{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T18:26:10Z","timestamp":1782325570819,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T00:00:00Z","timestamp":1604880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>To avoid spreading the Corona Virus Disease 2019 (COVID-19), health authorities have forced people to reorganize their working and private lives and to avoid open and public spaces as much as possible. This has also been the case for women both during pregnancy and after delivery. Here, we investigated the associations between subjective beliefs in risk of infections and health anxiety, depression, stress, and other perinatal dimensions. To this end, we assessed 103 women (mean age: 28.57 years) during pregnancy and after delivery. They completed a series of questionnaires covering sociodemographic information, perinatal information, health anxiety, post-partum depression, and stress. Sixty-six participants (64.1%) were in the pre-partum stage, and 37 (35.9%) were post-partum. Health anxiety was unrelated to depression or stress. Knowing and being close to infected people was associated with higher health anxiety. Strict following of the safety recommendations was associated with greater health anxiety, depression, and stress. Postponing or cancelling routine medical check appointments was observed among participants with high health anxiety scores. Higher illness severity, overall health anxiety scores, and lower stress scores predicted those participants who postponed or cancelled their routine medical check appointments. Post-partum stage and a larger number of children were associated with higher stress scores, but not with depression or stress. The results are of practical and clinical importance; it appears that health anxiety, which is to say fear of getting infected with COVID-19 during pregnancy or at the post-partum stage, was associated with postponing or cancelling routine medical check appointments, but not with stress or depression.<\/jats:p>","DOI":"10.3390\/ijerph17218272","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T10:47:28Z","timestamp":1605005248000},"page":"8272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Health Anxiety Predicts Postponing or Cancelling Routine Medical Health Care Appointments among Women in Perinatal Stage during the Covid-19 Lockdown"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9977-5126","authenticated-orcid":false,"given":"Mehran","family":"Shayganfard","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Arak University of Medical Sciences, Arak 3848176341, Iran"},{"name":"Endocrinology and Metabolism Research Center, Arak University of Medical Sciences, Arak 3848176341, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fateme","family":"Mahdavi","sequence":"additional","affiliation":[{"name":"Student Research Committee, Arak University of Medical Sciences, Arak 3848176341, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Haghighi","sequence":"additional","affiliation":[{"name":"Research Center for Behavioral Disorders and Substances Abuse, Hamadan University of Medical Sciences, Hamadan 65174, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1301-5522","authenticated-orcid":false,"given":"Dena","family":"Sadeghi Bahmani","sequence":"additional","affiliation":[{"name":"Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA"},{"name":"Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran"},{"name":"Center for Affective-, Stress- and Sleep Disorders (ZASS), University of Basel, Psychiatric Clinics (UPK), 4002 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2175-2765","authenticated-orcid":false,"given":"Serge","family":"Brand","sequence":"additional","affiliation":[{"name":"Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA"},{"name":"Center for Affective-, Stress- and Sleep Disorders (ZASS), University of Basel, Psychiatric Clinics (UPK), 4002 Basel, Switzerland"},{"name":"Division of Sport Science and Psychosocial Health, Department of Sport, Exercise, and Health, University of Basel, 4052 Basel, Switzerland"},{"name":"Substance Abuse Prevention Research Center, Health, Institute, Kermanshah University of Medical Sciences, Kermanshah 67146, Iran"},{"name":"School of Medicine, Tehran University of Medical Sciences, Tehran 25529, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1017\/S0950268820000783","article-title":"The challenges and considerations of community-based preparedness at the onset of COVID-19 outbreak in Iran, 2020","volume":"148","author":"Moradzadeh","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1089\/hs.2020.0041","article-title":"Iran Without Mandatory Quarantine and with Social Distancing Strategy Against Coronavirus Disease (COVID-19)","volume":"18","author":"Abdi","year":"2020","journal-title":"Health Secur."