Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study.
Identifieur interne : 000843 ( Main/Corpus ); précédent : 000842; suivant : 000844Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study.
Auteurs : Xue Yang ; Bo Song ; Anise Wu ; Phoenix K H. Mo ; Jiangli Di ; Qian Wang ; Joseph T F. Lau ; Linhong WangSource :
- Journal of medical Internet research [ 1438-8871 ] ; 2021.
English descriptors
- KwdEn :
- Adult (MeSH), Anxiety (epidemiology), Anxiety (psychology), COVID-19 (epidemiology), COVID-19 (prevention & control), COVID-19 (psychology), China (epidemiology), Cognition (MeSH), Cross-Sectional Studies (MeSH), Depression (epidemiology), Depression (psychology), Female (MeSH), Humans (MeSH), Mental Health (statistics & numerical data), Pandemics (MeSH), Pregnancy (MeSH), Pregnant Women (psychology), Prenatal Care (statistics & numerical data), Quarantine (psychology), Suicidal Ideation (MeSH), Surveys and Questionnaires (MeSH), Telemedicine (MeSH).
- MESH :
- geographic , epidemiology : China.
- epidemiology : Anxiety, COVID-19, Depression.
- prevention & control : COVID-19.
- psychology : Anxiety, COVID-19, Depression, Pregnant Women, Quarantine.
- statistics & numerical data : Mental Health, Prenatal Care.
- Adult, Cognition, Cross-Sectional Studies, Female, Humans, Pandemics, Pregnancy, Suicidal Ideation, Surveys and Questionnaires, Telemedicine.
Abstract
BACKGROUND
Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak.
OBJECTIVE
This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China.
METHODS
An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020.
RESULTS
Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ
CONCLUSIONS
Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.
DOI: 10.2196/24495
PubMed: 33302251
PubMed Central: PMC7836909
Links to Exploration step
pubmed:33302251Le document en format XML
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Mo</name><affiliation><nlm:affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</nlm:affiliation></affiliation></author><author><name sortKey="Di, Jiangli" sort="Di, Jiangli" uniqKey="Di J" first="Jiangli" last="Di">Jiangli Di</name><affiliation><nlm:affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Qian" sort="Wang, Qian" uniqKey="Wang Q" first="Qian" last="Wang">Qian Wang</name><affiliation><nlm:affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author><author><name sortKey="Lau, Joseph T F" sort="Lau, Joseph T F" uniqKey="Lau J" first="Joseph T F" last="Lau">Joseph T F. Lau</name><affiliation><nlm:affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Linhong" sort="Wang, Linhong" uniqKey="Wang L" first="Linhong" last="Wang">Linhong Wang</name><affiliation><nlm:affiliation>National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:33302251</idno><idno type="pmid">33302251</idno><idno type="doi">10.2196/24495</idno><idno type="pmc">PMC7836909</idno><idno type="wicri:Area/Main/Corpus">000843</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000843</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study.</title><author><name sortKey="Yang, Xue" sort="Yang, Xue" uniqKey="Yang X" first="Xue" last="Yang">Xue Yang</name><affiliation><nlm:affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</nlm:affiliation></affiliation></author><author><name sortKey="Song, Bo" sort="Song, Bo" uniqKey="Song B" first="Bo" last="Song">Bo Song</name><affiliation><nlm:affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author><author><name sortKey="Wu, Anise" sort="Wu, Anise" uniqKey="Wu A" first="Anise" last="Wu">Anise Wu</name><affiliation><nlm:affiliation>Department of Psychology, University of Macau, Macao, Macao.</nlm:affiliation></affiliation></author><author><name sortKey="Mo, Phoenix K H" sort="Mo, Phoenix K H" uniqKey="Mo P" first="Phoenix K H" last="Mo">Phoenix K H. Mo</name><affiliation><nlm:affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</nlm:affiliation></affiliation></author><author><name sortKey="Di, Jiangli" sort="Di, Jiangli" uniqKey="Di J" first="Jiangli" last="Di">Jiangli Di</name><affiliation><nlm:affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Qian" sort="Wang, Qian" uniqKey="Wang Q" first="Qian" last="Wang">Qian Wang</name><affiliation><nlm:affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author><author><name sortKey="Lau, Joseph T F" sort="Lau, Joseph T F" uniqKey="Lau J" first="Joseph T F" last="Lau">Joseph T F. Lau</name><affiliation><nlm:affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</nlm:affiliation></affiliation></author><author><name sortKey="Wang, Linhong" sort="Wang, Linhong" uniqKey="Wang L" first="Linhong" last="Wang">Linhong Wang</name><affiliation><nlm:affiliation>National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Journal of medical Internet