Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study.

Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak. This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China. An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020. Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ214=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths. Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.

Yang X ，Song B ，Wu A ，Mo PKH ，Di J ，Wang Q ，Lau JTF ，Wang L ... -  《JOURNAL OF MEDICAL INTERNET RESEARCH》

Negative cognitive and psychological correlates of mandatory quarantine during the initial COVID-19 outbreak in China.

Xin M ，Luo S ，She R ，Yu Y ，Li L ，Wang S ，Ma L ，Tao F ，Zhang J ，Zhao J ，Li L ，Hu D ，Zhang G ，Gu J ，Lin D ，Wang H ，Cai Y ，Wang Z ，You H ，Hu G ，Lau JT ... -  《-》

Previous psychopathology predicted severe COVID-19 concern, anxiety, and PTSD symptoms in pregnant women during "lockdown" in Italy.

Ravaldi C ，Ricca V ，Wilson A ，Homer C ，Vannacci A ... -  《-》

Path analysis of COVID-19 cognition, social support, and mental health of pregnant women with interventional prenatal diagnosis during the COVID-19 pandemic based on structural equation modeling.

This study aims to investigate the relationship between Corona Virus Disease 2019 (COVID-19) cognition, social support, and mental health among pregnant women proposed for undergoing interventional prenatal diagnosis in Sichuan Province during the COVID-19 pandemic. A total of 2270 pregnant women (2232 valid) who were proposed to undergo interventional prenatal diagnosis at a tertiary hospital prenatal diagnosis center in Sichuan Province from January to December 2022 were selected by Convenience sampling and surveyed using a self-administered general information questionnaire, social support rating scale, mental health questionnaire (including: Self-Rating Anxiety Scale, Self-Rating Depression Scale), and self-administered COVID-19 cognition questionnaire. Structural equation modeling showed that social support negatively predicted anxiety (β = -0.34, t = -14.98, P < .001) and negatively predicted depressive status (β = -0.21, t = -9.57, P < .001); COVID-19 cognition negatively predicted anxiety (β = -0.76, t = -5.34, P < .001) and depression (β = -0.40, t = -2.99, P < .01); anxiety positively predicted anxiety (β = 0.73, t = 37.34, P < .001). The overall knowledge rate of COVID-19 cognition among 2232 pregnant women who were to undergo interventional prenatal diagnosis was 76.40%. The fit indices of the model were: CMIN/DF = 3.071, GFI = 0.999, AGFI = 0.993, CFI = 0.999, RMSEA = 0.030, NFI = 0.998, and TLI = 0.992, indicating that the model had a good fit and the model was scientifically valid. Pregnant women in Sichuan province who are to undergo prenatal interventional diagnosis have a medium level of COVID-19 awareness, and their level of COVID-19 awareness and social support will directly affect their anxiety and depression level, and their anxiety level will also affect their depression level. We should give more attention to pregnant women, especially those in particular situations such as advanced age, poor maternal history, family history of genetic disease, etc, they should be given adequate care and social support, and multiple channels and types of health education should be provided for the COVID-19 to improve the pregnant women's knowledge of COVID-19, which is important for improving the mental health of pregnant women.

Yang H ，Wang X ，Luo W ，Wan L ，Zhu H ，Peng W ，Guan Y ... -  《-》

The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study.

Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=-.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=-.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Social media may be a "double-edged sword" for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic.

Yang X ，Yip BHK ，Mak ADP ，Zhang D ，Lee EKP ，Wong SYS ... -  《JMIR Public Health and Surveillance》