Predictors of maternal mental health and coping during the COVID-19 pandemic: A multi-country cross-sectional study

Objectives and study: This study aimed to examine predictors of post-partum maternal mental health (MMH) and coping during COVID-19 lockdown across seven countries (the UK, China, Japan, Malaysia, Mexico, Argentina, and Thailand). Methods: An anonymous questionnaire, developed in the UK in English and translated into local languages, was used in 2021-2022 to collect data on MMH and perceived coping ability from women aged [&ge;]18 years with an infant born before or during lockdowns. Five MMH components (worry, sadness, loneliness, difficulty relaxing, annoyance) and coping were assessed on a 4-point Likert scale, then dichotomised. MMH and coping were compared across countries using Chi-square tests with post-hoc pairwise comparisons conducted via Bonferroni-adjusted z-tests. Predictors of MMH and coping were examined using multivariable logistic regression. Results: A total of 7,650 women were analysed. Younger infant age, higher income, walking and exercise, and level of support were associated with better MMH and coping, whereas higher education was associated with better coping but poorer MMH. MMH and coping differed across countries (all p<0.001), which remained after adjusting for covariates: mothers in Asian countries reported better MMH, while those in the UK and Thailand reported better coping. Conclusions: Postpartum MMH and coping during lockdown were shaped by both individual and contextual factors. Findings highlight cross-country differences and underscore the need to strengthen maternal support system during future disruptions to perinatal care. Keywords: Mental Health, COVID-19, Postpartum Period, Coping Behaviour, Social Support, Cross-Cultural Comparison