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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 142-149

Quality of the life and depression levels of pregnant women with suspected/confirmed Coronavirus Disease 2019 in Turkey


1 Uskudar University, Faculty of Health Sciences, Midwifery Department, Istanbul, Turkey
2 Kadikoy District Health Directorate, Istanbul, Turkey

Date of Submission17-Apr-2021
Date of Decision02-Jul-2021
Date of Acceptance13-Jul-2021
Date of Web Publication13-Aug-2021

Correspondence Address:
Ayca Demir Yildirim
Mimar Sinan, Selmani Pak Cd, 34672 Üsküdar/İstanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnbs.jnbs_18_21

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  Abstract 


Objective: This study was conducted to investigate the effect of depression levels on the quality of life of pregnant women with probable and confirmed coronavirus disease 2019 (COVID-19) diagnosis. Methods: This is a cross-sectional study. The sample of the study was composed of thirty pregnant women who were defined as probable and confirmed cases in the COVID-19 Case Tracking module of the Public Health Software System. Results: The average age of pregnant women participating in the study was 32.53 ± 3.71 (min: 24, max: 40). The mean Beck Depression Inventory for Primary Care score of the pregnant women participating in the study was 2.2 ± 2.8 (min: 7, max: 20). Only five of the pregnant women had a high probability of depression. Considering the participants' average scores from the Short Form-36 Health Survey subdimensions, it is seen that the highest score of pregnant women is in the mental health category (x: 71.37 ± 2 8.8 6). The COVID-19 test result and the parameters of quality of life subscale were compared, and a statistically significant relationship was found between the social life quality of not only pregnant women with positive COVID-19 test results but also that of the women with negative test results (t: −2,627, P: 0.014). Conclusion: It is obvious that people's mental health is negatively affected during the COVID-19 pandemic. For this reason, midwifery care, which will be given to ensure that pregnant women are least affected by the COVID-19 pandemic, to protect their mental health, and to increase their quality of life, is even more important.

Keywords: Coronavirus disease 2019, depression, pandemic, pregnancy, quality of life


How to cite this article:
Yildirim AD, Erdem F, Esencan TY, Erdem B. Quality of the life and depression levels of pregnant women with suspected/confirmed Coronavirus Disease 2019 in Turkey. J Neurobehav Sci 2021;8:142-9

How to cite this URL:
Yildirim AD, Erdem F, Esencan TY, Erdem B. Quality of the life and depression levels of pregnant women with suspected/confirmed Coronavirus Disease 2019 in Turkey. J Neurobehav Sci [serial online] 2021 [cited 2021 Oct 25];8:142-9. Available from: http://www.jnbsjournal.com/text.asp?2021/8/2/142/323803




  Introduction Top


Infectious diseases threaten immunosuppressive populations, such as the elderly, chronically ill, immunocompromised, and pregnant women more. According to research published to date, coronavirus is more dangerous for pregnant women than normal individuals.[1],[2] According to evidence-based studies, coronavirus increases the risk of preterm birth.[3],[4] Respiratory diseases can cause negative consequences for pregnant women in obstetric and neonatal terms.[5] Physiological and immunological natural changes in pregnant women can also increase the risk of complications arising from respiratory tract infections. Death rates are also higher due to the fact that pregnant women are more susceptible to diseases in pandemics that have occurred in recent years.[5],[6] : In addition to all this during pregnancy, there is an increase in heart rate and oxygen volume. Decreased lung capacity and increased maternal cardiovascular with increased respiratory system due to the need for more oxygen use physiologically, as well as the immunological adaptation process also increase the risk of serious respiratory and infectious diseases.[5],[7] According to the data obtained from multiple studies, the morbidity and mortality rates of pregnant women are higher due to influenza compared to women who are not. A similar association was found in pregnant women who had severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the other coronaviruses.[5]

There are many literature studies about the effects of the new type of coronavirus disease (COVID) in pregnancy. However, in most of the studies conducted, the samples are tiny. Most of the studies undertaken involved women in the last 3 months of pregnancy due to the previous onset of the pandemic. There are still many questions waiting to be answered about the new coronavirus and pregnancy period. Some of the studies in the literature show that pregnant women are more at hazard for COVID-19 infection than normal individuals.[6] In the studies, seven of the pregnant women who were positive in the last 3 months of pregnancy had a fever, four had a cough, three had myalgia and sore throat, and two had signs of weakness.[8],[9]

