Attachment Style, Pregnancy-Related Internet Use And Mental Health Of Primiparous Pregnant Women During COVID-19 Pandemic

Attachment Style, Pregnancy-Related Internet Use And Mental Health Of Primiparous Pregnant Women During COVID-19 Pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Attachment Style, Pregnancy-Related Internet Use And Mental Health Of Primiparous Pregnant Women During COVID-19 Pandemic Bérengère Batail Gautier, Marie Danet This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6278475/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim: To explore the relationship between pregnancy-related Internet use during pregnancy and attachment style, social support, anxio-depressive symptoms and well-being during COVID- 19 pandemic. Methods: 99 pregnant women, recruited online and through perinatal professionals, completed an online questionnaire assessing attachment style, pregnancy-related Internet use, anxio-depressive symptoms, social support, and well-being in COVID-19 pandemic context. Linear regression analyses were performed to determine the relationship between Internet use and pregnant women attachment styles. Results: Insecure, preoccupied, and fearful attachment styles were predictive of Internet use in case of negative emotions. The relationship between preoccupied attachment and Internet use in case of negative emotion was mediated by anxiety. Preoccupied, fearful and dismissing attachment styles were predictive of Internet use for information seeking. The COVID-19 pandemic has increased Internet use during pregnancy, particularly for information seeking and in case of negative emotions. The link between fearful and preoccupied attachment styles was mediated by well-being in the pandemic context. Conclusions: This study showed a link between attachment style, anxiety, well-being in COVID-19 pandemic context and Internet use during pregnancy. Perinatal professionals, by taking an interest on digital education and participating in the development of quality online resources, could prevent misinformation and reduce anxiety symptoms of insecure pregnant women. Internet Use Pregnancy Attachment insecurity anxiety COVID-19 social support Figures Figure 1 Figure 2 Figure 3 Introduction Pregnancy is considered as a developmental crisis (Reeves & Wendland, 2017 ). Researches on adult attachment promoted understanding of women’s psychological and relational adjustment during pregnancy (Luz et al., 2016 ). Attachment styles influence adaptation to stress (Rusconi & Suardi, 2011), with pregnancy being a unique stressor linked to concerns about relationships (Reeves & Wendland, 2017 ). Secure attachment serves as a protective factor, while insecure attachment increases vulnerability to anxiety and depression (Mazzeschi et al., 2015 ), particularly pregnancy-related anxiety (Reeves & Wendland, 2017 ) and perinatal depression. Specifically, preoccupied attachment is significantly associated with depressive and anxiety symptoms during pregnancy (Feeney et al., 2001 ; Pesonen et al., 2004 ). Attachment style also influences social relationships (Berlin et al., 2008). Insecure individuals have negative models of self and/or others (Bartholomew & Horowitz, 1991 ), perceive less support, and struggle with relationships (Mallinckrodt & Wei, 2005 ; Pesonen et al., 2004 ; Simpson et al., 1992 ). They experience less effective support seeking (Simpson et al., 1992 ) and less perceived support (Simpson & Rholes, 2008 ), especially during pregnancy (Rini et al., 2006 ) and may turn to alternative sources like the Internet (Danet & Miljkovitch, 2016 ; Lin et al., 2011 ). Preoccupied individuals use social media more frequently when experiencing anxiety and loneliness (Oldmeadow et al., 2013 ), whereas avoidant individuals are less likely to seek online support (Arseneault, 2012 ). Internet is widely use for health purposes. Jacobs et al. ( 2019 ) found that 95.6% pregnant women used it daily for pregnancy-related reasons, primarily to seek information (Gleeson et al., 2019 ). This motivation is stronger among primiparous women, who have less knowledge about pregnancy, childbirth, and childcare (Gleeson et al., 2019 ; Jacobs et al., 2019 ). Internet also facilitates social networking and experience-sharing, offering