Mental health and social support among Saudi antenatal clients during the COVID-19 crisis

Document Type : Original Article


1 Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia

2 Nursing Department, College of Applied Medical Sciences, Shaqra University, Al Dawadmi, Saudi Arabia Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek Khans St 5/1, Nursultan, 010000 Kazakhstan


Background: A healthy mental state is essential throughout pregnancy. The Coronavirus disease 2019 (COVID-19) pandemic has posed a challenge to psychological resilience, especially among pregnant women.
Objective: This study measured the mental health and social support of Saudi pregnant women during the COVID-19 pandemic.
Methods: The study utilized a cross-sectional design, with 243 respondents as its convenience sample from hospitals and health centers in Al Duwadimi, Saudi Arabia. This study applied the “Arabic Version of the Depression, Anxiety, and Stress Scale” and the “Multidimensional Scale for Perceived Social Support for Arab Women.” The Pearson correlation was used to measure the association between respondents’ profiles and social support. Multiple regression analysis was used to measure predictors of mental health.
Results: The pregnant women had normal depression levels, extremely severe anxiety, and severe stress. The pregnant women also perceived high social support. A very weak inverse association was found between age and number of children with overall social support. Social support, especially from the husband, decreased the depression level in the pregnant women.
Conclusion: Pregnant women in Saudi Arabia experienced higher levels of depression, anxiety, and stress during the COVID-19 outbreak, which was linked to the support they received from their relatives. This finding implies the need to enhance support from family members during infectious disease outbreaks.


Junel Bryan A Bajet [Pubmed] [Google Scholar]


