Mental health among pregnant women during the pandemic in Sweden– a mixed methods approach using data from the Mom2B mobile application for research

  1. Emma Fransson
  2. Maria Karalexi
  3. Mary Kimmel
  4. Emma Bränn
  5. Natasa Kollia
  6. Vera van Zoest
  7. Eira Nordling
  8. Fotios C Papadopoulos
  9. Alkistis Skalkidou

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Abstract

Public health emergencies such as the coronavirus (SARS-CoV-2) pandemic have significant impact on mental health, and have been shown to impact on already prevalent affective disorders during and after pregnancy. The aim of this study was to utilize modern tools to assess depressive and anxiety symptoms, as well as wellbeing and life changes in pregnant women during the pandemic in Sweden, where no lockdown has been in place.

Data from the Mom2B, a national ongoing mobile application-based study of pregnant and newly-delivered women were utilized. Participants (n= 1345) filled out self-report screeners of depression, anxiety and wellbeing. Questions about COVID symptoms and effects on life and health care were added from March 2020. Movement data was collected using the phone’s GPS sensor. Mood scores were compared with throughout the months of 2020 and to the levels of a previous collected material. Highest levels of depression and anxiety were evident in April and October 2020. Symptoms were higher among those feeling socially isolated, but not for those infected or with symptomatic family members. Wellbeing and mobility were strongly positively correlated and were lowest in April. Women reported on cancelled healthcare appointments and worry about their partners being absent from the delivery.

The Mom2B application enabled gathering information at a national level in real-time as the pandemic has been evolving. Levels of perinatal affective symptoms and low wellbeing were elevated compared with previous years as well as with months with fewer cases of SARS-Cov-2. Similar applications can help healthcare providers and governmental bodies to in real time monitor high-risk groups during crises, as well as to adjust measures and the support offered.

Funding

This project was funded by the Uppsala Region to AS, the Swedish Association of Local Authorities and Regions (SKR) to the department of Obstetrics and Gynecology, Akademiska University Hospital, the Swedish Research Council (Grant number 2020-01965) to AS, as well as the Fredrik and Inger Thuring’s Foundation to EF.

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  1. ScreenIT

    SciScore for 10.1101/2020.12.18.20248466: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: The included self-report instruments were based on the results from a previous study in Uppsala County, Sweden (17), whereas the mobile application further recorded digital phenotyping data, such as movement patterns, internet and mobile use, as well as voice recordings, after receiving informed consent from participants.
    IRB: Ethical approval for the BASIC study was granted by the Regional Ethical Review Board of Uppsala, Sweden (Dnr 2009/171), and for the Mom2B-study by the Swedish Ethical Review Authority (Dnr 2019-01170), with amendments.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableAll Swedish-speaking women above 18 years of age owning a mobile smartphone who are either pregnant or have delivered within three months are eligible for participation.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Ethical approval for the BASIC study was granted by the Regional Ethical Review Board of Uppsala, Sweden (Dnr 2009/171), and for the Mom2B-study by the Swedish Ethical Review Authority (Dnr 2019-01170), with amendments.
    BASIC
    suggested: (BaSiC, RRID:SCR_016371)
    Google search volumes data: The interest of internet users for the situation around the pandemic over time (January-October 2020) in Sweden was assessed using Google Trends (https://trends.google.com/trends/explore?geo=SE&q=Corona).
    Google
    suggested: (Google, RRID:SCR_017097)
    Analyses were performed using the SPSS software, version 22.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: The novel way provided through the Mom2B application to introduce new questions and gather self-reported information in a user-friendly way at national level is a strength of this study. Future research could further address whether possible preventive interventions might be incorporated and delivered directly through the application, adding to the health care systems arsenal during crises. Among the limitations of the present study, we should first acknowledge that selection bias should be considered: only 1% of the background eligible population contributed data; the application cannot be used by women not able to communicate in Swedish, or those not owning a mobile smartphone (8%). Nonetheless, the present results are in line with another recent Swedish study with better representation (37). We cannot exclude a potential bias in the results due to the self-reported nature of the information gathered. In addition, we used the EPDS and WHO-5 scores for outcome assessment, which are validated screening questionnaires, and sensitive in identifying women likely to suffer from perinatal mood or anxiety disorders; however, these tools are not sufficient to establish the diagnosis of perinatal depression or anxiety. Data on mobility at the individual level would have allowed for more advanced analyses, which could address directionality in the associations with mood; this will be possible in the near future. Lastly, the ongoing use of Mom2B, allowing for...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.12.18.20248466v1 on medRxiv