Influencing Factors of Pregnant Women’s Anxiety and Depression
During the 2019-nCoV Pandemic Based on Logistic Regression
Analysis
Jialu Li
1
, Xiaoxiao Wang
2
and Zhiqiang Luan
1,*
1
International College Beijing, China Agricultural University, Haidian District, 100086, Beijing, China
2
College of Humanities and Development Studies, China Agricultural University, Haidian District, 100086, Beijing, China
Keywords: Anxiety, Depression, Logistic Regression Analysis, 2019-nCOV Pandemic, Data Science.
Abstract: This research investigates and analyzes the maternal mental health status during the 2019-nCoV pandemic in
2019 based on Maslow's Hierarchy of Needs Theory by conducting a questionnaire survey of 268 women
who were pregnant or gave birth during the 2019-nCoV pandemic at Jingwei Women's Slimming Center in
Guangrao County, Dongying City, Shandong Province, and analyzing the collected data using the Chi-Square
test and the Binary Logistic Regression Analysis. This survey research shows that the detection rate of
maternal anxiety and depression during the 2019-nCoV pandemic is high, and factors such as maternal
occupation, education level, annual household income, family relationships, frequency of maternity checkups,
family accompaniment, and the number of pregnancies and deliveries during the pandemic influence their
anxiety and depression status.
1 INTRODUCTION
In December 2019, 2019-nCoV pneumonia spread
rapidly worldwide (Baranow 2021). The novel
coronavirus is highly infectious with a long
incubation period, which threatens the lives of
infected individuals and has severe effects on
relatives of infected individuals and the surrounding
population (Verdecchia et al. 2020). There is no
specific drug for this disease, and maternal, as a
particularly susceptible group for 2019-nCoV, have a
higher probability of serious illness. Therefore, it is
even more important for pregnant women to be well
protected during the pandemic, have reasonable
psychological expectations to cope with the dual
stress of the pandemic and pregnancy, and prevent
negative emotions such as anxiety and depression.
The recurrent and long-term nature of the 2019-nCoV
pneumonia pandemic and the strict requirements of
the social pandemic prevention policy during the
pandemic make maternal psychology more sensitive,
which can hurt both the mother and the fetus (Liu et
al. 2021). This research investigates maternal anxiety
and depression during the 2019-nCoV pandemic
*
Corresponding author’s e-mail
using a questionnaire and analyzes the factors that
affect maternal mental health based on the Chi-
Square test and Logistic Regression.
2 LITERATURE REVIEW
Maternal anxiety and depression can occur during
pregnancy due to endocrine, psycho-social and other
factors. Individuals' personalities determine their
habits and behaviors differently and therefore have
individual variability in the degree and direction of
social occurrences that cause them to become
psychologically stressed, which in turn affects their
physiological reactions and the generation of psycho-
spiritual emotions. The suddenness and uncertainty
of the 2019-nCoV pandemic cause more significant
psychological stress to pregnant women. Studies
have shown that being unemployed, having an annual
household income of less than 80,000 yuan per year,
having poor family relationships, family members
generally not accompanying maternity visits, and
reducing the frequency of maternity visits due to the
pandemic hurt maternal mental health during the
Li, J., Wang, X. and Luan, Z.
Influencing Factors of Pregnant Women’s Anxiety and Depression During the 2019-nCoV Pandemic Based on Logistic Regression Analysis.
DOI: 10.5220/0012043600003620
In Proceedings of the 4th International Conference on Economic Management and Model Engineering (ICEMME 2022), pages 753-759
ISBN: 978-989-758-636-1
Copyright
c
2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)
753
2019-nCoV Pneumonia pandemic. In addition to
questionnaire research, previous studies require data
science methods to process the collected data, such as
Linear Regression or Logistic Regression.
3 METHODOLOGY
3.1 Aims and Objectives
A significant global public health event has an
enormous impact on maternal mental health (Lu
2020), and data from previous studies have claimed
that the probability of detecting positive maternal
anxiety and depression in China is 11.9% and 8.2%,
respectively (Zheng et al. 2019). However, few
studies have been conducted on maternal anxiety and
depression during the 2019-nCoV pandemic. The
main question of this research is the factors
influencing maternal anxiety and depression at the
psychological and spiritual levels in the context of the
2019-nCoV pandemic.
This research aims to identify the factors
influencing maternal anxiety and depression during
the 2019-nCoV pandemic with the help of data
science research methods and provide some
theoretical and data support for strategic
recommendations to address this issue.
