Whether and how lockdown and mandatory quarantine regarding COVID-19 may affect mental health among pregnant women in China: Potential social, cognitive, and eHealth-related mechanisms.

BACKGROUND Although lockdown and mandatory quarantine have played crucial roles in the sharp decrease in the number of newly confirmed/suspected COVID-19 cases, concerns are raised over their threat to mental health especially among vulnerable groups including pregnant women. Few empirical studies have tested whether and how these control measures may affect mental health. No study investigated prevalence and impacts of utilizing eHealth among pregnant women during the outbreak. OBJECTIVE This study investigated 1) the roles of lockdown and mandatory quarantine in affecting mental health problems (i.e., anxiety and depressive symptoms), 2) the potential mediation effects of perceived social support and maladaptive cognition, and 3) the moderation roles of eHealth-related factors (i.e., social media use for health information and means of utilizing prenatal care services during COVID-19) among pregnant women in China. METHODS An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions (24 February-10 March, 2020). RESULTS Of the participants, 62.6% reported lockdown in the areas of residence and 3.8% were subjected to mandatory quarantine; 44.6% reported probable depression, 29.2% had probable anxiety, and 7.4% reported suicidal ideation. Only 3.3% of the participants reported using online prenatal care service during the outbreak. Significant socio-demographic/maternal variables of anxiety/depressive symptoms included age, education, occupation, area of residence, gestational duration, number of children born, complication during pregnancy, means of utilizing prenatal care services, and social media use for health information. Multiple Indicators Multiple Causes (MIMIC) modeling [χ2(df)=495.21(14), p<.05, CFI=.99, NNFI=.98, RMSEA=.04 (90%CI=.038, .045)] showed quarantine status was strongly associated with poor mental health status directly and indirectly through decreased perceived social support and increased maladaptive cognition (B=.04, β =.02, 95%CI=.01 to .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=.02 to .03, p=.001). Multi-group analyses revealed social media use for health information and means of utilizing prenatal care services were significant moderators of the model paths. CONCLUSIONS The findings provide epidemiological evidence for the importance to integrate mental health care and eHealth into the planning and implementation of control measure policy. The observed social and cognitive mechanisms and moderators are modifiable, and can inform the design of evidence-based mental health promotion among pregnant women. CLINICALTRIAL