COVID-19 and mental health of pregnant women in Ceará, Brazil

Machado, Márcia Maria Tavares; Rocha, Hermano Alexandre Lima; Castro, Marcia C.; Sampaio, Edgar Gomes Marques; Oliveira, Francisco Ariclene; Silva, Jordan Prazeres Freitas da; Aquino, Camila Machado de; Sousa, Liduina de Albuquerque Rocha de; Carvalho, Francisco Herlanio Costa; Altafim, Elisa Rachel Pisani; Correia, Luciano Lima

doi:10.11606/s1518-8787.2021055003225

Márcia Maria Tavares Machado

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-0149-5792

Hermano Alexandre Lima Rocha

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

Harvard TH Chan School of Public Health. Department of Global Health and Population. Boston, MA, USA

https://orcid.org/0000-0001-9096-0969

Marcia C. Castro

Harvard TH Chan School of Public Health. Department of Global Health and Population. Boston, MA, USA

https://orcid.org/0000-0003-4606-2795

Edgar Gomes Marques Sampaio

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-2373-0757

Francisco Ariclene Oliveira

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-0290-4797

Jordan Prazeres Freitas da Silva

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-7916-9508

Camila Machado de Aquino

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Materno-Infantil. Fortaleza, CE, Brasil

https://orcid.org/0000-0001-7108-5396

Liduina de Albuquerque Rocha de Sousa

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Materno-Infantil. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-9163-8311

Francisco Herlanio Costa Carvalho

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Materno-Infantil. Fortaleza, CE, Brasil

https://orcid.org/0000-0002-6400-4479

Elisa Rachel Pisani Altafim

Fundação Maria Cecilia Souto Vidigal. São Paulo, SP, Brasil

https://orcid.org/0000-0002-5732-0473

Luciano Lima Correia

Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Coletiva. Fortaleza, CE, Brasil

https://orcid.org/0000-0001-8948-8660

Correspondence: Marcia Maria Tavares Machado Rua Papi Junior, 1223 5o andar 60430-235 Fortaleza, Ceará, Brasil E-mail: marciamachado@ufc.br

Authors’ Contributions: Study design and planning: MMTM, HALR, MCC, LLC. Data collection, analysis and interpretation: MMTM, HALR, MCC, LLC, EGMS. Manuscript drafting or review; approval of the final version; and public responsibility for the content of the article: all of the authors.

Conflict of Interests: The authors declare no conflict of interest.

Variable		n	%
Age range	Up to 35 years	837	80.4
Age range	> 35 years	204	19.6
Median (IQR) income per capita (US$)		500.26 (316.96–1,009.25)
Marital status	Married or common-law marriage	921	88.5
	Widowed/Divorced/Separated	16	1.5
	Single	104	10.0
Education	Middle School or less	7	0.7
	High School	196	18.8
	College/University	397	38.1
	Postgraduate	441	42.4
Participates in the government’s cash transfer programs		51	4.9
N. of people living with the pregnant woman	Lives alone	10	1.0
	1	341	32.8
	2	299	28.7
	3	211	20.3
	4	108	10.4
	5 or more	72	6.9
Items of the SRQ scale:	1. Do you have unpleasant sensations in your stomach?	466	44.8
	2. Do you have poor digestion (heartburn, nausea, etc.)?	753	72.3
	3. Do you have lack of appetite?	222	21.3
	4. Do you have frequent headaches?	336	32.3
	5. Have you been crying more than usual?	518	49.8
	6. Have you been feeling sad lately?	603	57.9
	7. Do you feel like a useless, worthless person?	179	17.2
	8. Do you feel incapable of playing a useful role in your life?	171	16.4
	9. Have you lost interest in things?	341	32.8
Scores of the SRQ items:	0 to 1 item	221	21.2
	2 to 3 items	344	33.0
	4 to 6 items	367	35.3
	7 to 9 items	109	10.5
Common mental disorder		476	45.7
Fear of COVID-19 Scale	0 item	75	7.2
	1 item	112	10.8
	2 items	223	21.4
	3 items	448	43.0
	4 items	183	17.6

Variables	Total	Common mental disorders^a		Crude PRR (95%CI)	p^b

		Present	Absent

		%	%
Do I feel uncomfortable thinking about the Coronavirus?^c					< 0.001
Yes	878	49.3	50.7	1.87 (1.43–2.44)
No	163	26.4	73.6	1
Am I very much afraid of the Coronavirus?^c					< 0.001
Yes	777	49.0	51.0	1.36 (1.14–1.63)
No	264	36.0	64.0	1
Can’t sleep because I am worried about getting the Coronavirus?^c					< 0.001
Yes	195	69.7	30.3	1.74 (1.53–1.96)
No	846	40.2	59.8	1
When watching news and stories about COVID-19 on social media, do I get nervous or anxious?^c					< 0.001
Yes	784	51.4	48.6	1.81 (1.47 - 2.22)
No	257	28.4	71.6	1
Would you like to talk to a professional about your thoughts and feelings?					< 0.001
Yes	511	60.9	39.1	1.95 (1.69–2.26)
No	530	31.1	68.9	1
What is your opinion about social distancing?					0.020
It is not a sacrifice	92	34.8	65.2	1
It is a necessary sacrifice	923	47.5	52.5	1.36 (1.02–1.82)
Negative feelings towards COVID-19 (n. of “Yes” answers)					< 0.001
0 or 1	187	25.7	74.3	1
2	223	39.0	61.0	1.52 (1.13–2.04)
3	448	47.8	52.2	1.86 (1.43–2.42)
4 positive answers	183	69.4	30.6	2.70 (2.08–3.51)

