ublic health measures to limit the spread of coronavirus disease 2019 (COVID-19) include requirements not to leave home except for specified purposes, to work from home when practical, to limit proximity to other people, to not visit residential aged care homes, to limit the number of people at social events (weddings, funerals, celebrations), to restrict interstate and international travel, and to accept the enforcement of these restrictions. The mental health consequences of these measures are likely to be unevenly distributed across the community because they also depend on individual social and economic circumstances. A recent position paper 1 summarised international expert opinion on research priorities for mental health during the COVID-19 pandemic. The first recommendation was to gather high quality population level data on its mental health effects. The aim of our study was to assess the mental health of people in Australia during the first month of COVID-19-related restrictions. Our specific objectives were to estimate population prevalence rates of clinically significant symptoms of depression, generalised anxiety, thoughts of being better off dead, increased irritability, and high optimism about the future; to estimate the prevalence of direct experiences of COVID-19, loss of employment caused by COVID-19 restrictions, concern about contracting COVID-19, and major disadvantage because of the restrictions; and to assess associations between these experiences and mental health symptoms. Methods A short, anonymous survey (estimated completion time, 8 minutes) of people living in Australia and aged at least 18 years was available on the Monash University website (https:// www.monash.edu/medic ine/living-with-covid-19-restr ictio nssurvey) from 3 April 2020 (four days after national stage two COVID-19 restrictions were announced by the Prime Minister; phase one restrictions had been gradually introduced during March) until midnight on 2/3 May 2020 (further information: online Supporting Information). Mental health Psychological symptoms experienced during the preceding fortnight were assessed with the Patient Health Questionnaire 9 (PHQ-9) and the Generalised Anxiety Disorder Scale (GAD-7). The PHQ-9 2 is an easily understood scale that asks respondents to rate their experience of nine symptoms from 0 (not experienced) to 3 (experienced nearly every day); a total PHQ-9 score of 10 or more indicates clinically significant (moderate to severe) symptoms, while scores of 5-9 indicate mild symptoms. The GAD-7 3 is an easily understood scale that asks respondents to rate their experience of seven symptoms of anxiety with the same response options as the PHQ-9; a total GAD-7 score of 10 or more indicate clinically significant (moderate to severe) symptoms, while scores of 5-9 indicate mild symptoms. Optimism about the future was assessed with a visual analogue scale (from 0, not at all optimistic, to 10, extremely optimistic).

Background The COVID-19 pandemic, and the restrictions required to halt spread of the infection, are associated with increased population burden of moderate to severe symptoms of depression and anxiety. The aim was to quantify the mental health burden of the most severe COVID-19 related restrictions. Methods A natural experiment in which differences between Australian states and territories in the severity of restrictions for pandemic control, divided the population. People in Victoria experienced the most severe, and people in all other states and territories less severe or negligible restrictions. Data were collected in national, anonymously completed, online surveys (in April and in July / August 2020) of adults in Australia. Outcomes were, in the previous fortnight, experiencing clinically significant depressive symptoms (Patient Health Questionnaire 9 score ≥10); or symptoms of generalised anxiety (Generalised Anxiety Disorder Scale 7 score ≥10). Results In total, 23,749 eligible respondents contributed complete data. There were no differences in the population burden of mental health problems between Victoria and the other states and territories at Survey One. By Survey Two prevalence rates of clinically significant depressive (Adjusted Odds Ratio (aOR) 1.96; 95% CI 1.62; 2.37) and anxiety (aOR 1.87; 95%CI 1.53; 2.29) symptoms were substantially and significantly higher in Victoria than in other states and territories. Limitations Online surveys are less accessible to some groups of people. The data are self-report and not diagnostic. Conclusions The most severe COVID-19 restrictions are associated with near double the population prevalence of moderate to severe depressive and generalised anxiety symptoms.

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Background Preparing for pregnancy and being in the best possible health before conception improves reproductive outcomes. For women living with a chronic non-communicable disease (NCD), pregnancy planning is essential to allow optimal disease control in preparation for pregnancy. Aim The aim was to review the literature relating to the pregnancy planning health information and service needs of women with NCDs. Method The MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), PsycINFO (Ovid), CINAHL and Scopus databases were searched. Studies were included if they were published in peer-reviewed English language journals between January 2010 and June 2020 and reported on the pregnancy planning health information and service needs of women with rheumatic diseases, asthma, cystic fibrosis, depression and/or anxiety, type 1 diabetes mellitus, epilepsy, or multiple sclerosis. Risk of bias was assessed using QualSyst. The characteristics of the studies were tabulated and summarised. Key findings of the included studies were analysed thematically using an inductive approach, where the study findings determined the themes. Findings are reported in a narrative synthesis. Results The database searches yielded 8291 results, of which 4304 remained after duplicates were removed. After abstract screening 104 full-text papers were reviewed. Of these 15 met inclusion criteria and were included in analysis. The narrative synthesis of the included studies revealed six themes: ‘Women with chronic conditions have unmet preconception health information needs’, ‘Women with chronic conditions want personalised preconception health information’, ‘Preferred sources of preconception health information’, ‘Learning from the experiences of other women’, ‘Improving preconception health discussions with health care professionals’, and ‘Women want holistic care’. These themes were consistent across all studies, highlighting the similarity of experiences and needs of women with different chronic conditions. Conclusion To improve pregnancy outcomes for women living with NCDs, health care providers need to ask women of reproductive age proactively and routinely about their pregnancy intentions and provide them with personalised advice on how to avoid unplanned pregnancy and be in optimal health when they wish to conceive. PROSPERO registration number CRD42020176308.

Background: This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. Methods: Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. Results: Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. Conclusions: Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.