Predictors of maternal mental health and coping during the COVID-19 pandemic: A multi-country cross-sectional study

Objectives and study

This study aimed to examine predictors of post-partum maternal mental health (MMH) and coping during COVID-19 lockdown across seven countries (the UK, China, Japan, Malaysia, Mexico, Argentina, and Thailand).

Methods

An anonymous questionnaire, developed in the UK in English and translated into local languages, was used in 2021-2022 to collect data on MMH and perceived coping ability from women aged ≥18 years with an infant born before or during lockdowns. Five MMH components (worry, sadness, loneliness, difficulty relaxing, annoyance) and coping were assessed on a 4-point Likert scale, then dichotomised. MMH and coping were compared across countries using Chi-square tests with post-hoc pairwise comparisons conducted via Bonferroni-adjusted z-tests. Predictors of MMH and coping were examined using multivariable logistic regression.

Results

A total of 7,650 women were analysed. Younger infant age, higher income, walking and exercise, and level of support were associated with better MMH and coping, whereas higher education was associated with better coping but poorer MMH. MMH and coping differed across countries (all p<0.001), which remained after adjusting for covariates: mothers in Asian countries reported better MMH, while those in the UK and Thailand reported better coping.

Conclusions

Postpartum MMH and coping during lockdown were shaped by both individual and contextual factors. Findings highlight cross-country differences and underscore the need to strengthen maternal support system during future disruptions to perinatal care.

Key messages

• Consistent predictors of better mental health and coping included younger infant age, higher income, regular physical activity, and enough support-factors that are modifiable and relevant in future public health emergencies.

• Country of residence remained an independent predictor even after adjusting for individual and social factors, suggesting cultural norms, health service models, and policy responses play important roles.

• Although the COVID-19 pandemic is largely over, the findings offer important lessons for future crises. Strengthening support systems, promoting physical activity, and ensuring equitable caregiving within households can help protect postpartum mothers’ wellbeing during any major social disruption.