broader support than local communities (Pantic, 2014 ) and reducing loneliness (Gleeson et al., 2019 ). Pregnant women also use Internet to develop their social network through exchanges and share experiences. Internet also facilitates social networking and experience-sharing, offering broader support than local communities (Pantic, 2014 ) and reducing loneliness for mothers (Gleeson et al., 2019 ). Additionally, it provides reassurance (Gleeson et al., 2019 ) and allows emotional expression, which helps reduce anxiety and depression (Pantic, 2014 ). As insecure pregnant women are less satisfied with their social support (Rini et al., 2006 ), insecure attachment in pregnant women may be associated with pregnancy-related Internet use in order to seek information and find support (Lin et al., 2011 ). The COVID-19 pandemic disrupted life habits, impacting pregnancy monitoring due to health measures and mothers' fear of SARS-CoV-2 exposure (Doncarli et al., 2021 ). Online resources helped compensate for reduced exchanges with health professionals (Yuksel & Cakmak, 2020 ). However, difficulties in finding reliable pregnancy-related information affected well-being (Durankuş & Aksu, 2020 ). Forum discussions centered on concerns about COVID-19’s risks for pregnancy, the baby, and the hospital environment (Basu et al., 2021 ; Chivers et al., 2020 ). As a consequence, pregnancy-related Internet use during the pandemic may be associated with lower well-being and higher anxio-depressive symptoms in pregnant women. As previously mentioned, attachment styles influence adjustment and perception of social support during pregnancy and are linked to pregnancy-related Internet use outside the pandemic (Danet, 2020 ). The pandemic increased anxiety-depressive symptoms and stress in women (Davenport et al., 2020 ; Lebel et al., 2020 ), which can reactivate attachment representations and shape perceptions and behaviors (Miljkovitch, 2001 ) The perinatal period is also a time of vulnerability (Hamelin-Brabant et al., 2015 ). Consequently, studying the prepartum period during COVID-19 in relation to attachment, particularly in primiparous women, is relevant. Therefore, this study aimed to: 1) replicate previous findings in a larger population, including the second trimester (unlike Danet ( 2020 ) which focused on the third) and in a context of heightened stress; 2) examine links between attachment, pregnancy-related Internet use, social support, and anxiety-depressive symptoms in the context of pandemic-related stress in relation to well-being experienced specifically during the pandemic period. We hypothesized that insecure attachment, particularly fearful attachment, would be linked to pregnancy-related Internet use. Specifically, we expected: 1) avoidant attachment to correlate with information-seeking online; 2) preoccupied attachment to relate to pregnancy-related Internet use to seek advices in case of negative emotions; 3) fearful attachment to associate with both information-seeking and the perceived effect on emotions of pregnancy-related Internet use. Conceptual frameworks of insecure attachment style as a vulnerable factor during pregnancy and Internet use to seek support and information have emphasized the importance of understanding the interplay between the individual components (perceived social support, anxiety-depressive symptoms, sense of well-being experienced specifically during the pandemic period). Fearful and preoccupied attachment styles may be related with the experience of more negative emotions and well-being in stressful period. Negative emotions and well-being have been found to be linked with media use in order to search for information and cope with negative feeling. Individuals with a fearful or preoccupied attachment style may be unsatisfied by the social support provided by relative ones, which may lead to seek another source of support. Thus, we hypothesized a mediation of the associations between: 1) preoccupied attachment styles and pregnancy-related Internet use to seek advices in case of negative emotions; 2) fearful attachment style and pregnancy-related Internet use to search for information, by individual components (perceived social support, anxiety-depressive symptoms, sense of well-being experienced