3.2 Research Method
This research is based on Maslow's Hierarchy of
Needs Theory (Jegede 1977) to study and analyze the
factors influencing maternal anxiety and depression
in the 2019-nCoV pandemic. Maslow's Hierarchy of
Needs Theory suggests that human needs can be
divided into five levels: physiological needs, safety
needs, belonging and love, respect and self-
actualization.
The basic information of maternal age,
occupation, education level, and SAS and SDS scores
are collected through a general profile survey,
Anxiety Self-Rating Anxiety Scale and Anxiety Self-
Rating Depression Scale.
After collating the questionnaire results, data pre-
treatment is performed to screen out the questionnaire
data that met the inclusion criteria and group the data
results, such as maternal age greater than or equal to
35 years and less than 35 years, SAS score showing
anxiety positive and SAS score showing anxiety
negatively. The Chi-Square independence test is
performed on the pretreated data to investigate the
correlation between individual factors such as age,
occupation, and education level and positive maternal
anxiety or depression detection. The Binary Logistic
Regression Analysis is performed on the pretreated
data to investigate the effect of all factors
investigated in the questionnaire on positive
detection of maternal anxiety or depression and
determine the risk factors leading to positive
detection of maternal anxiety or depression.
3.3 Data collection - A Questionnaire
Survey
3.3.1 Survey Population
Women can become pregnant or give birth during the
2019-nCoV pandemic who participate in the Jingwei
Women's Slimming Center program in Guangrao
County, Dongying City, Shandong Province, from
September 2021 to February 2022. Eligible women
are invited offline to fill out the online questionnaire
by scanning the "Questionnaire Star" app on WeChat,
and each cell phone terminal could only be filled out
once. After the questionnaires are collected to a
sufficient number (statistically significant), the
questionnaires with qualified quality are counted as
valid questionnaires according to the content of the
completed questionnaires.
Valid questionnaire criteria:
Inclusion criteria: (a)women in pregnancy;
(b)filling out the questionnaire by themselves;
(c)answering time ≥ 180s.
Exclusion criteria: (a)the answers are missing;
(b)similar questions are not logically consistent; (c)a
recent major stressful event.
3.3.2 Questionnaire Research Method
This research designs the general situation
questionnaire combined with the internationally used
Self-Rating Anxiety Scale (SAS) and Self-Rating
Depression Scale (SDS). It creates a QR code through
Questionnaire Star. Women who meet the criteria
scan the QR code to obtain the questionnaire scale,
complete it on the specified occasion, and submit it
anonymously. The data are exported through the
Questionnaire Star system, and the data that does not
meet the survey criteria and invalid data is removed
semi-manually. The data of the valid questionnaires
are processed and analyzed. The final quantitative
analysis results are obtained.
General Survey. It includes primary maternal
conditions such as age, occupation, education level,
annual household income, place of residence, family
relationships, frequency of maternity checkups,
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accompanying family members, number of
pregnancies and deliveries, and gestational weeks.
The Self-Rating Anxiety Scale. The Self-Rating
Anxiety Scale (SAS) is developed by William W.K.
Zung, a Duke University, U.S.A professor. The SAS
scale uses a 4-point scale consisting of 20 different
entries, mainly assessing the frequency of symptoms.
The criteria are: "1" means no or very little of the
time; "2" means sometimes; "3" means most of the
time; "4 " indicates most or all of the time. According
to the Chinese normative results, the cut-off value of
the standard score is 50, where 50-59 is mild, 60-69
is moderate, and 70 or more is severe (Wu et al.
2021).
The Self-Rating Depression Scale. The Self-Rating
Depression Scale (SDS) (Chen et al. 2020) is
developed by the same William W.K. Zung and
consists of 20 different entries with a total of 1, 2, 3
and 4 scores for each admission and a total score of
20 to 80 for each subscale. Depression severity = the
cumulative score/80 for each entry, where those
below 0. 5 are considered not depressed; those above
0. 5 are considered depressed.
3.3.3 Clinical Validity of the Scale
When the SAS is used with the HAMA scale, the
Pearson correlation coefficient for the total score of
the two scales is 0.365, and the Spearman correlation
coefficient is 0.341, which shows that the validity of
the SAS is very high (Wang & Chi 1984).
When the SDS is used with the HAMA scale, the
Pearson correlation coefficient for the total score of
the two scales is 0.778, and the Spearman correlation
coefficient is 0.783, confirming the clinical validity
of the SDS (Wang & Chi 1984).
4 DATA ANALYSIS
During the survey period, 268 questionnaires were
collected, 28 invalid questionnaires were eliminated
by pretreatment, and 240 valid questionnaires
meeting the research criteria were finally obtained.
Using SPSS26.0 statistical software, the
measurement data are expressed as percentages. The
test is used for comparison between groups; the count
data are expressed as percentages, and the 2 test is
used to compare groups.