  1. Chen H, Selix N, Nosek M. Perinatal anxiety and depression during COVID-19. J Nurse Pract 2021;17:26-31.
    doi:10.1016/j.nurpra.2020.09.014 PMid:33013242 PMCid:PMC7524675
  2. Salehi L, Rahimzadeh M, Molaei E, Zaheri H, Esmaelzadeh‐Saeieh S. The relationship among fear and anxiety of COVID‐19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model. Brain Behav 2020;10: e01835. doi:10.1002/brb3.1835 PMid:32969190 PMCid:PMC7536966
  3. Wastnedge EA, Reynolds RM, Van Boeckel SR, Stock SJ, Denison FC, Maybin JA, et al. Pregnancy and COVID-19. Physiol Rev 2021; 101:303-18. doi:10.1152/physrev.00024.2020 PMid:32969772 PMCid:PMC7686875
  4. Smith MV, Shao L, Howell H, Lin H, Yonkers KA. Perinatal depression and birth outcomes in a Healthy Start project. Matern Child Health J 2011;15:401-9. doi:10.1007/s10995-010-0595-6 PMid:20300813 PMCid:PMC3757503
  5. Feduniw S, Modzelewski J, Kwiatkowski S, Kajdy A. Prevalence and impact of anxiety on mental health of pregnant women in the time of catastrophic events including COVID-19 pandemic-a rapid systematic review. Preprint. May. 2020. Available from: [Last access date 31 October 2022] doi:10.17504/ PMCid:PMC8234699
  6. Hamel L, Salganicoff A. Is there a widening gender gap in coronavirus stress? April 6, 2020. Available from: [Last access date 31 October 2022]
  7. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384:1800-19. doi:10.1016/S0140-6736(14)61277-0 PMid:25455250
  8. Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 2013;91: 593-601I. doi:10.2471/BLT.12.109819 PMid:23940407 PMCid:PMC3738304
  9. Lebel C, Walton M, Letourneau N, Giesbrecht GF, Kaplan BJ, Dewey D. Prepartum and postpartum maternal depressive symptoms are related to children's brain structure in preschool. Biol Psychiatr. 2016; 80:859-68. doi:10.1016/j.biopsych.2015.12.004 PMid:26822800
  10. World Health Organization. Coronavirus disease 2019 (COVID-19) situation report - 65. Geneva, Switzerland. 2020.
  11. Saadat S, Rawtani D, Hussain CM. Environmental perspective of COVID-19. Sci Total Environ 2020; 728: 138870. doi:10.1016/j.scitotenv.2020.138870 PMid:32335408 PMCid:PMC7194675
  12. Rasul S, Bowen A, Muhajarine N. Factors that moderate or mediate pregnancy complications in women with anxiety and depression. J Preg Child Health. 2017;4:360.
  13. Berthelot N, Lemieux R, Garon‐Bissonnette J, Drouin‐Maziade C, Martel É, Maziade M. Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstet Gynecol Scand 2020;99:848-55. doi:10.1111/aogs.13925 PMid:32449178
  14. Durankuş F, Aksu E. Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study. J Matern Fetal Neonatal Med 2022: 35: 205-211. doi:10.1080/14767058.2020.1763946 PMid:32419558
  15. Abedzadeh-Kalahroudi M, Karimian Z, Nasiri S, Khorshidifard MS. Anxiety and perceived stress of pregnant women towards Covid-19 disease and its related factors in Kashan (2020). Iran J Obstetr Gynecol Infertil 2021;24:8-18.
  16. Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. COVID-19 and mental health during pregnancy: The importance of cognitive appraisal and social support. J Affect Dis 2021;282:1161-9. doi:10.1016/j.jad.2021.01.027 PMid:33601691 PMCid:PMC7837227
  17. Schwartz DA. The effects of pregnancy on women with COVID-19: Maternal and infant outcomes. Clin Infect Dis 2020; 71:2042-2044. doi:10.1093/cid/ciaa559 PMid:32392330 PMCid:PMC7239237
  18. Ohoka H, Koide T, Goto S, Murase S, Kanai A, Masuda T. Effects of maternal depressive symptomatology during pregnancy and the postpartum period on infant-mother attachment. Psychiatry Clin Neurosci 2014;68:631-9 doi:10.1111/pcn.12171 PMid:24521214
  19. Li J, Mao J, Du Y, Morris JL, Gong G, Xiong X. Health-related quality of life among pregnant women with and without depression in Hubei, China. Matern Child Health J 2012;16: 1355-63. doi:10.1007/s10995-011-0900-z PMid:22045020
  20. Moussa MT, Lovibond P, Laube R, Megahead HA. Psychometric properties of an arabic version of the depression anxiety stress scales (DASS). Res Soc Work Pract 2017; 27:375-86 doi:10.1177/1049731516662916
  21. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-43. doi:10.1016/0005-7967(94)00075-U PMid:7726811
  22. Aroian K, Templin TN, Ramaswamy V. Adaptation and psychometric evaluation of the Multidimensional Scale of Perceived Social Support for Arab immigrant women. Health Care Women Int. 2010;31:153-69. doi:10.1080/07399330903052145 PMid:20390643
  23. Peter PJ, de Mola CL, de Matos MB, Coelho FM, Pinheiro KA, da Silva RA, etal. Association between perceived social support and anxiety in pregnant adolescents. Braz J Psychiatry 2016;39:21-7. doi:10.1590/1516-4446-2015-1806 PMid:27508395 PMCid:PMC7112740
  24. Ginja S, Coad J, Bailey E, Kendall S, Goodenough T, Nightingale S. Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study. BMC Pregnancy Childbirth 2018; 18:441. doi:10.1186/s12884-018-2049-x PMid:30419842 PMCid:PMC6233574
  25. Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health. 2021; 18:10. doi:10.1186/s12978-021-01070-6 PMid:33461593 PMCid:PMC7812564
  26. Tani F, Castagna V. Maternal social support, quality of birth experience, and post-partum depression in primiparous women. J Maternal-Fetal Neonatal Med 2017; 30:689-92. doi:10.1080/14767058.2016.1182980 PMid:27123699
  27. Yue C, Liu C, Wang J, Zhang M, Wu H, Li C, Yang X. Association between social support and anxiety among pregnant women in the third trimester during the coronavirus disease 2019 (COVID-19) epidemic in Qingdao, China: The mediating effect of risk perception. Int J Soc Psychiatry 2021; 67:120-127. doi:10.1177/0020764020941567 PMid:32643510 PMCid:PMC7348553
  28. Orr ST. Social support and pregnancy outcome: a review of the literature. Clin Obstetr Gynecol 2004;47:842-55.
    doi:10.1097/01.grf.0000141451.68933.9f PMid:15596938
  29. Wahn EH, Nissen E. Sociodemographic background, lifestyle and psychosocial conditions of Swedish teenage mothers and their perception of health and social support during pregnancy and childbirth. Scand J Public Health 2008; 36: 415-23. doi:10.1177/1403494807085315 PMid:18539696