specifically during the pandemic period). Materials and Methods A quantitative and prospective study was conducted from July 15 to September 31, 2020. It has been approved by the ethics committee of University of [blinded for peer-review] – n°[blinded for peer-review]. Online self-questionnaires on the Lime Survey® were sent to participants. The questionnaires were designed to assess socio-demographic characteristics, term, anxiety and depression symptoms, well-being during COVID-19 pandemic, Internet use related to pregnancy, attachment style and social support. Pregnant women were invited to participate during pregnancy follow-up consultations and on social networks. The participants consented online. Completion time was estimated to be 20 minutes on average. The inclusion criteria were primiparous pregnant women in the second and third trimesters of pregnancy, i.e., beyond the 15th week of amenorrhea. The decision to exclude first-trimester pregnant women was based on the variability of the term of pregnancy diagnosis and the higher risk of perinatal loss. Furthermore, the first-trimester corresponds to the psychic stage of pregnancy acceptance during which women recognize the pregnancy, accept its reality and adapt their behaviors to this new reality (Luz et al., 2016 ). To study behaviors specifically related to pregnancy, it therefore seemed more suitable to focus on pregnant women beyond the 15th Week of Amenorrhea. Exclusion criteria were age < 18 and women who did not read French. Materials The questionnaire collected the following variables: Socio-demographic variables: Age, level of education, marital status, socio-professional category, occupation, term, perception of place on the social scale (assessed by the MacArthur Scale of Subjective Social Status (Adler et al., 2000 ; Snibbe et al., 2007 ), with the lowest corresponding at the most disadvantaged people (the least money, least education and least respected jobs, or no jobs at all) in the country). Hospital Anxiety and Depression Scale (HADS) is a 14-items questionnaire providing an anxiety score (7 items), a depression score (7 items), and a total score assessing symptoms of anxiety and depression (Langevin et al., 2011). The items are rated from 0 to 3. HADS is the most suitable for jointly measuring anxiety and depressive symptoms in an obstetrical context (Bocquet & Deruelle, 2014 ). Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) (Trousselard et al., 2016 ) was use to assess well-being in COVID-19 pandemic context. The instruction was modified to state: "since the beginning of the pandemic” instead of: "during the last two weeks". The WEMWBS contained a 14-items rated from 1 to 5 and has displayed good reliability during COVID-19 pandemic (Gray et al., 2020 ) Questions were also asked about whether participants had been infected or likely to have been exposed to COVID-19 through contact or occupation and whether they lived in an area more (red) or less (green) affected by the virus, defined as COVID-zone in our analysis to follow French government classification. Pregnancy-Related Internet Use questionnaire consists of 27 questions rated on a Likert scale ranging from 1 (never) to 5 (always) (Danet, 2020 ). The items, rated from 1 to 5, were designed to specifically assess pregnancy-related use and the reasons for this use. The questionnaire is divided into four subscales which measured: Internet Use (IU) to seek advice in case of negative effects (5 items), Internet use to seek information (10 items), Internet use to share your experience (9 items) and perceived effect on emotions of Internet use (3 items). In a previous study, each subscale displayed a good reliability (Danet, 2020 ). Relationship Scale Questionnaire (RSQ) (Guédeney et al., 2010 ) was used to assess attachment styles. The RSQ, widely used in research (Kurdek, 2002 ), was chosen because the attachment styles it measures refer to a wider range of relationships than others (e.g., romantic relationships: Experiences in Close Relationships (ECR)(Brennan et al., 1998 )). The RSQ is a 30-items questionnaire assessing experiences of friendships and romantic relationships, and providing a score for each attachment style by combining the two dimensions assessed, model of the self and model