Hostname: page-component-5db58dd55d-mhzq2 Total loading time: 0 Render date: 2026-06-04T14:55:29.077Z Has data issue: false hasContentIssue false
  • English
  • Français

COVID-19 experiences and persistent maternal mental health symptoms: Examining the role of long COVID, self-efficacy, and partner support

Published online by Cambridge University Press:  11 July 2025

Fabiola Silletti Open the ORCID record for Fabiola Silletti [Opens in a new window] ,
Amanda Koire ,
Candice Ma ,
Hung-Chu Lin ,
Leena Mittal ,
Joshua L. Roffman ,
Carmina Erdei ,
Pasquale Musso Open the ORCID record for Pasquale Musso [Opens in a new window]  and
Cindy H. Liu Open the ORCID record for Cindy H. Liu [Opens in a new window]
Fabiola Silletti
Affiliation:
Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA
Amanda Koire
Affiliation:
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Candice Ma
Affiliation:
Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA
Hung-Chu Lin
Affiliation:
Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA Department of Psychology, University of Louisiana at Lafayette, Lafayette, LA, USA
Leena Mittal
Affiliation:
Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Joshua L. Roffman
Affiliation:
Harvard Medical School, Boston, MA, USA Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
Carmina Erdei
Affiliation:
Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
Pasquale Musso
Affiliation:
Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy
Cindy H. Liu*
Affiliation:
Department of Pediatrics, Division of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA, USA Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
*
Corresponding author: Cindy H. Liu; Email: chliu@bwh.harvard.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Perinatal women were particularly impacted during the pandemic, with documented consequences for both mothers’ and infants’ well-being. This study investigated the longitudinal relationships between COVID-19-related experiences during the peripartum and women’s depression and anxiety symptoms at long-term follow-up. We explored the moderating role of long COVID for the first time, along with perceived partner support and maternal self-efficacy. A sample of 190 US perinatal women completed a survey from May 21, 2020, to September 15, 2021 (T1), and again between December 14, 2022, and February 14, 2024 (T2). The survey assessed COVID-19-related experiences, mental health, long COVID, maternal self-efficacy, partner support, and life events. Anxiety was associated with both long COVID and decreased partner support, and both depression and anxiety were linked to lower self-efficacy. A larger number of COVID-19-related experiences during the peripartum period was associated with higher levels of later depression and anxiety symptoms. Long COVID exacerbated these links, while partner support buffered them. Maternal self-efficacy dampened the association between COVID-19-related experiences and subsequent depression, but not anxiety. Findings suggest that COVID-19 has lasting effects on perinatal women’s mental health, with partner support and maternal self-efficacy acting as resilience factors, highlighting the potential benefit of targeted interventions to enhance these modifiable factors.

Keywords

Peripartummental healthlong COVIDpartner supportself-efficacy

Information

Type
Regular Article
Information
Development and Psychopathology , Volume 37 , Issue 5 , December 2025 , pp. 2684 - 2693
Check for updates
Copyright
© The Author(s), 2025. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abu Sabbah, E. A., Eqylan, S. B., Al-Maharma, D. Y., Thekrallah, F., & Safadi, R. R. (2022). Fears and uncertainties of expectant mothers during the COVID-19 pandemic: Trying to reclaim control. International Journal of Qualitative Studies on Health and Well-Being, 17(1), 2018773. https://doi.org/10.1080/17482631.2021.2018773 CrossRefGoogle ScholarPubMed