According to a systematic review and meta-analysis investigating the complications of COVID-19 infection during pregnancy, COVID-19 was associated with preeclampsia, cesarean delivery, and perinatal death.[4] Covid-19 symptoms were found to be similar in all women regardless of pregnancy.[2],[6],[7]

The available data show us that studies on pregnancy and COVID-19 and their comparison with nonpregnant women of the same age are needed. It is unknown whether there is vertical transmission of COVID-19 infection from pregnant women to the fetus.[5],[7] Studies have shown no virus in the amniotic fluid, cord blood, breast milk, and newborn throat swab of the COVID-19-infected mother.[7] Although several studies suggested a transmission from the mother after COVID-19 infection in newborns, certain information could not be proven in these studies due to the samples taken from newborns and contact history with other people.[10] However, perinatal complications and first trimester complications are still unknown, and more studies are needed on this.

When pandemics are examined in terms of their psychosocial effects, it is seen that the vulnerable population is intensely affected. Especially, COVID-19-infected patients, the elderly or immunocompromised people, and pregnant women are at increased risk for adverse psychosocial outcomes.[11] Approximately 10% of pregnant women worldwide have experienced a mental disorder, especially depression. This situation is even higher in developing countries.[12] In studies on COVID-19 and mental health status, the risk of depression and anxiety in women, health-care workers, and the elderly population, especially in risk factor groups, is much higher than in the normal population.[12],[13] With the emergence of COVID-19 in China on January 20 and the confirmation of the process of human-to-human transmission, levels of social anxiety started to increase in China, and especially, pregnant women were adversely affected at this stage.[14]

Saccone et al.[15] examined anxiety conditions of 100 pregnant women throughout the COVID-19 pandemic in Italy and found that the epidemic had moderate and severe psychological effects.

In another study in Canada, Davenport et al.[16] examined the relation of depression and pregnancy with 520 pregnant women. It was found that 15% of the pregnant women had depression symptoms before the pandemic, while 40% of them had depression findings during the pandemic period. It has been stated that the COVID-19 pandemic is a factor that increases the risk of depression in pregnant women.[16]

Many countries have taken steps toward the risk group first to protect the mental health of society. Since the beginning of the covid-19 pandemic in our country, the sensitive group; people over 65, pregnant women and people at risk are protected by government policies. Among the steps taken for pregnant women is the administrative leave for all pregnant women from the pandemic onset. In addition to the normalization process (June 2), the administrative leave for pregnant women in over 24 gestational weeks keeps them away from crowded environments.[17]

It is acknowledged that the quality of life decreases and the possibility of depressive symptoms increases during pregnancy compared to the period before pregnancy.[18] This research aims to search the correlation among the quality of life and depression risk of women who are pregnant during the COVID-19 pandemic process.


  Study Method Top


The permission from the Ethics Committee for the study was obtained with the decision of Haydarpasa Numune Training and Research Hospital Clinical Research Ethics Committee numbered HNEAH-KAEK/78.

In the study, it was aimed to investigate depression in the pregnant population, who were probable or approved cases of COVID-19 infection, which is a new concept for the whole world and to investigate the impact of this status on the quality of life. This is a cross-sectional study.

The study was carried out with pregnant women who were registered as probable and confirmed cases by the Ministry of Health's Public Health Software System COVID-19 Case Tracking module. The universe of the research occurs of 43 pregnant women (19–45 ages) who were defined as likely and confirmed cases in the case tracking module system. Since 35 of 43 pregnant women in the system had a mobile phone number, 35 pregnant women were reached and 5 of these pregnant women did not accept to participate in the study. The power analysis for the sample calculation of the research was calculated using the G*Power program. Since the prevalence of new coronavirus on pregnant women is not known, a power analysis was made over a domain of 0.5 and a power over 85%. After this calculation, the sample size consisted of thirty pregnant women with probable and confirmed cases.

The inclusion criteria in the study are:

  • Pregnancy
  • A probable or confirmed case of COVID-19
  • Approval of the study.


The exclusion criteria from the study are:

  • Being a nonpregnant woman with COVID-19 infection
  • Disapproval of participation in the study.