research</title><idno type="eISSN">1438-8871</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Anxiety (epidemiology)</term><term>Anxiety (psychology)</term><term>COVID-19 (epidemiology)</term><term>COVID-19 (prevention & control)</term><term>COVID-19 (psychology)</term><term>China (epidemiology)</term><term>Cognition (MeSH)</term><term>Cross-Sectional Studies (MeSH)</term><term>Depression (epidemiology)</term><term>Depression (psychology)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Mental Health (statistics & numerical data)</term><term>Pandemics (MeSH)</term><term>Pregnancy (MeSH)</term><term>Pregnant Women (psychology)</term><term>Prenatal Care (statistics & numerical data)</term><term>Quarantine (psychology)</term><term>Suicidal Ideation (MeSH)</term><term>Surveys and Questionnaires (MeSH)</term><term>Telemedicine (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>China</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Anxiety</term><term>COVID-19</term><term>Depression</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Anxiety</term><term>COVID-19</term><term>Depression</term><term>Pregnant Women</term><term>Quarantine</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Mental Health</term><term>Prenatal Care</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Cognition</term><term>Cross-Sectional Studies</term><term>Female</term><term>Humans</term><term>Pandemics</term><term>Pregnancy</term><term>Suicidal Ideation</term><term>Surveys and Questionnaires</term><term>Telemedicine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">33302251</PMID><DateCompleted><Year>2021</Year><Month>01</Month><Day>28</Day></DateCompleted><DateRevised><Year>2021</Year><Month>01</Month><Day>30</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1438-8871</ISSN><JournalIssue CitedMedium="Internet"><Volume>23</Volume><Issue>1</Issue><PubDate><Year>2021</Year><Month>01</Month><Day>22</Day></PubDate></JournalIssue><Title>Journal of medical Internet research</Title><ISOAbbreviation>J Med Internet Res</ISOAbbreviation></Journal><ArticleTitle>Social, Cognitive, and eHealth Mechanisms of COVID-19-Related Lockdown and Mandatory Quarantine That Potentially Affect the Mental Health of Pregnant Women in China: Cross-Sectional Survey Study.</ArticleTitle><Pagination><MedlinePgn>e24495</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2196/24495</ELocationID><Abstract><AbstractText Label="BACKGROUND">Although lockdown and mandatory quarantine measures have played crucial roles in the sharp decrease of the number of newly confirmed/suspected COVID-19 cases, concerns have been raised over the threat that these measures pose to mental health, especially the mental health of vulnerable groups, including pregnant women. Few empirical studies have assessed whether and how these control measures may affect mental health, and no study has investigated the prevalence and impacts of the use of eHealth resources among pregnant women during the COVID-19 outbreak.</AbstractText><AbstractText Label="OBJECTIVE">This study investigated (1) the effects of lockdown and mandatory quarantine on mental health problems (ie, anxiety and depressive symptoms), (2) the potential mediation effects of perceived social support and maladaptive cognition, and (3) the moderation effects of eHealth-related factors (ie, using social media to obtain health information and using prenatal care services during the COVID-19 pandemic) on pregnant women in China.</AbstractText><AbstractText Label="METHODS">An online cross-sectional survey was conducted among 19,515 pregnant women from all 34 Chinese provincial-level administrative regions from February 25 to March 10, 2020.</AbstractText><AbstractText Label="RESULTS">Of the 19,515 participants, 12,209 (62.6%) were subjected to lockdown in their areas of residence, 737 (3.8%) were subjected to mandatory quarantine, 8712 (44.6%) had probable mild to severe depression, 5696 (29.2%) had probable mild to severe anxiety, and 1442 (7.4%) had suicidal ideations. Only 640 (3.3%) participants reported that they used online prenatal care services during the outbreak. Significant sociodemographic/maternal factors of anxiety/depressive symptoms included age, education, occupation, the area of residence, gestational duration, the number of children born, complication during pregnancy, the means of using prenatal care services, and social media use for obtaining health information. Multiple indicators multiple causes modeling (χ<sup>2</sup><sub>14</sub>=495.21; P<.05; comparative fit index=.99; nonnormed fit index=.98; root mean square error of approximation=.04, 90% CI 0.038-0.045) showed that quarantine was directly and indirectly strongly associated with poor mental health through decreased perceived social support and increased maladaptive cognition (B=.04; β=.02, 95% CI 0.01-0.02; P=.001), while lockdown was indirectly associated with mental health through increased social support and maladaptive cognition among pregnant women (B=.03; β=.03, 95% CI 0.02-0.03; P=.001). Multigroup analyses revealed that the use of social media for obtaining health information and the means of using prenatal care services were significant moderators of the model paths.