Adrianto, N., Caesarlia, J., & Pajala, F. B. (2022). Depression in pregnant and postpartum women during COVID-19 pandemic: Systematic review and meta-analysis. Obstetrics & Gynecology Science, 65(4), 287–302. https://doi.org/10.5468/ogs.21265 CrossRefGoogle ScholarPubMed
Ahmad, M., & Vismara, L. (2021). The psychological impact of COVID-19 pandemic on women’s mental health during pregnancy: A rapid evidence review. International Journal of Environmental Research and Public Health, 18(13), 7112. https://doi.org/10.3390/ijerph18137112 CrossRefGoogle ScholarPubMed
Albanese, A. M., Russo, G. R., & Geller, P. A. (2019). The role of parental self-efficacy in parent and child well-being: A systematic review of associated outcomes. Child: Care, Health and Development, 45(3), 333–363. https://doi.org/10.1111/cch.12661 CrossRefGoogle ScholarPubMed
Bach, K. (2022, August 24). New data shows Long Covid is keeping as many as 4 million people out of work. Brookings. https://www.brookings.edu/research/new-data-sh Google Scholar
Board, G. P. M. (2019) A world at risk. (World Health Organization and the World Bank.).Google Scholar
Buthmann, J. L., Miller, J. G., & Gotlib, I. H. (2024). Maternal-prenatal stress and depression predict infant temperament during the COVID-19 pandemic. Development and Psychopathology, 36(1), 161–169. https://doi.org/10.1017/S0954579422001055 CrossRefGoogle ScholarPubMed
Callard, F., & Perego, E. (2021). How and why patients made long Covid. Social Science & Medicine, 268, 113426. https://doi.org/10.1016/j.socscimed.2020.113426 CrossRefGoogle ScholarPubMed
Clemente-Suárez, V. J., Navarro-Jiménez, E., Jimenez, M., Hormeño-Holgado, A., Martinez-Gonzalez, M. B., Benitez-Agudelo, J. C., Perez-Palencia, N., Laborde-Cárdenas, C. C., & Tornero-Aguilera, J. F. (2021). Impact of COVID-19 Pandemic in Public Mental Health: An Extensive Narrative Review. Sustainability, 13(6), 3221. https://doi.org/10.3390/su13063221 CrossRefGoogle Scholar
Coleman, P. K., & Karraker, K. H. (2003). Maternal self-efficacy beliefs, competence in parenting, and toddlers’ behavior and developmental status. Infant Mental Health Journal, 24(2), 126–148. https://doi.org/10.1002/imhj.10048 CrossRefGoogle Scholar
Cruz-Ramos, M. C., Resurrección, D. M., & Hernández-Albújar, Y. (2023). Childbirth experience during the COVID-19 pandemic: A qualitative thematic analysis. Midwifery, 121, 103669. https://doi.org/10.1016/j.midw.2023.103669 CrossRefGoogle ScholarPubMed
Datye, S., Smiljanic, M., Shetti, R., MacRae-Miller, A., van Teijlingen, E., Vinayakarao, L., & Conrad, M. L. (2024). Prenatal maternal mental health and resilience in the United Kingdom during the SARS-CoV-2 pandemic: A cross-national comparison. Frontiers in Psychiatry, 15, 1411761. https://doi.org/10.3389/fpsyt.2024.1411761 CrossRefGoogle ScholarPubMed
Ducharme, J. (2022). Long COVID experts: U.S. Government needs to do more. Time. https://time.com/6213103/us-government-long-covid-response/.Google Scholar
Fan, S., Guan, J., Cao, L., Wang, M., Zhao, H., Chen, L., & Yan, L. (2021). Psychological effects caused by COVID-19 pandemic on pregnant women: A systematic review with meta-analysis. Asian Journal of Psychiatry, 56, 102533. https://doi.org/10.1016/j.ajp.2020.102533 CrossRefGoogle ScholarPubMed
Genova, F., Renata, T., & Marzilli, E. (2023). Parental postnatal depression in the time of the COVID-19 pandemic: A systematic review of its effects on the parent-child relationship and the child’s developmental outcomes. International Journal of Environmental Research and Public Health, 20(3), 2018. https://doi.org/10.3390/ijerph20032018.Google Scholar
Goodman, S. H., Simon, H., McCarthy, L., Ziegler, J., & Ceballos, A. (2022). Testing models of associations between depression and parenting self-efficacy in mothers: A meta-analytic review. Clinical Child and Family Psychology Review, 25(3), 471–499. https://doi.org/10.1007/s10567-022-00398-0 CrossRefGoogle ScholarPubMed