Variables	Total	Common Mental Disorders^a		Crude PRR (95%CI)	p^b

		Present	Absent

		%	%
Socioeconomic and demographic variables
Neighborhood where the woman lives by HDI:					0.420
Low HDI (up to 0.49)	571	47.5	52.5	1.09 (0.88–1.34)
Medium HDI (0.50–0.79)	317	43.2	56.8	0.99 (0.79–1.24)
High HDI (> 0.80)	142	43.7	56.3	1
Age ranges:					0.037
Up to 35 years	837	47.3	52.7	1.21 (1.01–1.45)
> 35 years	204	39.2	60.8	1
Level of schooling:					0.039
Up to 12 years of schooling	203	52.2	47.8	1.18 (1.02–1.38)
More than 12 years of schooling	838	44.2	55.8	1.00
Marital status:					0.003
With a partner	921	43.9	56.1	1
Without a partner	120	60.0	40.0	1.37 (1.16 - 1.61)
Participates in the government’s cash transfer program:					0.927
Yes	51	45.1	54.9	1
No	990	45.8	54.2	1.01 (0.74–1.38)
Works outside the home:					0.043
No	222	53.2	46.8	1.22 (1.05–1.41)
Yes, before social distancing	682	43.7	56.3	1.00
Yes, before and during social distancing	137	43.8	56.2	1 (0.81–1.23)
Number of people living with the pregnant woman:					0.031
0 or 1 person	351	40.5	59.5	1
2 or 3 people	510	47.3	52.7	1.17 (1.00–1.37)
4 or more people	180	51.7	48.3	1.28 (1.06–1.54)
Gestational and assistance variables
Gestational period:					0.005
1^st trimester	190	53.7	46.3	1.32 (1.11–1.56)
2^nd trimester	365	48.2	51.8	1.18 (1.02–1.38)
3^rd trimester	486	40.7	59.3	1
Prenatal appointments:					< 0.001
Not attending prenatal appointments	43	67.4	32.6	1.57 (1.26–1.96)
In a basic health unit	139	56.1	43.9	1.31 (1.11–1.54)
In a private medical office/ health insurance office	859	43.0	57.0	1
Does someone accompany you at the prenatal appointments?					0.542
Goes alone	282	47.2	52.8	1.06 (0.91–1.23)
Child’s father/partner	695	44.5	55.5	1
Mother	33	54.5	45.5	1.23 (0.89–1.69)
Other	31	51.6	48.4	1.16 (0.82–1.65)
Did you stop having prenatal consultations during the social distancing period?					0.017
Yes	259	52.1	47.9	1.20 (1.04–1.38)
No	782	43.6	56.4	1
Do you have another child aged 1 to 6 years?					0.636
Yes	303	46.9	53.1	1.04 (0.9–1.2)
No	738	45.3	54.7	1
Does the child’s father live in the same house?					0.013
Yes	924	44.2	55.8	1
Right now he is living in another house	43	53.5	46.5	1.21 (0.91–1.62)
No	74	60.8	39.2	1.38 (1.13–1.68)

Variables	Adjusted PRR^b	95%CI	p
Score of negative feelings towards COVID-19^c:
4 positive answers	3.15	2.22–4.46	< 0.001
3 positive answers	1.93	1.4–2.65	< 0.001
2 positive answers	1.52	1.07–2.17	0.021
0 or 1	1
Number of people living with the pregnant woman:
4 or more people	1.36	1.03–1.78	0.028
2 or 3 people	1.20	0.96–1.49	0.105
0 or 1 person	1
Situation of antenatal care:
Not attending	1.84	1.19–2.85	0.007
Attends at the basic health unit	1.32	1.01–1.73	0.042
Attends at a private/medical insurance office	1
Works outside the home:
Yes	0.79	0.63–0.99	0.037
No	1
Gestational period:
1^st trimester	1.43	1.10–1.85	0.008
2^nd trimester	1.17	0.94–1.44	0.155
3^rd trimester	1
Do you wish to talk to a professional about your feelings?
Yes	2.30	1.89–2.8	< 0.001
No	1

[1] Correspondence: Marcia Maria Tavares Machado Rua Papi Junior, 1223 5o andar 60430-235 Fortaleza, Ceará, Brasil E-mail: marciamachado@ufc.br

Brasil

Brasil

COVID-19 and mental health of pregnant women in Ceará, Brazil

ABSTRACT

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS