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IMPORTANCE: Antenatal stress is a significant risk factor for poor postpartum mental health. The association of pandemic-related stress with postpartum outcomes among mothers and infants is, however, less well understood. OBJECTIVE: To examine the association of antenatal COVID-19-related stress with postpartum maternal mental health and infant outcomes. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among 318 participants in the COVID-19 Risks Across the Lifespan study, which took place in Australia, the UK, and the US. Eligible participants reported being pregnant at the first assessment wave between May 5 and September 30, 2020, and completed a follow-up assessment between October 28, 2021, and April 24, 2022. MAIN OUTCOMES AND MEASURES: COVID-19-related stress was assessed with the Pandemic Anxiety Scale (score range, 0-4, with higher scores indicating greater COVID-19-related stress). The 8-item Patient Health Questionnaire (score range, 0-3, with higher scores indicating more frequent symptoms of depression) was used to measure maternal depression at each time point, and the 7-item General Anxiety Disorder scale (score range, 0-3, with higher scores indicating more frequent symptoms of anxiety) was used to measure generalized anxiety at each time point. At follow-up, postpartum distress was assessed with the 10-item Postpartum Distress Measure (score range, 0-3, with higher scores indicating greater postpartum distress), and infant outcomes (negative and positive affectivity and orienting behavior) were captured with the Infant Behavior Questionnaire (score range, 1-7, with higher scores indicating that the infant exhibited that affect/behavior more frequently). RESULTS: The study included 318 women (mean [SD] age, 32.0 [4.6] years) from Australia (88 [28%]), the US (94 [30%]), and the UK (136 [43%]). Antenatal COVID-19-related stress was significantly associated with maternal postpartum distress (β = 0.40 [95% CI, 0.28-0.53]), depression (β = 0.32 [95% CI, 0.23-0.41]), and generalized anxiety (β = 0.35 [95% CI, 0.26-0.44]), as well as infant negative affectivity (β = 0.45 [95% CI, 0.14-0.76]). The findings remained consistent across a range of sensitivity analyses. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that targeting pandemic-related stressors in the antenatal period may improve maternal and infant outcomes. Pregnant individuals should be classified as a vulnerable group during pandemics and should be considered a public health priority, not only in terms of physical health but also mental health.

Importance: Antenatal stress is a significant risk factor for poor postpartum mental health. The role of pandemic-related stress in postpartum outcomes among mothers and infants is, however, less well understood. Objective: To examine the role of antenatal COVID-19-related stress on postpartum maternal mental health and infant outcomes. Design, setting and participants: This was a cohort study in participants from the COVID-19 Risks Across the Lifespan (CORAL) study (N =3208). 318 women who reported being pregnant at the first assessment wave between May to September 2020 and completed a follow-up assessment between October 2021 to April 2022. Main outcomes and measures: COVID-19-related stress was assessed with the Pandemic Anxiety Scale. Maternal depression (PHQ-8) and generalized anxiety (GAD-7) was measured at each timepoint. At the follow up, postpartum distress was assessed with the Postpartum Distress Measure and infant outcomes (negative and positive affectivity, and orienting behavior) were captured with the Infant Behavior Questionnaire. Results: The results are based on data from 318 women (age: M = 32.03; SD =4.63) from Australia (28%), the US (29%) and the UK (43%). Antenatal COVID-19-related stress was significantly associated with maternal postpartum distress, depression and generalized anxiety, as well as infant negative affectivity. The effects held across a range of sensitivity analyses. Conclusion and relevance: Mitigating the impact of antenatal pandemic-related stressors on postpartum mental health is critical to improve maternal and infant outcomes. Pregnant women should be classified as a vulnerable group in pandemics, and be considered a public health priority, not only in terms of physical but also mental health.

In adolescence, there is a heightened propensity to take health risks such as smoking, drinking or driving too fast. Another facet of risk taking, social risk, has largely been neglected. A social risk can be defined as any decision or action that could lead to an individual being excluded by their peers, such as appearing different to one&rsquo, s friends. In the current study, we developed and validated a measure of concern for health and social risk for use in individuals of 11 years and over (N = 1399). Concerns for both health and social risk declined with age, challenging the commonly held stereotype that adolescents are less worried about engaging in risk behaviours, compared with adults. The rate of decline was steeper for social versus health risk behaviours, suggesting that adolescence is a period of heightened concern for social risk. We validated our measure against measures of rejection sensitivity, depression and risk-taking behaviour. Greater concern for social risk was associated with increased sensitivity to rejection and greater depressed mood, and this association was stronger for adolescents compared with adults. We conclude that social risks should be incorporated into future models of risk-taking behaviour, especially when they are pitted against health risks.

Individuals vary in their ability to tolerate uncertainty. High intolerance of uncertainty (the tendency to react negatively to uncertain situations) is a known risk factor for mental health problems. In the current study we examined the degree to which intolerance of uncertainty predicted depression and anxiety symptoms and their interrelations across the first year of the COVID-19 pandemic. We examined these associations across three time points (May 2020 – April 2021) in an international sample of adults (N = 2087, Mean age = 41.13) from three countries (UK, USA, Australia) with varying degrees of COVID-19 risk. We found that individuals with high and moderate levels of intolerance of uncertainty reported reductions in depression and anxiety symptoms over time. However, symptom levels remained significantly elevated compared to individuals with low intolerance of uncertainty. Individuals with low intolerance of uncertainty had low and stable levels of depression and anxiety across the course of the study. Network analyses further revealed that the relationships between depression and anxiety symptoms became stronger over time among individuals with high intolerance of uncertainty and identified that feeling afraid showed the strongest association with intolerance of uncertainty. Our findings are consistent with previous work identifying intolerance of uncertainty as an important risk factor for mental health problems, especially in times marked by actual health, economic and social uncertainty. The results highlight the need to explore ways to foster resilience among individuals who struggle to tolerate uncertainty, as ongoing and future geopolitical, climate and health threats will likely lead to continued exposure to significant uncertainty.