Data collection tools and data collection

Within the scope of the study, the contact information of the pregnant women with a probable or confirmed infection diagnosed of COVID-19 pandemic was obtained through the Public Health Management System (HSYS) COVID-19 Case Follow-up module and the women were contacted by phone, the study informed consent form was read verbally, and data were collected verbally and online from the pregnant women who agreed to participate in research. A sociodemographic data form (16 questions), obstetric information form (8 questions) and an information form collecting general information about COVID-19 (15 questions), “the Beck Depression Inventory For Primary Care (BDI-PC)” (7 questions), and Short Form-36 (SF-36) Health Survey (36 questions) were prepared in the Google questionnaire format and sent as a message to the phones of pregnant women who accepted to participate in the research.

The Beck Depression Inventory for Primary Care

The validity and reliability study of the scale was made by Aktürk et al.[18] The BDI-PC is a screening test that reduces false-positive depression rates. BDI-PC scans for depression down seven headings, handling the indications of sadness, pessimism, past failures, self-dislike, self-criticalness, loss of interest, and suicidal thoughts or wishes. Each title includes a four-digit scoring from 0 to 3; the BDI-PC score is obtained by rallying the top scores in each title. A maximum total of 21 points can be obtained. Although no cutoff score is declared, the possibility of depression is over 90% at scores above 4.

Short Form-36 Health Survey

Its Turkish validity and reliability research was done by Koçyiğit et al.[19] SF-36 is a self-assessment scale and includes eight dimensions of health such as physical functionality, sociable functionality, role limitations on account of physical functionality (role functionality-physical), bodily pain, common mental health, role limitations because of emotional functionality (role functioning-emotional), lifely (energy and fatigue), and common health perception through 36 items. Cronbach's alpha coefficients of each subscale were calculated separately in reliability studies and were found between 0.7324 and 0.7612. Item-total score correlations were calculated between 0.4712 and 0.8872. In the validity study, a multitrait-multimethod matrix was used and the correlation coefficients were found between 0.44 and 0.65. The SF-36 scale is scored over 100 points, and the scores obtained vary between 0 and 100 points for each component. High scores on this scale indicate a better level in health, while low scores indicate deterioration in health.

Evaluation of data

SPSS package program was used to evaluate the data. Whether the data had a normal distribution or not were checked with the Kolmogorov–Smirnov test. Chi-square, t-test, Fisher's Chi-square test, and Mann–Whitney U-test were used to evaluate the differences and relationships between variables. P ≤ 0.05 was accepted as statistically significant.


  Results Top


The average age of pregnant women participating in the study was 32.53 ± 3.71 (min: 24, max: 40). The average body mass index was 26; this was thought to be due to the weight gained during pregnancy. The average first gestational age was 29.3 ± 4.48 (min: 18, max: 38). The mean BDI-PC score of the pregnant women participating in the study was 2.2 ± 2.8 (min: 7, max: 20). Only five of the pregnant women had a high probability of depression.

Considering the sociodemographic characteristics of the pregnant women participating in the study, it is seen that 76.7% of them were between the ages of 19–35 and 23.3% were above the age of 36. Regarding their general health status, 86.7% of them did not have any chronic disease and 53.3% did not have any surgery. Considering the obstetric status of the participants in the study, it was understood that the age at first gestation of 86.7% was between 19 and 35, the number of pregnancies of 50% was 2, and 60.9 of them had an interval of above 24 months between pregnancies [Table 1].
Table 1: The sociodemographic and obstetric data of the pregnant women participating in the study

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When [Table 2] is examined, it is seen that 36.7% of the pregnant women had contact with someone diagnosed with COVID-19 and that 66.7% of the people they came into contact with were family members (88.9% were spouses). COVID-19 polymerase chain reaction test result of only 20% of the pregnant women participating in the study was positive. 56.7% of the pregnant women had no symptoms of COVID-19. It is observed that 90% of them were outpatients at home rather than in the hospital, and none (100%) was hospitalized in intensive care. 50% of them stated that they used the drug called hydroxychloroquine used in the treatment of COVID-19. None of the pregnant women lost any relatives due to COVID-19. When the isolation conditions were examined, 53.3% of them stated that the isolation was unnecessary and 43.3% of them stated that they went out without isolation.
Table 2: Coronavirus disease 2019 data of the pregnant women participating in the study

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[Table 3] shows the average score obtained from the subdimensions of the SF-36 Health Survey. When the quality of life of pregnant women is evaluated in eight sections, it is seen that the mental health category has the highest score (: 71.37 ± 28.86). It is seen that physical functioning (: 68.3 ± 33.01) and emotional role difficulty (: 67.66 ± 43) score is above the average.
Table 3: Subdimension mean scores of the Short Form-36 Health Survey of the pregnant women participating in the study

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It is understood that the lowest score is in the general health perception with an average of 32.5 ± 9.3. Social functioning (: 40.0 ± 35.26), energy/vitality (: 45.0 ± 22.25), and pain perception (: 47.5 ± 33.37) also seem to be perceived lower than average [Table 3].