4.1 Detection of Depressive and
Anxiety Symptoms
240 pregnant women are aged 20-37 years, with an
average of (26.55±3.913) years. The average
gestational age is 216 cases of primigravida and 24
cases of transnational. According to the Self-Rating
Depression Scale (SDS), the index is ≥0.5 in 74 cases,
accounting for 30.83%. According to the Self-Rating
Anxiety Scale (SAS), there are 81 cases (33.75%)
with an index ≥0.5.
Table 1: Univariate analysis of anxiety and depression in pregnant women (n=240).
Categories
Anxiety
χ2
P
Depression
χ2
P
Ratio
Percentage
(%)
Ratio
Percentage
(%)
Occupation
On-the-job
Awaitin
g
em
p
lo
y
ment
7/109
74/131
6.4
56.5
66.699
0.000
6/109
68/131
5.5
51.9
60.073
0.000
Education
High School and below
Colle
g
e and above
64/144
17/96
44.4
17.7
18.414
0.000
57/144
17/96
39.6
17.7
12.924
0.000
Annual household income
80,000 yuan per year
≥80,000 yuan per yea
r
58/116
23/124
50.0
18.5
26.515
0.000
54/116
20/124
46.6
16.1
26.010
0.000
Residence
Urban
Rural
69/223
12/17
30.9
70.6
11.104
0.001
68/223
6/17
30.5
35.3
0.171
0.679
Family relationships
Harmonious
38/162
23.5
23.620
0.000
32/162
19.8
28.695
0.000
Influencing Factors of Pregnant Women’s Anxiety and Depression During the 2019-nCoV Pandemic Based on Logistic Regression Analysis
755
Unharmonious 43/78 55.1 42/78 53.8
Frequency of maternity
checkups
Not affected by the pandemic
Delayed delivery due to the
p
andemic
57/199
24/41
28.6
58.5
13.587
0.000
56/199
18/41
28.1
43.9
3.960
0.047
Family Accompaniment
Generally accompanied
Generally unaccompanie
d
61/213
20/27
28.6
74.1
22.124
0.000
53/213
21/27
24.9
77.8
31.437
0.000
Maternity
Primigravida
PMS
57/216
24/24
26.4
100.0
52.346
0.000
50/216
24/24
23.1
100.0
59.820
0.000
Week of pregnancy
<28 weeks
≥28 weeks
69/192
12/48
35.9
25.0
2.055
0.152
62/192
12/48
32.3
25.0
0.957
0.328
Age
≥35 years old
<35
y
ears ol
d
7/18
74/222
38.9
33.3
0.230
0.632
8/18
66/222
44.4
29.7
1.690
0.194
4.2 Univariate Analysis of Anxiety and
Depression in Pregnant Women
Univariate analysis of age, education, occupation,
annual household income, and week of pregnancy is
performed by applying Chi-Square analysis. The Chi-
Square test can be used for the analysis of count data
for multiple classifications of two or more factors,
i.e., to study the correlation between two variables,
with p<0.05 as a statistically significant difference,
indicating that there is a significant difference
between groups and that the variable is associated
with depression, and There is an association between
positive anxiety detections (table 1).
According to the Chi-Square test results, covering
the needs of pregnant women on the five levels of
Maslow's theory, it can be seen that Maslow's
Hierarchy of Needs Theory can explain the data
results well from a theoretical perspective.
4.3 Multi-Factor Analysis of Pregnant
Women with Anxiety and
Depression
Logistic Regression Analysis is performed at a = 0.05
to investigate the effect of the above factors on the
detection of positive anxiety or depression (including
whether there is a statistically significant effect and
the specific direction and degree of the effect), using
single factors such as age, occupation, and annual
household income as independent variables and
anxiety and depression scores as dependent variables.
A difference of p<0.05 is considered statistically
significant, indicating that a 0.05 level of significance
is presented and that this variable affects the positive
detection of anxiety and depression (table 2 and table
3).
Table 2: Logistic regression analysis of factors influencing maternal anxiety.
Influencing Factors β
Standard
Erro
r
Waldχ
2
P OR (95%CI)
Awaiting employment
Poor family relationships
Family members generally do
not accompany maternity visits
2.491
1.046
1.932
0.535
0.424
0.758
21.648
6.092
6.496
0.000
0.014
0.011
0.403 (0.152~1.068)
2.845 (1.240~6.526)
6.903 (1.562~30.501)
*p<0.05 **p<0.01
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Table 3: Logistic regression analysis of factors influencing maternal depression.