of others: secure (positive model of self and others), preoccupied (negative model of self and positive model of others), avoidant (positive model of self and negative model of others) and fearful (negative model of self and others). The French version of the RSQ has good psychometric qualities (Guédeney et al., 2010 ). Items are rated on a 5-point Likert scale, from 1 to 5. Sarason Social Support Questionnaire (SSQ6) (Bruchon-Schweitze et al., 2003 ) assesses two aspects of perceived social support "Availability" (i.e., number of people who can provide support or help - social network – in 6 situations/item) and "Satisfaction” (degree of satisfaction. i.e., match between perceived need and support received). Availability score is obtained by summing the number of people indicated for each item and ranges from 0 to 54. Satisfaction score is obtained by summing each of the 6 items score (from 1 = Very dissatisfied to 6 = Very satisfied) and ranges from 6 and 36. The SSQ6 "has been validated and is used in the gestational period during prenatal consultations" (Bocquet & Deruelle, 2014 ). Population Sociodemographic characteristics are presented in Table 1 . [Table 1 near here].The mean age of the pregnant women (n = 99) was 28.4 years (4.6). These data are comparable to those presented in the last French perinatal survey of 2016 (Blondel et al., 2017 ). The mean term was 25.6 weeks (SD = 7.4), corresponded to the middle of the 6th month of pregnancy. Table 1 Socio-demographic characteristics of the sample Mean (± standard deviation) or Number (frequency in %) Min – max Age 28.4 (4.6) 18–42 Marital status : In couple 98 (99%) Education level : Middle school 1 (1.01%) High school 20 (20.2%) Community college 25 (25.3%) Bachelor or equivalence 21 (21.2%) Master’s or equivalence 26 (26.3%) Ph D or equivalence 6 (6.1%) Unployement status Yes 80 (80.8%) No 19 (19.2%) Socio-professional categories Liberal profession 1 (1%) Farmer. forester. fisherman 1 (1%) Tradesman. craftsman 7 (7.1%) Company director 2 (2%) General manager or senior manager 13 (13.1%) Executive 13 (13.1%) Public employees 15 (15.6%) Office worker 25 (25.6%) Other employees 1 (1%) Supervisor / Foreman 1 (1%) Worker 19 (19.2%) Social scale 5.8 (1.5) 2–8 Results Descriptive statistics Data were analyzed using R software (R Development Core Team, 2011 ). Our main outcomes are presented in Table 2 . [Table 2 near here].A majority of pregnant women (80.8%) used the Internet in regards to their pregnancy « often » or « very often ». In our sample, 21.2% and 7% of women endorsed significant anxiety and depressive symptoms, respectively. Table 2 Description of scores on the Internet Use (IU), Attachment Style (RSQ), Social Support, Anxiety and depressive disorder (HADS) and COVID-19 health context variables Mean (± standard deviation) or Number (frequency in %) Min – max IU negative emotions 2.50 (. 82) 1.16–4.33 IU to seek information 2.28 (.73) 1.2–4.4 IU to share your experience 1.77 (.69) 1-4.55 IU on emotions 1.78 (.82) 1–4 Secure attachment 2.95 (.56) 1.6–4.4 Aviodant attachment 3.34 (.77) 1–5 Fearful attachment 3.24 (.86) 1.25-5 Preocuppied attachment 3.02 (.75) 1.5–4.75 Social support- availability 18.84 (9.16) 5–51 Social support Satisfaction 25.71 (4.86) 6–30 HADS-depression 5.16 (3.24) 0–18 HADS-anxiety 8.37 (2.84) 4–16 HADS-total 13.52 (4.83) 7–30 Covid-exposure 41 (41.41%) Covid-contamination 5 (5.05%) Zone Green 52 (52.53%) Red 47 (47.47%) WEMWBS 48.40 (7.59) 24–66 Notes. IU: Internet use; HADS : Hospital Anxiety and Depression Scale; WEMWBS : Warwick-Edinburh Mental Well-Being Scale Main hypothesis – correlational analyses Correlations between Internet use, attachment style, social support, anxiety-depressive symptoms, and health context are presented in Table 3 . [Table 3 near here]. The results showed significant correlations between Internet use to seek information and attachment styles (fearful, preoccupied, detached). Results also showed a significant correlation between Internet use to seek support for negative affect and fearful, preoccupied attachment styles. Table 3 Correlation matrix between the variables Internet use, attachment style, social support, HADS, and WEMWBS 1 2 3 4 5 6 7 8 9 10 11 12 13 1- IU negative affects 2- IU to seek information .72*** 3- IU to share your experience .40*** .45*** 4- IU on emotions .57*** .51*** − .20 5- Secure attachment − .18 − .22* .10 − .24* 6- Avoidant attachment .18 .23* .16 .19 − .09 7- Fearful attachment .33** .30** .14 .27** − .43*** .56*** 8- Preocuppied attachment .18** .22* .16 .16 − .31 − .19 .23* 9- Social support- availability − .12 − .19 − .24* − .19 .25* − .21* − .33** − .17 10- Socialsupport-Satisfaction − .07 − .10 − .20* − .18 .18 − .16 − .26** .09 .35*** 11- HADS-depression .11 .08 .10 .14 − .27** .15 .30** .19 − .45*** − .21* 12- HADS-anxiety .28** .16 − .03 .03 − .31** − .07 .33** .33** − .17 − .05 .25* 13- HADS-total .24* .15 .05 .11 − .36*** .06 .40*** .33** − .40*** − .17 .82*** .76*** 14- WEMWBS − .25* − .31** − .22** − .26* .32* − .004 − .33** − .24* .34*** .24* − .55*** − .30** − .54*** Notes. * p < .05; ** p < . 01; *** p < . 001. IU: Internet use; HADS : Hospital Anxiety and Depression Scale; WEMWBS : Warwick-Edinburh Mental Well-Being Scale. Secondary hypothesis – regression and mediation analyses Relationship between preoccupied attachment style and Internet use for negative emotions. Preoccupied attachment style was predictive of Internet use to seek support for negative emotions ( β = .29, R 2 = .07, p < .004). As shown in Fig. 1 , this relationship was mediated by anxiety symptoms (direct effect = .29 ; p = .006 ; indirect effect = .07; p = .038). [Figure 1 near here]. Relationship between fearful attachment style and use of the Internet to seek information Fearful attachment style was predictive of Internet use to seek support for negative emotions ( β = .30, R 2 = .11, p < .001), to seek information ( β =-.25, R 2 = .09, p = .003), and for an affect on emotions ( β = .26, R 2 = .072, p = .007). Results also showed an association between fearful attachment and social support satisfaction ( r = − .33, p < .001) but no association between social support satisfaction and Internet use to seek information ( r =-.10, p = .06) or when experiencing negative emotions ( r =-.07 ; p = .24). Relationship between avoidant attachment style and Internet use A linear regression model specified the interaction between Internet use to seek information and avoidant attachment style. Avoidant attachment style predicted Internet use for information seeking ( β = .21, R 2 = .05, p = .025). Effect of the COVID-19 pandemic on the relationship between attachment style and Internet use The COVID residence area was the most predictive variable for Internet use in negative affect regardless of attachment style (secure: β = .55, R 2 = .19, p < .001; avoidant: β = .53, R 2 = .20, p < .001; fearful: β = .49, R 2 = .22, p < .01; preoccupied: β = 0.51, R 2 = 0.21, p < .001). The WEMWB-COVID well-being scale was the most predictive variable for information-seeking Internet use (secure: β = − .02, R 2 = .19, p = .018; avoidant: β = − .02, R 2 = .19, p = .004; fearful: β =-.02, R 2 = .19, p = .025; preoccupied: β = − .02, R 2 = .19, p = .01). Table 4 summarizes the regression coefficients and R 2 coefficients of determination for the 16 multiple regression models testing the relationship between attachment style and Internet use. [Table 4 near here].Thus, controlling for the effect of the WEMWBS and area of residence variables, only the link between Internet use and information seeking and avoidant attachment style remained significant. Table 4 Summary of regression coefficient β (coefficient of determination R 2 ) of multiple regression models of attachment model on Internet use controlling for WEMWBS, area of residence Secure Avoidant Fearful Preoccuppied 1- IU negative emotions .11 (.20) .13 (.21) .17 (.22) .17 (.21) 2- IU to seek informations − .15 (0.15) .18 (.17)* .15 (.16) .11 (.15) 3- IU to share your experience − .02 (.09) .07 (.10) .018 (.09) .07 (.09) 4- IU on emotions − .24 (0.11) .17 (.12) .16 (.12) .08 (.10) Note. * p < .05. IU: Internet Use Relationship between insecure attachment, well-being and Internet use to seek information during the pandemic The linear regression coefficients between fearful attachment style and information-seeking Internet use and the regression coefficient between health-related well-being and information-seeking Internet use were significant. As shown in Fig. 2 , this effect was mediated