Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset

Marci Lobel*, Heidi Preis, Brittain Mahaffey, Nora K. Schaal, Karen Yirmiya, Shir Atzil, Inbal Reuveni, Matteo Balestrieri, Chiara Penengo, Chiara Colli, Marco Garzitto, Lorenza Driul, Michalina Ilska, Anna Brandt-Salmeri, Anna Kołodziej-Zaleska, Rafael A. Caparros-Gonzalez, Rita Amiel Castro, Pearl La Marca-Ghaemmaghami, Hannah Meyerhoff

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. Methods: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. Results: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. Conclusions: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Original languageAmerican English
Article number115499
JournalSocial Science and Medicine
StatePublished - Dec 2022

Bibliographical note

Publisher Copyright:
© 2022 Elsevier Ltd


  • Anxiety
  • COVID-19 global pandemic
  • Depression
  • Maternal stress
  • Pregnancy
  • Women's health


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