Study Instrument
Perinatal depression was used as a dependent variable and evaluated by the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was compiled by Cox et al. in 1987 and has proved suitable for perinatal depression screening with good reliability and validity (10). The EPDS was also wildly used on fathers in their partners’ pregnancy and postpartum (11, 12). The EPDS scale contains 10 items, and each item is scored on a four-point scale ranging 0–3 points by severity. In line with previous studies, this study used a total score of 0–9 points indicating no depression, and 10-30 points indicating depression.
We used 4 periods to address the COVID-19 epidemic as an independent variable in Wuhan, China. Period 1 of pre-epidemic of COVID-19 defined before the official announcement of human to human transmission by the National Health Commission of China (Dec 31, 2019 to Jan 18, 2020); Period 2 of pre-outbreak of COVID-19 with limited number of confirmed patients defined from the announcement of human to human transmission to traffic restrictions (Jan 19, 2020 to Jan 23, 2020); Period 3 of traffic restrictions defined from the outbreak of COVID-19 to the announcement of no increased number of confirmed COVID-19 patients (Jan 24, 2020 to Mar 27, 2020); Period 4 of traffic restrictions dismissed and public traffic transportations reopened (Mar 28, 2020 to Apr 11, 2020). Moreover, we obtained family function as an important independent variable to address the association with paternal perinatal depression. The APGAR scale was used to evaluate family function. The scale was developed by Smilkstein, and includes 5 dimensions of family function (adaptation, partnership, growth, affection, and resolution) (13). Each dimension is divided into 3 levels, with values from 0 (hardly ever) to 2 (almost always). A total score of 0–3 is considered poor, 4–6 fair, and 7–10 good.
Demographic factors used as independent variables in this including age (<29, 30-34, and >34 years), ethnicity (Han, other), education (junior high or below, senior high, and college or more), Hukou (rural, urban), family income of last year (<50,000 RMB, 50,000 RMB-100,000 RMB, ≥100,000 RMB, and unclear), insurance (yes, no), and first-time father (yes, no).
Other independent variables of health behavior factors were used in this study, including self-rated sleep quality (good, fair, and poor), smoking/passive smoking within one year (no, yes), drinking/alcohol consumption within one year (no, yes), and exercise within one year (no, yes).