Goyal, D., Rosa, L. D. L., Mittal, L., Erdei, C., & Liu, C. H. (2022). Unmet prenatal expectations during the COVID-19 pandemic. MCN: The American Journal of Maternal/Child Nursing, 47(2), 66–70. https://doi.org/10.1097/NMC.0000000000000801 Google ScholarPubMed
Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). The Guilford Press.Google Scholar
IPBES (2020). Workshop report on biodiversity and pandemics of the intergovernmental platform on biodiversity and ecosystem services. (Intergovernmental Platform on Biodiversity and Ecosystem Services [IPBES]). http://www.ipbes.net/pandemics.Google Scholar
Jiang, Q., Feldman, N., Koire, A., Ma, C., Mittal, L., Lin, H.-C., Erdei, C., Roffman, J. L., & Liu, C. H. (2024). Infant neurodevelopment during the COVID-19 pandemic: Associations with maternal pandemic-related experiences, parenting stress, and self-efficacy. Early Human Development, 193, 106018. https://doi.org/10.1016/j.earlhumdev.2024.106018 CrossRefGoogle ScholarPubMed
Kerker, B. D., Willheim, E., & Weis, J. R. (2023). The COVID-19 pandemic: Implications for maternal mental health and early childhood development. American Journal of Health Promotion, 37(2), 265–269. https://doi.org/10.1177/0890117122114064 CrossRefGoogle ScholarPubMed
Kola, L. (2020). Global mental health and COVID-19. The Lancet Psychiatry, 7(8), 655–657. https://doi.org/10.1016/S2215-0366(20)30235-2 CrossRefGoogle ScholarPubMed
Leahy-Warren, P., McCarthy, G., & Corcoran, P. (2012). First-time mothers: Social support, maternal parental self-efficacy and postnatal depression. Journal of Clinical Nursing, 21(3-4), 388–397. https://doi.org/10.1111/j.1365-2702.2011.03701.x CrossRefGoogle ScholarPubMed
Lemieux, A., Colby, G. A., Poulain, A. J., & Aris-Brosou, S. (2022). Viral spillover risk increases with climate change in high Arctic lake sediments. Proceedings of the Royal Society B: Biological Sciences, 289(1985), 20221073. https://doi.org/10.1098/rspb.2022.1073 CrossRefGoogle ScholarPubMed
Li, G., Tang, D., Song, B., Wang, C., Qunshan, S., Xu, C., Geng, H., Wu, H., He, X., & Cao, Y. (2020). Impact of the COVID-19 pandemic on partner relationships and sexual and reproductive health: Cross-sectional, online survey study. Journal of Medical Internet Research, 22(8), e20961. https://doi.org/10.2196/20961 CrossRefGoogle ScholarPubMed
Lin, H.-C., Zehnah, P. L., Koire, A., Mittal, L., Erdei, C., & Liu, C. H. (2022). Maternal self-efficacy buffers the effects of COVID-19-related experiences on postpartum parenting stress. Journal of Obstetric, Gynecologic & Neonatal Nursing, 51(2), 177–194. https://doi.org/10.1016/j.jogn.2021.12.004 CrossRefGoogle ScholarPubMed
Liu, C. H., Erdei, C., & Mittal, L. (2021a). Risk factors for depression, anxiety, and PTSD symptoms in perinatal women during the COVID-19 pandemic. Psychiatry Research, 295, 113552. https://doi.org/10.1016/j.psychres.2020.113552 CrossRefGoogle ScholarPubMed
Liu, C. H., Koire, A., Erdei, C., & Mittal, L. (2021b). Unexpected changes in birth experiences during the COVID-19 pandemic: Implications for maternal mental health. Archives of Gynecology and Obstetrics, 306, 687–697. https://doi.org/10.1007/s00404-021-06310-5 CrossRefGoogle ScholarPubMed
Liu, C. H., Wong, G. T. F., Hyun, S., Hahm, H. C. (2022). Concerns about the social climate, finances, and COVID-19 risk on depression and anxiety: An analysis on U.S. young adults across two waves. Journal of Psychiatric Research, 148, 286–292. https://doi.org/10.1016/j.jpsychires.2022.01.048 CrossRefGoogle ScholarPubMed
Mateus, V., Cruz, S., Costa, R., Mesquita, A., Christoforou, A., Wilson, C. A., Vousoura, E., Dikmen-Yildiz, P., Bina, R., Dominguez-Salas, S., Contreras-García, Y., Motrico, E., & Osório, A. (2022). Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data. Journal of Affective Disorders, 316, 245–253. https://doi.org/10.1016/j.jad.2022.08.017 CrossRefGoogle ScholarPubMed