Influencing Factors β
Standard
Erro
r
Waldc
2
P OR (95%CI)
Awaiting employment
Annual household income of
less than 80,000 yuan
Poor family relationships
Family members generally do
not accompany maternity visits
2.593
1.903
1.223
2.216
0.598
0.871
0.441
0.735
18.798
4.770
7.675
9.080
0.000
0.029
0.006
0.003
0.075 (0.023~0.241)
0.149 (0.027~0.823)
3.397 (1.430~8.069)
9.170 (2.170~38.758)
*p<0.05 **p<0.01
4.3.1 Logistic Regression Analysis of
Positive Anxiety Detection in Pregnant
Women
According to the results of the Logistic Regression
Analysis, the factors of occupation, family
relationships, and family accompaniment are related
to anxiety during the pandemic, and non-
employment, poor family relationships, and family
members generally not accompanying the maternity
check-ups are the high-risk factors for anxiety among
pregnant women during the pandemic. These
influencing factors reflect the needs of pregnant
women on the third level (belonging and love), fourth
level (respect), and fifth level (self-actualization),
and are higher and do not trigger anxiety due to
economic conditions or lack of personal security.
4.3.2 Logistic Regression Analysis of
Positive Detections of Depression in
Pregnant Women
The dependent variables of occupation, annual family
income, family relationships, and family
accompaniment are associated with depression, non-
employment, annual family income less than 80,000
yuan per year, poor family relationships, and family
members generally not accompanying the delivery of
high-risk factors for depression.
5 DISCUSSION
The 2019-nCoV pneumonia pandemic has caused
varying degrees of psychological and mental stress
since its occurrence. The maternal population is more
sensitive to mental and psychological levels as a
particular group. Due to the hormonal changes in the
body during pregnancy, the impact on maternal
behavioral habits caused by changes in the social
environment during the 2019-nCoV pandemic, and
concerns about the fetus’ health in the womb.
Maternal psychology can be affected by the 2019-
nCoV pandemic, a significant global public health
event. According to statistics, the global probability
of depression in women during pregnancy is
approximately 25% (Silveira et al. 2015), while the
overall incidence of depression in China is 8.5-23.5%
(Shen et al. 2021). Due to the uncertainty and
suddenness of the 2019-nCoV pandemic and the
prevention and control policies during the pandemic.
In order to better understand the psychological
condition of pregnant women during this particular
period, it is necessary to select a certain number of
pregnant women as a sample for data analysis.
Moreover, because of the differences in material
and spiritual needs of different families, people's
habits and requirements for life that are developed
before the pandemic is not met, and the social
atmosphere during the pandemic prevention and
control period causes changes in people's
psychological expectations for their future lives,
which aggravates people's worries, produce different
levels of stimulation. The survey data of this research
shows that the self-reported detection rate of maternal
anxiety is 33.75%. The survey data of this research
shows that the self-reported detection rate of maternal
anxiety is 33.75%. The self-reported detection rate of
depression is 30.83%, higher than the detection rate
of maternal anxiety measured using SAS in China,
which is 15.4% (Liu et al. 2020) and the detection rate
of maternal depression mentioned above, which is
25%. Maternal psychological stress is more
significant than usual in the period of the 2019-nCoV
pandemic, which is reflected in this research
Influencing Factors of Pregnant Women’s Anxiety and Depression During the 2019-nCoV Pandemic Based on Logistic Regression Analysis
757
specifically in the detection of anxiety and
depression.
According to the Chi-Square test, there is a direct
relationship between maternal occupation and annual
household income and their anxiety and depression
status during the neonatal pandemic. Women who are
unemployed or have an annual household income of
less than 80,000 yuan per year are more likely to
experience anxiety and depression during the 2019-
nCoV pandemic. Possible reasons for this result are:
pregnant women with job security during the 2019-
nCoV pandemic have a stable source of economic
income to meet their material needs and do not need
to overthink about food and clothing; pregnant
women are more worried about their return to work
after delivery during the 2019-nCoV pandemic due to
the downturn in the job market, and are therefore
more nervous and anxious; stable employment itself
provides an excellent social circle for pregnant
women before the pandemic and delivery. The stable
occupation offers an excellent social circle for
pregnant women before the pandemic and pending
delivery, allowing them to maintain a relatively good
frequency of communication with the society. (Guo
et al., 2020).
The family rapport of pregnant women during the
2019-nCoV pandemic is also a highly correlated
factor in triggering their anxiety and depression.