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"010365","DOI":"10.7189\/jogh.10.010365","article-title":"The COVID-19 outbreak in Iran","volume":"10","author":"Salimi","year":"2020","journal-title":"J. Glob. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101990","DOI":"10.1016\/j.ajp.2020.101990","article-title":"Iranian mental health during the COVID-19 epidemic","volume":"51","author":"Zandifar","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Wong, L.P., Alias, H., Danaee, M., Ziaee, M., Adebi, F., Ziaee, A., Mohajer, S., HajiAliBeigloo, R., Nia, M.N., and Jamei, F. (2020). Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound. Emerg. Dis.","DOI":"10.1111\/tbed.13662"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12992-020-00589-w","article-title":"Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"16","author":"Salari","year":"2020","journal-title":"Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.jad.2020.08.001","article-title":"Impact of COVID-19 pandemic on mental health in the general population: A systematic review","volume":"277","author":"Xiong","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"102076","DOI":"10.1016\/j.ajp.2020.102076","article-title":"Assessing the anxiety level of Iranian general population during COVID-19 outbreak","volume":"51","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"179","DOI":"10.32598\/bcn.11.covid19.1168.2","article-title":"The Role of Anxiety and Cortisol in Outcomes of Patients With Covid-19","volume":"11","author":"Ramezani","year":"2020","journal-title":"Basic Clin. Neurosci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Buss, D.M. (2019). Evoutionary Psychology. the New Science of the Mind, Routledge. [6th ed.].","DOI":"10.4324\/9780429061417"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jahangard, L., Mikoteit, T., Bahiraei, S., Zamanibonab, M., Haghighi, M., Sadeghi, B.D., and Serge, B. (2019). Prenatal and Postnatal Hair Steroid Levels Predict Post-Partum Depression 12 Weeks after Delivery. J. Int. Med., 8.","DOI":"10.3390\/jcm8091290"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1192\/bjp.bp.116.187179","article-title":"Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis","volume":"210","author":"Dennis","year":"2017","journal-title":"Br. J. Psychiatry J. Mental Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1080\/0167482X.2020.1755838","article-title":"Conceived in the covid-19 crisis: Impact of maternal stress and anxiety on fetal neurobehavioral development","volume":"41","year":"2020","journal-title":"J. Psychosom. Obstet. Gynaecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.jad.2018.05.073","article-title":"Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis","volume":"238","author":"Furtado","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.midw.2016.02.013","article-title":"The co-existence of depression, anxiety and post-traumatic stress symptoms in the perinatal period: A systematic review","volume":"36","author":"Agius","year":"2016","journal-title":"Midwifery"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.wombi.2015.02.003","article-title":"The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review","volume":"28","author":"Staneva","year":"2015","journal-title":"Women Birth J. Aust. College Midwives"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Br\u00fcne, M. (2015). Textbook of evolutionary psychiatry and psychosomatic medicine. The Origins of Psychopathology, Oxford University Press.","DOI":"10.1093\/med:psych\/9780198717942.003.0004"},{"key":"ref_18","unstructured":"Stevens, A., and Price, J. (2000). Evolutionary Psychiatry. A New Beginning, Taylor & Francis Group."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"McGuire, M.T., and Troisi, A. (1998). Darwinian Psychiatry, Oxford University Press.","DOI":"10.1093\/med:psych\/9780195116731.001.0001"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kahyaoglu Sut, H., and Kucukkaya, B. (2020). Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study. Perspect. Psychiatry Care.","DOI":"10.1111\/ppc.12627"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Moyer, C.A., Compton, S.D., Kaselitz, E., and Muzik, M. (2020). Pregnancy-related anxiety during COVID-19: A nationwide survey of 2740 pregnant women. Arch. Women\u2019s Ment. Health, 1\u20139.","DOI":"10.1007\/s00737-020-01073-5"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ahlers-Schmidt, C.R., Hervey, A.M., Neil, T., Kuhlmann, S., and Kuhlmann, Z. (2020). Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic. Patient Educ. Couns.","DOI":"10.1016\/j.pec.2020.09.031"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1111\/aogs.13925","article-title":"Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic","volume":"99","author":"Berthelot","year":"2020","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jad.2020.07.126","article-title":"Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic","volume":"277","author":"Lebel","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1111\/1471-0528.16381","article-title":"Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: A cross-sectional study","volume":"127","author":"Liu","year":"2020","journal-title":"Bjog"},{"key":"ref_26","first-page":"467","article-title":"Lockdown with a Price: The impact of the COVID-19 Pandemic on Prenatal Care and Perinatal Outcomes in a Tertiary Care Center","volume":"9","author":"Justman","year":"2020","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1017\/S0033291702005822","article-title":"The health anxiety inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis","volume":"32","author":"Salkovskis","year":"2002","journal-title":"Psychol. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1017\/S0033291708003322","article-title":"A taxometric analysis of health anxiety","volume":"39","author":"Ferguson","year":"2009","journal-title":"Psychol. Med."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/bjd.13259","article-title":"The role of beliefs: Lessons from a pilot study on illness perception, psychological distress and quality of life in patients with primary cicatricial alopecia","volume":"172","author":"Chiang","year":"2015","journal-title":"Br. J. Dermatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/109019818401100101","article-title":"The Health Belief Model: A decade later","volume":"11","author":"Janz","year":"1984","journal-title":"Health Educ. Q."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/109019818801500203","article-title":"Social learning theory and the Health Belief Model","volume":"15","author":"Rosenstock","year":"1988","journal-title":"Health Educ. Q."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"First, M. (2015). Structured Clinical Interview for the DSM (SCID). Encycl. Clin. Psychol., 1\u20136.","DOI":"10.1002\/9781118625392.wbecp351"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1000125","DOI":"10.4172\/2167-1044.1000125","article-title":"Factor structure analysis, validity and reliability of the health anxiety inventory-short form","volume":"2","author":"Mehdi","year":"2013","journal-title":"J. Depress. Anxiety"},{"key":"ref_36","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [4th ed.]. DSM-IV-TR."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Montazeri, A., Torkan, B., and Omidvari, S. (2007). The Edinburgh Postnatal Depression Scale (EPDS): Translation and validation study of the Iranian version. BMC Psychiatry, 7.","DOI":"10.1186\/1471-244X-7-11"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale","volume":"150","author":"Cox","year":"1987","journal-title":"Br. J. Psychiatry J. Mental Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J. Health Soc. Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.ajp.2017.01.010","article-title":"Validity and reliability of the Cohen 10-item Perceived Stress Scale in patients with chronic headache: Persian version","volume":"26","author":"Khalili","year":"2017","journal-title":"Asian J. Psychiatry"},{"key":"ref_41","first-page":"361","article-title":"Reliability and validity of Persian version of perceived stress scale (PSS-10) in adults with asthma","volume":"17","author":"Maroufizadeh","year":"2014","journal-title":"Arch. Iran. Med."},{"key":"ref_42","first-page":"457","article-title":"Psychometric properties of the 14, 10 and 4-item \u201cPerceived Stress Scale\u201d among asthmatic patients in Iran","volume":"13","author":"Saman","year":"2014","journal-title":"Health Monit. J. Iran. Inst. Health Sci. Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Monni, G., Corda, V., and Iuculano, A. (2020). Prenatal screening diagnosis and management in the era of coronavirus: The Sardinian experience. J. Perinat Med.","DOI":"10.1515\/jpm-2020-0208"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Jeganathan, S., Prasannan, L., Blitz, M.J., Vohra, N., Rochelson, B., and Meirowitz, N. (2020). Adherence and Acceptability of Telehealth Appointments for High Risk Obstetrical Patients During the COVID-19 Pandemic. Am. J. Obstet. Gynecol. MFM, 100233.","DOI":"10.1016\/j.ajogmf.2020.100233"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.jad.2018.12.009","article-title":"Physical activity during pregnancy and postpartum depression: Systematic review and meta-analysis","volume":"246","author":"Nakamura","year":"2019","journal-title":"J. Affect. Disord."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/8272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:31:11Z","timestamp":1760178671000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/8272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,9]]},"references-count":45,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17218272"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17218272","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,9]]}}}