using reliability and reliability in Iran. The validity of the test for the Depression, Anxiety and Stress scales is 0.80, 0.76 and 0.77 and Cronbach's alpha, respectively.[19]

The DASS subscale consists of seven issues, with the final score determined by adding the scores of the relevant questions. Each query is assigned a score ranging from zero (does not matter to me at all) to three (absolutely does not apply to me). Since the DASS-21 is a condensed version of the main scale (42 questions), the score line on each of these subscales should be twice.[20]

Data analysis

Descriptive and inferential statistics were used to interpret the results. Analysis of descriptive statistics has been used to calculate the mean and standard deviation, in addition to modifying the absolute and relative frequency distributions, and statistical inference such as the t-test and Pearson regression analysis, Spearman analysis, Mann–Whitney test, and study of variance. SPSS (Statistical package for social science of IBM, version 22, platform for windows, Chicago, United States) was used in this analysis.


  Results Top


During this research, 32% of females in the high-risk group were under 20 years old and over 35 years old, 18% of them were under 20 years old, and 14% were over 35 years old. In this study, the mean age of most pregnant women in both normal (70.24 ± 92.2) and high-risk (26.26 ± 92.4) pregnancy groups was years. Most pregnant women were in the high-risk pregnancy group (46%). The majority of pregnant women in both the groups were normal pregnancies (44%) and high-risk pregnancies (46%).

The average psychological health score in pregnant women with average pregnancies was 32.12 ± 4.61, while the average psychological health score in pregnant women with high-risk pregnancies was 38.12 ± 2.42. Statistical t-test showed a significant difference between the two main study groups (pregnant women in the normal group - pregnant women in the high-risk group) with the mean score of psychological well-being (P = 0.002).

Well-being and depression have an important and opposite correlation in both pregnant women with normal pregnancies and in pregnant women with high-risk pregnancies. More precisely, the quality of life decreases with increasing depression (P < 0.001) [Table 1].
Table 1: Comparison of the frequency of depression in women who are pregnant with normal and high-risk pregnancies in 2020

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According to Scheffe statistical method, psychological well-being is very different in the group of high-risk and normal pregnant women. Also, in Scheffe test, scores were classified based on job, gestational weekend, gestational age and showed a significant difference between housewives, self-employed and employees (P = 0.05).

[Table 2] shows the effect of socio-economic variables on one-way self-efficacy using one-way analysis of variance. The results show that the mean score of mental health in pregnant women is 62.32. 12.48. Most pregnant women in the high-risk group have a lack of self-efficacy. In other words, 45% had moderate self-efficacy, 4.50% had high self-efficacy and 50.5% had low self-efficacy.
Table 2: Comparison of Psychological S.D and Mean in women who are pregnant with normal and high-risk pregnancies in 2020

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According to the findings from the study measuring the well-being of pregnant women with stable and high-risk pregnancies, the mean of relationship satisfaction achieved in expectant mothers with normal pregnancies was greater than that of pregnant women with high-risk pregnancies. They outperform, and the gap is statistical significance.

This discovery showed that the self-efficacy score varied significantly with age, time of wedding, and period of maternity. The Scheffe test revealed that population over the age of 30 had marginally higher self-efficacy scores than people below the age of 25 (P = 0.024). In addition, in the second trimester of pregnancy, the self-efficacy rate was marginally higher. In the first section, significance was greater than self-efficacy (P = 0.014).

Psychological well-being and sanity are the discrete and conditional factors in this study. Because of the differences between the independent and dependent variables, simple linear regression is the favored mathematical method. The predictor variables was found to be regular (P = 0.046) using the Kolmogorov test [Table 3].
Table 3: Investigation between during the coronavirus disease 19 epidemic, psychological health, and its aspects of independent variables

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  Discussion Top


Studies on Coronavirus (COVID-19) in pregnant women worldwide have shown that the symptoms and effects of the virus during pregnancy and childbirth in mothers with underlying conditions such as diabetes - hypertension and increased cardiovascular discomfort.[21] Postpartum is the most important time in a woman's life, and it is widely regarded as a stressful and painful time for people.[22] Most pregnant women in Iran were exposed to psychological trauma and mental disorders during the Corona crisis. According to the majority of Iranian studies, the neutral status of women's psychological development was strong, but under COVID-19 circumstances, the desirability of women's psychological development decreased. Ritter et al claimed in their analysis of the psychological health well-being of pregnant women with spinal arthritis and stable pregnant women.[23]

Comparison of depression in two groups of pregnant women with normal and high-risk pregnancies showed that the mean DASS test scores in normal pregnancies were lower than high-risk pregnancies and there was a major difference between two classes (P < 0.006).[24]

The outcomes demonstrate that the rate of depression has significantly increased in the high-risk pregnancy group and the difference between the DASS test scores in the two groups may be due to different pregnancy conditions in the category of high-risk pregnant women and normal pregnancies. In fact, pregnancy is a stressful period for a woman and can be accompanied by frustrating feelings, sadness, and depression, these results from the study of angered variables related to depression during pregnancy. In coordination, the researchers said, there is a specific factor that affects the growth of depression during pregnancy.[25]

The Rezaei et al study found a similar result in Iran, including a high degree of psychological health well-being among Iranian women.[26] The Mehrabi et al study found that the mean of moral well-being in infertile mothers and cancer was 95% and 97.7%, collectively.[27] The results of McCoubrie and Davies's studies in this report have a significant and consistent relationship with psychological health fitness, age, and educational achievement rate.[28] According to Adegbola's analysis, self-efficacy has a deep and significant correlation with psychological, which supports the study's findings that psychological well-being is related to moral and existential aspects of health.[29] The research of Reicks et al has shown that performing religious and psychological duties, such as prayer, is effective in increasing self-esteem and self-confidence, as well as improving self-efficacy.[30] The current study also discovered that moral well-being can predict self-efficacy. In this study, psychological health and its dimensions were able to predict self-efficacy, with current health having the greatest impact on predicting pregnant women's self-efficacy. This discovery is similar to the findings of the Syed Imam study on student well-being, which discovered that it predicts psychological health, self-efficacy, and self-esteem.[31]

Pregnancy as an idea articulated as a stressful period of time for women, causing terror, stress among pregnant women, and heightened fear and anxiety as a result of acute respiratory disease COVID-19 reduces psychological well-being, which is why the current study's results are evident.[32] Labor risks vary by mother, but most of them experienced elevated levels of stress and anxiety, resulting in the birth of babies with special conditions such as premature birth, preterm birth, sickness, and vomit.[22],[33] To compare the performance of this report, we can refer to a study conducted by Durankuş in 2020, which found that COVID-19 raised the occurrence of depression and stress in pregnant women, causing the level of stress and depression to rise during COVID-19.[33],[34] Turkey discovered that anxiety in pregnant women was caused by fear of the unexpected, disturbance of routine prenatal treatment, and disruption of social life as a result of quarantine.[35] The use of advanced and diverse maternal health-care delivery by health-care providers will reduce the fear of pregnant women in disaster situations such as the COVID-19 pandemic.[36] The Corbett et al analysis discovered that most pregnant women (83.1%) were less concerned about health and more concerned about coronavirus and economic factors, indicating that the current is right for pregnant women.[37] According to the findings of the current report, pregnant women in the 6th–9th months of their pregnancy are more worried and nervous, and their well-being is greatly impacted by COVID-19 illness, and reports indicate that the medical health of pregnant women in the coronavirus outbreak has deteriorated.[38] In the present study of Nodoushan et al, as in the present study, it was shown that the effects of stress caused by COVID-19 in pregnant women are greater than in the precoronary period.[39]

The coronavirus outbreak has impacted all elements of society, including women who are pregnant, causing psychological deals of depression, as well as preventing the birth of healthy babies, as most mothers and their infants are born prematurely as a result of lockdown and increased stress. Finally, as tensions rise, even within Iran's religious and Islamic communities, the moral well-being of pregnant women is declining, and this study needs to be replicated globally in order to eliminate cultural considerations as a source of intervention. To summarize, we believe that conducting our study again after the COVID-19 pandemic is over and assessing the results would be of significant empirical value in order to draw final conclusions about the impact of the SARS-COVID-19 epidemic on pregnant women's mental health. Changes in blood factors and body hormones (changes in circulating blood flow and changes in hormone levels) led to a decrease in healthy pregnancies during the Covid-19 crisis. Most changes are due to changes in blood factors and body hormones that increase during pregnancy in women. The main disadvantages of this study are the small sample size as well as the short pregnancy stage for pregnant women. This issue needs more extensive research on a global scale and women of different races.


  Conclusion Top


During the COVID-19 crises, the study goals reflected the majority of pregnant adults who did not have psychological well-being, while psychological health and its facets, on the other contrary, had been aware of creating self-efficacy as an established behavioral characteristic. As a result, it is crucial to study more about the effect of psychological well-being on the sanity of women who are pregnant all over the whole planet. Mostly during COVID-19 epidemic, mental stress levels in pregnant and lactating women range from moderate to severe. Depression is often more common in women with a family history of psychiatric treatment, those in their first trimester of pregnancy, and others in a single or intimate relationship.

Financial support and sponsorship

This study was funded by Yazd Shahid Sadoughi University of Medical Sciences under the project proposed by Occupational Health Research Center.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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