by well-being during Covid-19 pandemic (direct effect = .25 ; p = .003 ; indirect effect = .07 ; p = .016). [Figure 2 near here]. The linear regression coefficients between preoccupied attachment style and information-seeking Internet use and the regression coefficient between health context-related well-being and information-seeking Internet use were significant. As shown in Fig. 3 , this effect was mediated by well-being during Covid-19 pandemic (direct effect = .21 ; p = .03 ; indirect effect = .06 ; p = .018). [Figure 3 near here]. Discussion The aim of this study was to explore the link between prenatal Internet use and insecure attachment styles by accounting for anxiety-depressive symptoms, social support, and COVID-19 health context. Consistent with our primary hypothesis, we found significant associations between Internet use and insecure attachment styles. Specifically, the results suggested that preoccupied attachment style was a significant predictor of Internet use for negative emotions and for seeking information. Fearful attachment appeared to be a significant predictor of Internet use for negative affect and seeking information. Finally, avoidant attachment was significantly predictive of Internet use for information seeking. The results showed that anxiety mediated the link between preoccupied attachment and Internet use for emotional support. This aligns with findings that preoccupied pregnant women experience the most anxiety in relation to their pregnancy and display compulsive support-seeking (Pazzagli et al., 2015 ). Their ambiguous attitude toward others—seeing them positively but viewing themselves negatively—may lead them to seek support while avoiding face-to-face emotional expression (Bartholomew & Horowitz, 1991 ). The anonymity and asynchrony of Internet use (Danet & Miljkovitch, 2017 ) seem to enable them to seek support while managing their fear of social rejection. Results suggest that the COVID-19 pandemic altered the relationship between attachment style and Internet use during the pregnancy. Regardless of attachment style, women in heavily affected areas used the Internet more for emotional support. The pandemic disrupted in-person prenatal care—consultations were merged with ultrasounds (HAS, 2020 ), support centers closed, and home visits shifted online (Delet et al., 2020 ). Birth classes were often unavailable (Evrard, 2020 ), reducing key support opportunities (Chivers et al., 2020 ). This decline in face-to-face interactions in the most affected areas likely increased social media use for pregnancy-related concerns (Wang et al., 2022 ), providing advice and emotional support (Chivers et al., 2020 ). Our study suggested that women's well-being may have been affected differently based on attachment style, with more insecurity linked to a greater negative impact of COVID-19. Additionally, women most affected by the health crisis reported increased Internet use for information-seeking. Well-being in this context mediated the link between preoccupied and fearful attachment styles and information-seeking online. These women, more vulnerable to stress, may have relied on the Internet more than secure individuals. Pregnant women had concerns including contamination and effects on baby (Chivers et al., 2020 ). Pregnant women with fearful and preoccupied attachment styles may have been more vulnerable to stress and more likely to need support during pregnancy. Reduced professional contact limited access to information (Evrard, 2020 ). leading women to seek multiple sources, despite inconsistencies (Chivers et al., 2020 ). Finally, the results showed well-being in the health context did not influence the link between avoidant attachment and Internet use for information-seeking. Avoidant pregnant women tend to feel invulnerable, regulating their attachment system to control behavior and emotions in stressful situations (Reeves & Wendland, 2017 ). Unlike preoccupied and fearful individuals, they were less likely to adapt their behaviors to the context (Moccia et al., 2020 ). Insecure pregnant women are more likely to use the Internet than secure women and are more psychologically vulnerable (Feeney et al., 2001 ; Pesonen et al., 2004 ; Reeves & Wendland, 2017 ). Since some rely on online