Milgrom, J., Hirshler, Y., Reece, J., Holt, C., & Gemmill, A. W. (2019). Social support—A protective factor for depressed perinatal women? International Journal of Environmental Research and Public Health, 16(8), 1426. https://doi.org/10.3390/ijerph16081426 CrossRefGoogle ScholarPubMed
Mohammadi, F., Kohan, S., Farzi, S., Khosravi, M., & Heidari, Z. (2021). The effect of pregnancy training classes based on bandura self-efficacy theory on postpartum depression and anxiety and type of delivery. Journal of Education and Health Promotion, 10(273), 1–6. https://doi.org/10.4103/jehp.jehp_105_21 CrossRefGoogle ScholarPubMed
Motrico, E., Bina, R., Domínguez-Salas, S., Mateus, V., Contreras-García, Y., Carrasco-Portiño, M., Ajaz, E., Apter, G., Christoforou, A., Dikmen-Yildiz, P., Felice, E., Hancheva, C., Vousoura, E., Wilson, C. A., Buhagiar, R., Cadarso-Suárez, C., Costa, R., Devouche, E., Ganho-Ávila, A.…Gómez-Baya, D. (2021). Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): Protocol for an international prospective cohort study. BMC Public Health, 21(1), 1–11. https://doi.org/10.1186/s12889-021-10330-w CrossRefGoogle ScholarPubMed
Muñoz-Chápuli Gutiérrez, M., Prat, A. S., Vila, A. D., Claverol, M. B., Martínez, P. P., Recarte, P. P., Benéitez, M. V., García, C. A., Muñoz, E. C., Navarro, M., Navarro, P. G., Álvarez-Mon, M., Ortega, M. A., & De León-Luís, J. (2024). Post-COVID-19 condition in pregnant and postpartum women: A long-term follow-up, observational prospective study. eClinicalMedicine, 67, 102398. https://doi.org/10.1016/j.eclinm.2023.102398 CrossRefGoogle ScholarPubMed
Penna, A. L., de Aquino, C. M., Pinheiro, M. S. N., Do Nascimento, R. L. F., Farias-Antúnez, S., Araújo, D. A. B. S., & Castro, M. C. (2023). Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: A global scoping review. BMC Public Health, 23(1), 388. https://doi.org/10.1186/s12889-023-15003-4 CrossRefGoogle ScholarPubMed
Perren, S., Von Wyl, A., Bürgin, D., Simoni, H., & Von Klitzing, K. (2005). Depressive symptoms and psychosocial stress across the transition to parenthood: Associations with parental psychopathology and child difficulty. Journal of Psychosomatic Obstetrics & Gynecology, 26(3), 173–183. https://doi.org/10.1080/01674820400028407 CrossRefGoogle ScholarPubMed
Prime, H., Walsh, F., & Masten, A. S. (2023). Building family resilience in the wake of a global pandemic: Looking back to prepare for the future. Canadian Psychology / Psychologie Canadienne, 64(3), 200–211. https://doi.org/10.1037/cap0000366 CrossRefGoogle Scholar
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306 CrossRefGoogle Scholar
Rastogi, R., Cerda, I. H., Ibrahim, A., Chen, J. A., Stevens, C., & Liu, C. H. (2023). Long COVID and psychological distress in young adults: Potential protective effect of a prior mental health diagnosis. Journal of Affective Disorders, 340, 639–648. https://doi.org/10.1016/j.jad.2023.08.031 CrossRefGoogle Scholar
Raveendran, A. V., Jayadevan, R., & Sashidharan, S. (2021). Long COVID: An overview. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 15(3), 869–875. https://doi.org/10.1016/j.dsx.2021.04.007 CrossRefGoogle ScholarPubMed
Razurel, C., Kaiser, B., Antonietti, J.-P., Epiney, M., & Sellenet, C. (2017). Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support. Women & Health, 57(2), 154–172. https://doi.org/10.1080/03630242.2016.1157125 CrossRefGoogle ScholarPubMed
Sacchi, C., De Carli, P., Gregorini, C., Monk, C., & Simonelli, A. (2024). In the pandemic from the womb. Prenatal exposure, maternal psychological stress and mental health in association with infant negative affect at 6 months of life. Development and Psychopathology, 36(2), 810–820. https://doi.org/10.1017/S0954579423000093 CrossRefGoogle ScholarPubMed
