Estimates and Determinants of Psychological Problems of Pregnant Women during COVID-19 Epidemic in South Africa


  •   A. M. Hoque

  •   M. Hoque

  •   M. E. Hoque

  •   G. Van Hal


The COVID-19 epidemic has impacted significantly on the general population including pregnant women. The psychological impact of COVID-19 among vulnerable population like pregnant women is yet to be estimated. Therefore, the objective of this study was to estimate the prevalence and factors associated with anxiety, depression, and overall psychological problems. A questionnaire-based cross-sectional study was conducted among black pregnant women attending a Primary Health Care facility in South Africa. Logistic regression analysis was performed to determine the significant factors for psychological problems. A total of 346 pregnant women participated in this study. The rates of anxiety, depression and overall psychological problems were 35.7%, 38.2% and 34.3% respectively. Gestational age between 14-26 weeks were 60% (OR=.397, p<0.05), part-time employment 53% (OR=0.47, p<0.05) and pregnant women having adequate funding for monthly expenses were 62% less likely (OR=0.381, p<0.05) to have anxiety problems. Married women were 2.5 times more likely (OR=2.54, p<0.05) and women living together or widowed were 2.9 times more likely (OR=2.91, p<0.05) to have anxiety. Pregnant women aged between 20-29 years were nine times (OR=9.03, p=0.016), women aged 30 to 39 years were 6.3 times (OR=6.3, p=0.032) more likely to have depression. Parity one 91% (OR=0.094, p=0.007), parity two 86% (OR=.143, p=0.027) and part-time employment 65% (OR=0.354, p=0.002) were less likely to have depression. Comparing with women aged >39 years, women who were between 20-29 years were 28 times (OR=27.8, p<0.01) and women aged between 30-39 years were nine times more likely to have overall psychological problems. Respondents with parity one was 83% (OR=0.17, p<0.05) less likely to have psychological problems when compared with other parity groups and women having adequate funding were 65% less likely (OR=0.35, p<0.05) to have overall psychological problems than those did not have adequate funding. Higher rates of anxiety, depression and overall psychological problems are found among black pregnant women. It is therefore imperative that appropriate and timely mental health care supports are provided to reduce adverse health outcomes.

Keywords: Anxiety, Depression, Psychological impact, Prevalence, Risk factors


Zhu N, Zhang D, Wang W, et al.: A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8): 727–733.

Department of health, Republic of South Africa, National COVID-19 daily report. Available on . Accessed on 18 August 2020.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020; 395(10229): 1054-62.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 2020; 323(13):1239-42.

Istituto Superiore di Sanità: Report about the Characteristics of Death Patients Positive to COVID-19 in Italy (Based on Data Updated on 17th March 2020).

Rubin GJ, Wessely S. The psychological effects of quarantining a city. BMJ, 2020; 368.

World Health Organization: Coronavirus Disease 2019 (COVID-19) Situation Report-78. 2020. Reference Source.

Pulla P. Covid-19: India imposes lockdown for 21 days and cases rise. BMJ, 2020; 368.

Brooks SK, Webster RK, Smith LE, Woodland L et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet, 2020; 395(10227):912-20.

Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. The Canadian Journal of Psychiatry. 2004;49(6):403-7.

Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Medicine and Public Health Preparedness. 2015. 9(5):547-53.

Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, Chae JH. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38.

Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, Guan Z, Wu P. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Comprehensive psychiatry. 2012. 53(1):15-23.

Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ, 2004; 170(5):811-2.

Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. The Canadian Journal of Psychiatry. 2009;54(5):302-11.

Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, Sadavoy J, Verhaeghe LM, Steinberg R, Mazzulli T. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj. 2003; 168(10):1245-51.

Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerging infectious diseases. 2004. 10(7):1206.

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020; 17 (5):1729-34.

Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Prevalence of depression in the community from 30 countries between 1994 and 2014. Scientific reports. 2018; 8(1):1-0.

Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci JPN 2015; 40:219–21.

Qiao J. What are the risks of COVID-19 infection in pregnant women? The Lancet 2020 ; 395(10226):760-762.

Ortiz EI, Herrera E, De La Torre A. Coronavirus (COVID 19) Infection in Pregnancy. Colombia Médica. 2020. 51(2).

Zeng LN, Chen LG, Yang CM, Zeng LP, Zhang LY, Peng TM. Mental health care for pregnant women in the COVID-19 outbreak is urgently needed. Women and birth: Journal of the Australian College of Midwives. 2020; 1871-5192(20)30210-9.