recommendations for decisions (Dekker et al., 2016 ; Gao et al., 2013 ), which may impact their health (Wang et al., 2022 ), guided Internet use by perinatal professionals could help them make informed choices and adopt healthier behaviors (Åhman et al., 2016 ; Sanders & Crozier, 2018 ). Of the 281 questionnaires initiated, only 39.5% were completed, possibly due to the time required for the extensive variables, which could be a study limitation. The health context also made it difficult for perinatal professionals to recruit participants. However, the introduction of a QR code allowed for contactless questionnaire completion. Regarding sample representativeness, 69% of women had secondary education, higher than the 55.4% of pregnant women in France. Other sociodemographic variables were similar to the 2016 national perinatal survey (Blondel et al., 2017 ). Lastly, the cross-sectional design of the study limited causal conclusions. Declarations Institutional Review Board Statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of University of [blinded for peer-review] – n°[blinded for peer-review]-419-S82). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. 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L’Encéphale 36(1):69–76. https://doi.org/10.1016/j.encep.2008.12.006 Hamelin-Brabant L, de Montigny F, Roch G, Deshaies M-H, Mbourou-Azizah G, Silva RBD, Comeau Y, Fournier C (2015) Vulnérabilité périnatale et soutien social en période postnatale: Une revue de la littérature. Sante Publique 27(1):27–37. https://www.cairn.info/revue-sante-publique-2015-1-page-27.htm HAS (2020) Grossesse: Votre suivi pendant l’épidémie de COVID-19 . https://www.has-sante.fr/jcms/p_3187133/fr/grossesse-votre-suivi-pendant-l-epidemie-de-covid-19 Jacobs EJA, van Steijn ME, van Pampus MG (2019) Internet usage of women attempting pregnancy and pregnant women in the Netherlands. Sex Reproductive Healthc 21:9–14. https://doi.org/10.1016/j.srhc.2019.04.005 Kurdek LA (2002) On being insecure about the assessment of attachment styles. J Social Personal Relationships 19(6):811–834 Langevin François, Riou (2011) Boini, &. Hospital Anxiety and Depression Scale (HADS) Lebel C, MacKinnon A, Bagshawe M, Tomfohr-Madsen L, Giesbrecht G (2020) Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. J Affect Disord 277:5–13. https://doi.org/10.1016/j.jad.2020.07.126 Lin M-P, Ko H-C, Wu JY-W (2011) Prevalence and Psychosocial Risk Factors Associated with Internet Addiction in a Nationally Representative Sample of College Students in Taiwan. Cyberpsychology Behav Social Netw 14(12):741–746. https://doi.org/10.1089/cyber.2010.0574 Luz R, George A, Spitz E (2016) Attachement, parentalité et diagnostic prénatal: Perspectives théorique, clinique et de recherche en psychologie de la santé. Pratiques Psychologiques 22(4):399–415. https://doi.org/10.1016/j.prps.2016.03.005 Mallinckrodt B, Wei M (2005) Attachment, Social Competencies, Social Support, and Psychological Distress. J Couns Psychol 52(3):358–367. https://doi.org/10.1037/0022-0167.52.3.358 Mazzeschi C, Pazzagli C, Radi G, Raspa V, Buratta L (2015) Antecedents of maternal parenting stress: The role of attachment style, prenatal attachment, and dyadic adjustment in first-time mothers. Frontiers in Psychology , 6 . https://doi.org/10.3389/fpsyg.2015.01443 Miljkovitch R (2001) L’attachement au cours de la vie. Presses Universitaires de France Moccia L, Janiri D, Pepe M, Dattoli L, Molinaro M, De Martin V, Chieffo D, Janiri L, Fiorillo A, Sani G, Di Nicola M (2020) Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population. Brain Behav Immun 87:75–79. https://doi.org/10.1016/j.bbi.2020.04.048 Oldmeadow JA, Quinn S, Kowert R (2013) Attachment style, social skills, and Facebook use amongst adults. Comput Hum Behav 29(3):1142–1149. https://doi.org/10.1016/j.chb.2012.10.006 Pantic I (2014) Online Social Networking and Mental Health. Cyberpsychology Behav Social Netw 17(10):652–657. https://doi.org/10.1089/cyber.2014.0070 Pazzagli C, Laghezza L, Capurso M, Sommella C, Lelli F, Mazzeschi C, CONSEQUENCES OF FEAR OF CHILDBIRTH IN NULLIPAROUS AND PAROUS WOMEN (2015) Fear of Childbirth in Nulliparous and Parous Women. Infant Mental Health J 36(1):62–74. https://doi.org/10.1002/imhj.21483 . ANTECEDENTS AND Pesonen A-K, Räikkönen