The COVID-19 test result and the subdimension parameters of the health survey are compared in [Table 4], and a statistically significant relationship was found between the social quality of life of not only pregnant women with positive COVID-19 test results but also those with negative results (t: −2,627, P: 0.014). A statistically significant relationship was not found between the COVID-19 test result and the other subdimensions of the scale.
Table 4: Comparison of the pregnant women who have had coronavirus disease 2019 test in terms of the means of health survey subdimensions

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[Table 5] shows the relationship between the average scores of BDI-PC and the subdimensions of the SF-36 Health Survey Inventory, and a statistically significant relationship was found with emotional role difficulties and energy/vitality subdimensions. No significant difference was found in other parameters. It is observed that as the probability of depression increases in pregnant women, the energy/vitality quality of life and emotional quality of life deteriorate.
Table 5: Comparison of the relationship between average Beck Depression Inventory for Primary Care and Short Form-36 Health Survey subdimensions of pregnant women participating in the study

Click here to view



  Discussion Top


According to our study, the mean scores of the pregnant women in the BDI-PC were found to be 2.2 ± 2.8, and only five of them had a high probability of depression. The fact that the mean inventory scores of the pregnant women participating in our study are below 4 indicates that the probability of depression is low. In a systematic review examining the effects of maternal depression, anxiety, and perceived stress on pregnancy, it was found that depression during pregnancy differs between races and ethnic groups, women who have socioeconomic difficulties and a lack of social support have high depression, and the pregnant women who have negative health behaviors during pregnancy (such as smoking and substance use) have high depression scores.[20]

In a study measuring the depression levels in pregnant women, it was found that the depression rates increased during the pandemic period compared to the prepandemic.[21] When our study data were examined, it was thought that having a good socioeconomic status, 66.7% having a job, and almost all of them having social security were effective on low depression scale scores of the pregnant women.

It was determined that 20% of the pregnant women in our study were positive for COVID-19, and 90% of them received outpatient treatment. In a study examining pregnant women diagnosed with COVID-19 during pregnancy and the postpartum period in Brazil, 978 pregnant and postpartum women were treated for COVID-19 between February 26 and June 20, 2020, and 124 cases were reported and resulted in death. This stated mortality rate was 3, four times the general world average.[22] It is reported that the number of pregnant women diagnosed with COVID-19 during the obstetric period in Brazil is 12.7% compared to the average population, but this rate is actually higher.[23],[24],[25] A study of 82 pregnant women with a suspected and positive COVID-19 infection in Spain found that only 4 pregnant women showed serious symptoms. In addition, one of these pregnant women was diagnosed with preeclampsia; four pregnant women gave birth by cesarean section and were transferred to the intensive care unit.[26]

When the results of SF-36 Health Survey scores were examined in our study, it was found that the mental health category had the highest score (: 71, 37 ± 28.86). Furthermore, in a study in which the normative data of the SF-36 Health Survey in Turkey's population were examined, it was found that the score obtained for the female population in the mental health category was found to be x: 70.1 ± 11.4, which is similar to our study, and that the social functioning category had the highest score. When we compared other parameters, it was seen that the physical functioning was : 68.3 ± 33.01 in our study while this value was : 80.6 ± 21.7 in the female group of the Turkish population and that emotional role difficulty in our study was : 67.66 ± 43 while this score was : 89.0 ± 22.5 in the female group of the Turkish population.[27] It was thought that all these data were found to be lower than the normative data of Turkey due to the COVID-19 pandemic. In our study, the lowest score obtained from the inventory was found to be in the general health perception with an average of 32.5 ± 9.3. In the data obtained from the female group for Turkish society, it was observed that the lowest score was in the energy/vitality category, with an average of 63.4 ± 13.7.[27] When the inventory scores in our study and the COVID-19 test results were compared, a significant relationship was found between the social quality of life of not only pregnant women with positive COVID-19 results but also those with negative ones. This was thought to result from being in isolation for 14 days due to suspicion of COVID-19.