According to this research data, women with poor
family relationships are more likely to experience
anxiety and depression. This may be because the
2019-nCoV pandemic is a psychological burden for
women. During the pandemic, limited contact with
the outside world may lead to a lack of care and
companionship if women do not have good family
relationships. At the same time, the atmosphere
created by disharmonious family relationships can
cause more psychological stress for pregnant women
in the 2019-nCoV pandemic, making it difficult for
them to seek relief from their loved ones, resulting in
anxiety and depression.
There is also a correlation between maternal
psychological status during the 2019-nCoV
pandemic and their literacy level. According to the
data of this research, maternal anxiety and depression
during the 2019-nCoV pandemic are less likely to
occur in women with higher education (college and
above) than those with lower education (high school
and below). This result is possible because women
with higher education can make more reasonable
judgments about the pandemic trends combined with
a more comprehensive perspective, thus maintaining
a relatively optimistic attitude (Yan et al. 2021).
Pregnant women with higher education have a
broader knowledge base and a more rational and
objective perspective on issues, thus finding more
ways to vent their emotions in the face of problems
arising from the 2019-nCoV pandemic.
Data analysis shows that the absence of family
members during maternity checkups during the 2019-
nCoV pandemic is also a high-risk factor for maternal
psychological problems. Women their families
accompanied during labor and delivery are less likely
to experience anxiety and depression than those they
do not accompany during labor and delivery. This
may be because family members make pregnant
women feel more secure and aware of a stable
attachment. During this particular period of the 2019-
nCoV pandemic, the presence of family members
allows for the timely resolution of negative
psychological emotions, which is more conducive to
the long-term psychological health of pregnant
women.
This research found a correlation between the
frequency of maternity checkups and maternal
anxiety and depression during the pandemic. Women
who do not delay their delivery due to the pandemic
are less likely to have anxiety and depression than
women whose delivery is affected by the 2019-nCoV
pandemic. This result may be explained by the fact
that the pandemic affects the regular order of the
hospital, and women are more worried about whether
going to the hospital for maternity checkups would
affect their health and that of their fetuses (Zhang et
al. 2021).
According to the results of the Chi-Square test,
the factors that have an impact on pregnant women's
anxiety and depression cover the needs of pregnant
women on the five levels of Maslow's theory, which
shows that Maslow's Hierarchy of Needs Theory can
explain the data results well from a theoretical
perspective.
According to the results of the Logistic
Regression Analysis, the factors of occupation,
family relationships, and family accompaniment are
related to anxiety during the pandemic, and non-
employment, poor family relationships, and family
members generally not accompanying maternity
checkups are the high-risk factors for anxiety among
pregnant women during the pandemic. These
influencing factors reflect the needs of pregnant
women in terms of belonging, love, respect, and self-
actualization, and the higher level of needs, which do
not trigger anxiety due to economic conditions or
lack of personal security.
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6 CONCLUSION
In conclusion, the data analysis of this study suggests
that maternal mental health issues during the 2019-
nCoV pandemic cannot be ignored. The social status
of pregnant women and their current physiological
characteristics determine that they are in a
compassionate state, and the 2019-nCoV pandemic
has undoubtedly increased their psychological stress.
Currently, pregnant women have specific needs on
each of Maslow's five significant levels, emphasizing
the higher levels of belonging and love, respect, and
self-actualization. In light of this reality, government
departments and hospitals should introduce timely
policies to ensure that the necessary maternal
examinations are not affected by the pandemic to the
greatest extent possible. The family members of
pregnant women should give them proper care and
enhance effective communication so that their
negative emotions can be relieved in time. Pregnant
women themselves should maintain an optimistic
attitude and participate in social activities to maintain
interaction with the outside world while strictly
following the pandemic prevention and control
policy. At the same time, they should promptly
communicate with their relatives when they find
problems with their psychological condition and seek
professional help from relevant institutions. Only
through the joint efforts of many parties can we
promote the long-term and stable psychological
health of pregnant women under the 2019-nCoV
pandemic.
This research is based on Maslow's Hierarchy of
Needs Theory and the Binary Logistic Regression
Analysis. It has implications for alleviating maternal
anxiety and depression during the 2019-nCoV
pandemic and suggesting more targeted strategies for
coping with maternal mental health problems in the
post-pandemic era. However, this research inevitably
has some limitations that do not exclude pregnant
women’s geographical limitations in the selected
regions. Meanwhile, the sample size is small, and
some of the findings need further corroboration by
extensive data. In addition, this research provides
theoretical and data support for investigating
maternal psychological conditions and timely
interventions in a significant global public health
event such as the 2019-nCoV pandemic. It also
provides a reference for the model mechanism of
regular pregnancy checkups and special triage in
public settings carried out by relevant government
departments and medical systems during the
prevention and control of the 2019-nCoV pandemic.
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