</AbstractText><AbstractText Label="CONCLUSIONS">Our findings provide epidemiological evidence for the importance of integrating mental health care and eHealth into the planning and implementation of control measure policies. The observed social and cognitive mechanisms and moderators in this study are modifiable, and they can inform the design of evidence-based mental health promotion among pregnant women.</AbstractText><CopyrightInformation>©Xue Yang, Bo Song, Anise Wu, Phoenix K H Mo, Jiangli Di, Qian Wang, Joseph T F Lau, Linhong Wang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.01.2021.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Yang</LastName><ForeName>Xue</ForeName><Initials>X</Initials><Identifier Source="ORCID">0000-0001-7892-2994</Identifier><AffiliationInfo><Affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Song</LastName><ForeName>Bo</ForeName><Initials>B</Initials><Identifier Source="ORCID">0000-0002-0161-1052</Identifier><AffiliationInfo><Affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Anise</ForeName><Initials>A</Initials><Identifier Source="ORCID">0000-0001-8174-6581</Identifier><AffiliationInfo><Affiliation>Department of Psychology, University of Macau, Macao, Macao.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mo</LastName><ForeName>Phoenix K H</ForeName><Initials>PKH</Initials><Identifier Source="ORCID">0000-0001-9822-5424</Identifier><AffiliationInfo><Affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Di</LastName><ForeName>Jiangli</ForeName><Initials>J</Initials><Identifier Source="ORCID">0000-0002-5006-1800</Identifier><AffiliationInfo><Affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Qian</ForeName><Initials>Q</Initials><Identifier Source="ORCID">0000-0002-9674-4914</Identifier><AffiliationInfo><Affiliation>National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lau</LastName><ForeName>Joseph T F</ForeName><Initials>JTF</Initials><Identifier Source="ORCID">0000-0003-2344-7107</Identifier><AffiliationInfo><Affiliation>The Jockey Club School of Public Health and Primary, The Chinese University of Hong Kong, Hong Kong, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wang</LastName><ForeName>Linhong</ForeName><Initials>L</Initials><Identifier Source="ORCID">0000-0002-9541-3654</Identifier><AffiliationInfo><Affiliation>National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>01</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>Canada</Country><MedlineTA>J Med Internet Res</MedlineTA><NlmUniqueID>100959882</NlmUniqueID><ISSNLinking>1438-8871</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001007" MajorTopicYN="N">Anxiety</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002681" MajorTopicYN="N" Type="Geographic">China</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003071" MajorTopicYN="Y">Cognition</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003863" MajorTopicYN="N">Depression</DescriptorName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName><QualifierName UI="Q000523" MajorTopicYN="N">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008603" MajorTopicYN="N">Mental Health</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011247" MajorTopicYN="N">Pregnancy</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D037841" MajorTopicYN="N">Pregnant Women</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011295" MajorTopicYN="N">Prenatal Care</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011790" MajorTopicYN="N">Quarantine</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D059020" MajorTopicYN="N">Suicidal Ideation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011795" MajorTopicYN="N">Surveys and Questionnaires</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017216" MajorTopicYN="Y">Telemedicine</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">anxiety</Keyword><Keyword MajorTopicYN="Y">depression</Keyword><Keyword MajorTopicYN="Y">eHealth</Keyword><Keyword MajorTopicYN="Y">lockdown</Keyword><Keyword MajorTopicYN="Y">pregnant women</Keyword><Keyword MajorTopicYN="Y">quarantine</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>09</Month><Day>22</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>11</Month><Day>30</Day></PubMedPubDate><PubMedPubDate 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