The mean age of pregnant women participating in the study was found to be 32.53 ± 3.71. When similar studies were examined, Sheeba et al. in the study, the average age was 23,[28] while Davenport et al. and in their study, Micellia et al.found that the average age was 33.[16],[29] In another study conducted in Italy, it was found that the mean age of the women planning to become parents during the COVID-19 pandemic process was 30 and over.[30] When the studies about pregnancy are examined, it is seen that the average age is 30 and above mostly.[16],[29],[30]

In our study, the BDI-PC and the subdimensions of the SF-36 Health Survey were compared, and a statistically significant relationship was found between the BDI-PC and the subdimensions of emotional role difficulties and energy/vitality. In studies examining anxiety and depression in the COVID-19 pandemic, it is stated that the pandemic negatively affects psychology, and the diagnosis of depression increases in this process.[31],[32] The leading causes of the psychological effects of the COVID-19 pandemic are pandemic and government response, physical distancing measures, isolation, and quarantine processes.[33],[34] In a population-based comparison study examining pregnant women with and without depression during pregnancy, it was reported that depression is affected by the quality of life and this process experienced during pregnancy may also affect the flow of delivery, cause dystocia, and increase the risk of cesarean delivery.[35] In a study conducted with 280 pregnant women, it was stated that 35.7% of them were under the risk of depression and that age, education, occupation, and socioeconomic status were effective factors on depression.[16] In a systematic review and meta-analysis examining the psychiatric and neuropsychiatric consequences of the COVID-19 pandemic, studies on the MERS and SARS pandemics were examined, and emotional changes were found to be associated with depression.[12],[21],[32],[34] In our study, it was found that there is a relationship between the susceptibility of pregnant women to depression and their energy/vitality quality of life and emotional quality of life. When the literature was reviewed, no other similar study questioning the relationship between the quality of life of pregnant women and depression in the COVID-19 pandemic was found.

As a result, it is obvious that people's mental health is being negatively affected during the COVID-19 pandemic process. In this process, once again, the vulnerable populations (e.g. children and pregnant women) are being affected more. For this reason, midwifery care, which will be given to pregnant women to protect their mental health, to increase their quality of life, and to ensure that they are least affected by the COVID-19 pandemic, is even more important. It is possible to prevent pregnant women from depression by supporting them emotionally and increasing their energy. For this reason, obstetric care which will help to minimize the negative effects of the pandemic should not only focus on the physical well-being of pregnant women but also on providing emotional and mental well-being. Besides, it is seen that different studies examining the effects of the COVID-19 pandemic on pregnant women, especially on mental health, are needed. It is also very important to ensure the continuity of care of the pregnant women diagnosed with COVID-19 and to continue online midwifery care during the quarantine period in order to ensure that pregnant women are supported at this stage. Today, when a new era has begun with the COVID-19 pandemic, the integration of obstetric care and health-care professionals into this process and ensuring the continuity of service is an important step for our future.

Study limitations

This study is based which can be considered a geographical limitation. The fact that pregnant women have good socio-economic status is thought to have an effect on low Depression Scale scores.

Patient informed consent

Informed consent was obtained.

Ethics committee approval

The permission from the Ethics Committee for the study was obtained with the decision of Haydarpasa Numune Training and Research Hospital Clinical Research Ethics Committee numbered HNEAH-KAEK/78.

Financial support and sponsorship

No funding was received.

Conflicts of interest

There are no conflicts of interest to declare.

Author contribution subject and rate

Ayça Demir Yıldırım (50%): Designed the research, data collection, and analyses and wrote the whole manuscript.

Feyza Nur Erdem (20%): Organized the research and supervised the article write-up.

Tuğba Yılmaz Esencan (15%): Contributed with comments on manuscript organization and write-up.

Binnur Erdem (15%): Contributed with comments on research design.

Acknowledgments

We thank the pregnant women who contributed to the research.

Author's note: This study was presented as verbal statement at the First Anatolia Midwifery Congress on November 20–22, 2020. Therefore, the majority of plagiarism is the plagiarism of this study.



 
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