Shulman, H. B., D’Angelo, D. V., Harrison, L., Smith, R. A., & Warner, L. (2018). The pregnancy risk assessment monitoring system (PRAMS): Overview of design and methodology. American Journal of Public Health, 108(10), 1305–1313. https://doi.org/10.2105/AJPH.2018.304563 CrossRefGoogle ScholarPubMed
Shuman, C. J., Peahl, A. F., Pareddy, N., Morgan, M. E., Chiangong, J., Veliz, P. T., & Dalton, V. K. (2022). Postpartum depression and associated risk factors during the COVID-19 pandemic. BMC Research Notes, 15(1), 102. https://doi.org/10.1186/s13104-022-05991-8 CrossRefGoogle ScholarPubMed
Silletti, F. (2023). Women’s psychological distress in the perinatal period. Nature Reviews Psychology, 2(7), 388–388. https://doi.org/10.1038/s44159-023-00196-7 CrossRefGoogle Scholar
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092. https://doi.org/10.1001/archinte.166.10.1092 CrossRefGoogle ScholarPubMed
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., Howard, L. M., & Pariante, C. M. (2014). Effects of perinatal mental disorders on the fetus and child. The Lancet, 384(9956), 1800–1819. https://doi.org/10.1016/S0140-6736(14)61277-0 CrossRefGoogle ScholarPubMed
Sun, F., Zhu, J., Tao, H., Ma, Y., & Jin, W. (2021). A systematic review involving 11,187 participants evaluating the impact of COVID-19 on anxiety and depression in pregnant women. Journal of Psychosomatic Obstetrics & Gynecology, 42(2), 91–99. https://doi.org/10.1080/0167482X.2020.1857360 CrossRefGoogle Scholar
Sun, G., Wang, Q., Lin, Y., Li, R., Yang, L., Liu, X., Peng, M., Wang, H., Yang, X., Ren, W., Yang, H., & Cheng, Y. (2020). Perinatal depression of exposed maternal women in the COVID-19 pandemic in Wuhan, China. Frontiers in psychiatry, 11, 551812.CrossRefGoogle ScholarPubMed
Usmani, S., Greca, E., Javed, S., Sharath, M., Sarfraz, Z., Sarfraz, A., Salari, S. W., Hussaini, S. S., Mohammadi, A., Chellapuram, N., Cabrera, E., & Ferrer, G. (2021). Risk factors for postpartum depression during COVID-19 pandemic: A systematic literature review. Journal of Primary Care & Community Health, 12, 21501327211059348. https://doi.org/10.1177/21501327211059348 CrossRefGoogle ScholarPubMed
Van Den Heuvel, M. I., Vacaru, S. V., Boekhorst, M. G., Cloin, M., Van Bakel, H., Riem, M. M., & Beijers, R. (2022). Parents of young infants report poor mental health and more insensitive parenting during the first Covid-19 lockdown. BMC Pregnancy and Childbirth, 22(1), 302. https://doi.org/10.1186/s12884-022-04618-x CrossRefGoogle ScholarPubMed
Vásconez-González, J., Fernandez-Naranjo, R., Izquierdo-Condoy, J. S., Delgado-Moreira, K., Cordovez, S., Tello-De-la-Torre, A., Paz, C., Castillo, D., Izquierdo-Condoy, N., Carrington, S. J., & Ortiz-Prado, E. (2023). Comparative analysis of long-term self-reported COVID-19 symptoms among pregnant women. Journal of Infection and Public Health, 16(3), 430–440. https://doi.org/10.1016/j.jiph.2023.01.012 CrossRefGoogle ScholarPubMed
Wigert, H., Nilsson, C., Dencker, A., Begley, C., Jangsten, E., Sparud-Lundin, C., Mollberg, M., & Patel, H. (2020). Women’s experiences of fear of childbirth: A metasynthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-Being, 15(1), 1704484. https://doi.org/10.1080/17482631.2019.1704484 CrossRefGoogle ScholarPubMed
Xue, A., Oros, V., La Marca-Ghaemmaghami, P., Scholkmann, F., Righini-Grunder, F., Natalucci, G., Karen, T., Bassler, D., & Restin, T. (2021). New parents experienced lower parenting self-efficacy during the COVID-19 pandemic lockdown. Children, 8(2), 79. https://doi.org/10.3390/children8020079 CrossRefGoogle ScholarPubMed
Zhang, Y., Zhu, J., Li, S., Huang, L., Fang, Q., & Zheng, X. (2023). The effectiveness of an internet-based support program on maternal self-efficacy, postpartum depression and social support for primiparous women during the COVID-19 pandemic: Randomized controlled trial. Frontiers in Public Health, 11(1035872), 1–10. https://doi.org/10.3389/fpubh.2023.1035872 Google ScholarPubMed