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      COVID‐19‐related financial stress associated with higher likelihood of depression among pregnant women living in the United States

      brief-report
      1 , 2 , , 1
      American Journal of Human Biology
      John Wiley & Sons, Inc.

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          Abstract

          Objectives

          The COVID‐19 pandemic has led to unprecedented levels of unemployment and financial strain for many Americans. Among the individuals impacted by financial strain are pregnant women, for whom added financial stress may be particularly impactful due to the costs associated with prenatal care and providing for a newborn. Financial stress has been previously associated with elevated depression symptoms among pregnant women, which could have significant impacts on birth outcomes and long‐term offspring health. However, the impacts of COVID‐19‐associated financial stress on maternal depression in pregnancy has not been investigated.

          Methods

          Here, we evaluated whether COVID‐19‐associated financial stress was associated with increased likelihood of a clinically significant depression score (Edinburgh Postnatal Depression Score ≥ 15) among pregnant women living in the United States during the COVID‐19 pandemic. Data come from an online survey administered to a convenience sample in April 2020 ( N = 2099).

          Results

          Forty‐three percent of participants reported experiencing financial stress as a result of the pandemic, while 24% of participants had a clinically significant depression score. COVID‐19‐related financial stress was significantly associated with increased likelihood of a clinically significant depression score, even after adjustment for covariates including participant education and income (adjusted Odds Ratio: 2.23, 95% CI = 1.80, 2.77, P < .001).

          Conclusions

          Financial stress caused by the COVID‐19 pandemic is associated with more than two times the likelihood of depression during pregnancy, which could impact birth outcomes and long‐term offspring health.

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          Most cited references10

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          A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.

          Maternal depressive symptoms during pregnancy have been reported in some, but not all, studies to be associated with an increased risk of preterm birth (PTB), low birth weight (LBW), and intrauterine growth restriction (IUGR). To estimate the risk of PTB, LBW, and IUGR associated with antenatal depression. We searched for English-language and non-English-language articles via the MEDLINE, PsycINFO, CINAHL, Social Work Abstracts, Social Services Abstracts, and Dissertation Abstracts International databases (January 1980 through December 2009). We aimed to include prospective studies reporting data on antenatal depression and at least 1 adverse birth outcome: PTB (<37 weeks' gestation), LBW (<2500 g), or IUGR (<10th percentile for gestational age). Of 862 reviewed studies, 29 US-published and non-US-published studies met the selection criteria. Information was extracted on study characteristics, antenatal depression measurement, and other biopsychosocial risk factors and was reviewed twice to minimize error. Pooled relative risks (RRs) for the effect of antenatal depression on each birth outcome were calculated using random-effects methods. In studies of PTB, LBW, and IUGR that used a categorical depression measure, pooled effect sizes were significantly larger (pooled RR [95% confidence interval] = 1.39 [1.19-1.61], 1.49 [1.25-1.77], and 1.45 [1.05-2.02], respectively) compared with studies that used a continuous depression measure (1.03 [1.00-1.06], 1.04 [0.99-1.09], and 1.02 [1.00-1.04], respectively). The estimates of risk for categorically defined antenatal depression and PTB and LBW remained significant when the trim-and-fill procedure was used to correct for publication bias. The risk of LBW associated with antenatal depression was significantly larger in developing countries (RR = 2.05; 95% confidence interval, 1.43-2.93) compared with the United States (RR = 1.10; 95% confidence interval, 1.01-1.21) or European social democracies (RR = 1.16; 95% confidence interval, 0.92-1.47). Categorically defined antenatal depression tended to be associated with an increased risk of PTB among women of lower socioeconomic status in the United States. Women with depression during pregnancy are at increased risk for PTB and LBW, although the magnitude of the effect varies as a function of depression measurement, country location, and US socioeconomic status. An important implication of these findings is that antenatal depression should be identified through universal screening and treated.
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            Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice.

            i) To highlight the increasing use in the literature of unvalidated cut-off scores on the Edinburgh Depression Scale (EDS/EPDS), as well as different wording and formatting in the scale; ii) to investigate and discuss the possible impact of using an unvalidated cut-off score; iii) to highlight possible reasons for these 'errors'; and iv) to make recommendations to clinicians and researchers who use the EDS/EPDS. A convenience sample of studies that have used unvalidated cut-off scores, or different formatting, are cited as evidence that these types of 'errors' are occurring fairly frequently. Examination of previous data from one of the authors is undertaken to determine the effect of using an unvalidated cut-off score. Many studies report rates of high scorers on the EDS/EPDS using different cut-off scores to the validated ones. The effect of doing this on the overall rate can be substantial. The effect of using different formatting is not known, though excluding items from the EDS/EPDS must also make a substantial difference. We recommend that i) the validated score of 13 or more is used when reporting on probable major depression in postnatal English-speaking women, and 15 or more when reporting on antenatal English-speaking women; ii) that the wording used is "13 or more" (or equivalent), and not other terms that may cause confusion (e.g., '>12'; 'more than 12'; '13' etc), iii) if a different cut-off score to the validated one is used, a clear explanation is given as to why this has been done; and iv) that the scale should be worded and formatted as originally described by its authors.
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              The Epigenetic Clock at Birth: Associations With Maternal Antenatal Depression and Child Psychiatric Problems.

              Maternal antenatal depression may compromise the fetal developmental milieu and contribute to individual differences in aging and disease trajectories in later life. We evaluated the association between maternal antenatal depression and a novel biomarker of aging at birth, namely epigenetic gestational age (GA) based on fetal cord blood methylation data. We also examined whether this biomarker prospectively predicts and mediates maternal effects on early childhood psychiatric problems.
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                Author and article information

                Contributors
                zaneta.marie.thayer@dartmouth.edu
                Journal
                Am J Hum Biol
                Am J Hum Biol
                10.1002/(ISSN)1520-6300
                AJHB
                American Journal of Human Biology
                John Wiley & Sons, Inc. (Hoboken, USA )
                1042-0533
                1520-6300
                22 September 2020
                : e23508
                Affiliations
                [ 1 ] Department of Anthropology, Dartmouth College Hanover New Hampshire USA
                [ 2 ] Ecology, Evolution, Ecosystem and Society Program, Dartmouth College Hanover New Hampshire USA
                Author notes
                [*] [* ] Correspondence

                Zaneta M. Thayer, Department of Anthropology, Dartmouth College, Hanover, New Hampshire, 03755, USA.

                Email: zaneta.marie.thayer@ 123456dartmouth.edu

                Author information
                https://orcid.org/0000-0001-8028-942X
                https://orcid.org/0000-0001-7486-5208
                Article
                AJHB23508
                10.1002/ajhb.23508
                7536992
                32964542
                aafb0cb3-85e2-40f6-b1ef-012cc5dc5403
                © 2020 Wiley Periodicals LLC

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 25 May 2020
                : 30 July 2020
                : 08 September 2020
                Page count
                Figures: 1, Tables: 1, Pages: 5, Words: 2597
                Funding
                Funded by: Claire Garber Goodman Fund for Anthropological Research
                Funded by: Wenner‐Gren Foundation , open-funder-registry 10.13039/100001388;
                Award ID: 9687
                Categories
                Short Report
                Short Reports
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:06.10.2020

                Human biology
                Human biology

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