COVID-19 and mental health during pregnancy: The importance of cognitive appraisal and social support
Open accessAbstract
Background Pregnancy is a period of elevated risk for mental health difficulties, which are likely exacerbated by the COVID-19 pandemic. This study aims to understand the impact of COVID-19 on mental health and identify risk and protective factors during pregnancy.Methods Participants were 303 pregnant individuals from Ontario, Canada. Depression, anxiety and insomnia were measured using validated questionnaires. COVID-related experiences (i.e., financial difficulties, relationship conflict, social isolation) were assessed in relation to mental health. Social support and cognitive appraisal of the pandemic were examined as protective factors.Results 57% of the sample reported clinically elevated depression, >30% reported elevated worries, and 19% reported elevated insomnia. Depression (t = 25.14, p < .0001) and anxiety (t = 17.21, p < .0001) levels were higher than non-COVID pregnant samples. Social isolation, financial trouble, relationship difficulties and threat of COVID-19 were associated with mental health. Social support (r range -.24 to -.38, p <.01) was associated with lower mental health problems and negative cognitive appraisal (r range .20 to .33, p <.01) was linked to more mental health problems. Furthermore, social support and cognitive appraisal interacted (β = -.92, SE = .41, p < .05), such that higher social support acted as a protective factor, particularly for those who appraise the impact of COVID-19 to be more negative.Conclusions Findings underscore the need to address the high rates of mental health during pregnancy and outline potential targets (cognitive appraisal and social support) to protect pregnant people from experiencing mental health problems during the COVID-19 pandemic.
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Social support may be a vital protective factor for mental health across demographics.
“Social support, which includes support in developing and maintaining personal, family, and social relationships, may also be a vital protective factor for mental health across demographics [196–199].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [197]
The Results section finds that higher social support was associated with fewer mental health symptoms among pregnant participants who appraised COVID-19 negatively. The Introduction also cites evidence concerning non-pregnant individuals, but this paper does not establish a protective effect across demographics; its own finding is conditional and population-specific. (LLM, conf=0.84)
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Self-citation
- Authors
- Khoury, J. E., Atkinson, L., Bennett, T., Jack, S. M., & Gonzalez, A.
- Affiliations
- McMaster University (CA)
- Toronto Metropolitan University (CA)
- Corresponding author
- Khoury, Jennifer E.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 282
- Pages
- 1161-1169
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC7837227
- OpenAlex
- W3120171561
- Cited by
- 195
- References
- 76
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 23 · 2023: 48 · 2022: 56 · 2021: 46 · 2020: 1
- FWCI
- 37.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research (20011917)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Obstetrics and Gynecology › COVID-19 Impact on Reproduction
- Keywords
- COVID-19 pandemic, pregnancy, maternal mental health, depression, anxiety, insomnia, cognitive appraisal, social support, social isolation, financial hardship, relationship conflict, protective factors, risk factors
- MeSH terms
- COVID-19, SARS-CoV-2, Anxiety, Cognition, Depression, Female, Humans, Mental Health, Ontario, Pregnancy, Social Support, Pandemics
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