Topalidou A, Thomson G, Downe S. COVID-19 and maternal mental health: Are we getting the balance right?. MedRxiv. 2020 Jan 1.

Sasaki T-K, Yoshida A, Kotake K. Attitudes about the 2009 H1N1 influenza pandemic among pregnant Japanese women and the use of the Japanese municipality as a source of information. Southeast Asian J Trop Med Public Health, 2013; 44:388–99.

Yao H, Chen J-H, Xu Y-F. Rethinking online mental health services in China during the COVID-19 epidemic. Asian J Psychiatry. 2020; 50: 102015.

Department of Health. Guidelines for Maternity Care in South Africa: A Manual for Clinics, Community Health Canters and District Hospitals. 4th ed. Pretoria, South Africa: Department of Health; 2016.

Hoque AM, Bukus S, Hoque M, Hoque ME, Van Hal G. COVID-19 vaccine acceptability among Pregnant Women at a Primary Health Care Facility in Durban, south Africa. European Journal of Medical and Health Sciences ISSN (Online): 2593-8339.

Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of internal medicine, 2006.166(10):1092-7.

Pfizer I. PHQ-9 (Patient Health Questionnaire). Pfizer, New York. 1999.

He X, Li C, Qian J, et al. . Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients. Shanghai Arch Psychiatry, 2010; 22:200–3.

Que J, Shi L, Deng J, et al. Psychological impact of the COVID-19 pandemic on healthcare workers: a cross-sectional study in China. General Psychiatry, 2020; 33:1002-59.

Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006;166:1092–7.

Löwe B, Decker O, Müller S, et al. Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Med Care, 2008; 46:266–74.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001;16:606–13.

The National Collaborating Centre for Mental Health (UK). Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance. Leicester (UK): British Psychological Society; 2007.

Varshney M, Parel JT, Raizada N, Sarin SK (2020) Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey. PLoS ONE 15(5): e0233874.

Nath S, Ryan EG, Trevillion K, et al. Prevalence and identification of anxiety disorders in pregnancy: the diagnostic accuracy of the two-item Generalised Anxiety Disorder scale (GAD-2). BMJ Open, 2018. 8: 237-66.

Sinesi A, Maxwell M, O’Carroll R, et al. Anxiety scales used in pregnancy: systematic review. BJPsych Open, 2019. 5:(5).

Soto-Balbuena C, Rodríguez MF, Escudero AI. Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy. Psicothema, 2018; 30:257–63.

Craske MG, Stein MB. Anxiety. Lancet Lond Engl, 2016; 388:3048–59.

Bayrampour H, McDonald S, Tough S. Risk factors of transient and persistent anxiety during pregnancy. Midwifery, 2015. 31:582–9.

Zhang Y, Muyiduli X, Wang S, et al. Prevalence and relevant factors of anxiety and depression among pregnant women in a cohort study from south-east China. J Reprod Infant Psychol, 2018. 36(5):519‐529.

Jiao J. Under the epidemic situation of COVID-19, should special attention to pregnant women be given? J Med Virol., 2020.

Vizzini L, Popovic M, Zugna D, et al. Maternal anxiety, depression and sleep disorders before and during pregnancy, 1; and preschool ADHD symptoms in the NINFEA birth cohort study. Epidemiol Psychiatr Sci, 2019. 28:521–31.

Nakic´ Rados S, Tadinac M, Herman R. Anxiety during pregnancy and postpartum: course, predictors and comorbidity with postpartum depression. Acta Clin Croat 2018;57:39–51.

Verbeek T, Arjadi R, Vendrik JJ, et al. Anxiety and depression during pregnancy in Central America: a cross-sectional study among pregnant women in the developing country Nicaragua. BMC Psychiatry, 2015. 15:292.

Yonkers KA, Gilstad-Hayden K, Forray A, et al. Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with risk of adverse birth outcomes. JAMA Psychiatry, 2017. 74:1145–52.

LaRusso EM, Freeman MP. 18 - Antidepressants in Pregnancy. In: Mattison, D.R., editor. Clinical Pharmacology During Pregnancy [Internet]. Academic Press; 2013. 295-305.


Download data is not yet available.


How to Cite
Hoque, A. M., Hoque, M., Hoque, M. E., & Van Hal, G. (2021). Estimates and Determinants of Psychological Problems of Pregnant Women during COVID-19 Epidemic in South Africa. European Journal of Medical and Health Sciences, 3(1), 143-149.