K, Strandberg T, Keltikangas-Järvinen L, Järvenpää A-L (2004) Insecure adult attachment style and depressive symptoms: Implications for parental perceptions of infant temperament: Maternal and Paternal Depressive Symptoms. Infant Mental Health J 25(2):99–116. https://doi.org/10.1002/imhj.10092 R Development Core Team (2011) R: A language and environment for statistical computing. R Foundation for Statistical Computing Reeves N, Wendland J (2017) Style d’attachement, maternité et anxiété spécifique à la grossesse. Neuropsychiatrie de l’Enfance et de l’Adolescence 65(4):211–218. https://doi.org/10.1016/j.neurenf.2017.03.001 Rini C, Schetter CD, Hobel CJ, Glynn LM, Sandman CA (2006) Effective social support: Antecedents and consequences of partner support during pregnancy. Personal Relationships 13(2):207–229. https://doi.org/10.1111/j.1475-6811.2006.00114.x Rusconi, Suardi (2011) &. Le stress, quel lien avec l’attachement dans la transition à la parentalité ? 133–141 Sanders RA, Crozier K (2018) How do informal information sources influence women’s decision-making for birth? A meta-synthesis of qualitative studies. BMC Pregnancy Childbirth 18(1):21. https://doi.org/10.1186/s12884-017-1648-2 Simpson JA, Rholes WS (2008) Attachment, perceived support, and the transition to parenthood: Social policy and health implications. Social Issues Policy Rev 2(1):37–63. https://doi.org/10.1111/j.1751-2409.2008.00010.x Simpson JA, Rholes WS, Nelligan JS (1992) Support seeking and support giving within couples in an anxiety-provoking situation: The role of attachment styles. J Personal Soc Psychol 62(3):434–446. https://doi.org/10.1037/0022-3514.62.3.434 Snibbe AC, Stewart J, Adler NE (2007) Where Do I Stand? How People Determine Their Subjective Socioeconomic Status. https://macses.ucsf.edu/research/psychosocial/subjective.php Trousselard M, Steiler D, Dutheil F, Claverie D, Canini F, Fenouillet F, Naughton G, Stewart-Brown S, Franck N (2016) Validation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in French psychiatric and general populations. Psychiatry Res 245:282–290. https://doi.org/10.1016/j.psychres.2016.08.050 Wang Q, Xie L, Song B, Di J, Wang L, Mo PK-H (2022) Effects of Social Media Use for Health Information on COVID-19–Related Risk Perceptions and Mental Health During Pregnancy: Web-Based Survey. JMIR Med Inf 10(1):e28183. https://doi.org/10.2196/28183 Yuksel B, Cakmak K (2020) Healthcare information on YouTube: Pregnancy and COVID-19. Int J Gynecol Obstet 150(2):189–193. https://doi.org/10.1002/ijgo.13246 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6278475","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":432159973,"identity":"a77a543b-fbf2-467f-a8d4-bb0deba56316","order_by":0,"name":"Bérengère Batail Gautier","email":"","orcid":"","institution":"psychologist","correspondingAuthor":false,"prefix":"","firstName":"Bérengère","middleName":"Batail","lastName":"Gautier","suffix":""},{"id":432160354,"identity":"e8a93f93-bc27-42e0-88b4-6e2a0c515ac5","order_by":1,"name":"Marie Danet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIie3PsUrDQBzH8V/4Q7K0uP4Lok8gRAqtUKWv0hBoHsCloJS4pEvB1cV3uFG3Cwd1iXQNONggdBMyOhTxktJJ7nB0uO9yfw4+/O8Al+ufJgFqTm8DMBB4d1JPR38gRGFLyEvlBOil9kUt8fkwW8nZ4rWSNUanw+B+ddN9uohSIr1lBh4azKBIwvwByfnzUvlv3YI1aR5WgI+lgcgpVAfKE2WsScb9sdIkyjBnw8MG6y3UDmos3j/864a034++wUZS6i2AikRJPmlysiepjWyRL8MkFkXc7z0eyGTFZrKeUv01G12Jl7yqP7N5B8Gi2tS3l0ayL/x9ZQcul8vlsvcDLj5W60rM1kAAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-0075-7957","institution":"université de Lille","correspondingAuthor":true,"prefix":"","firstName":"Marie","middleName":"","lastName":"Danet","suffix":""}],"badges":[],"createdAt":"2025-03-21 14:36:52","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6278475/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6278475/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79320792,"identity":"05f76e49-c6e5-4625-a5dc-8db80d0f5dda","added_by":"auto","created_at":"2025-03-27 04:24:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22134,"visible":true,"origin":"","legend":"\u003cp\u003eMediation analysis of anxiety on the relationship between preoccupied attachment style and Internet use.\u003c/p\u003e\n\u003cp\u003eNote. \u003csup\u003e*\u003c/sup\u003ep \u0026lt;.05; \u003csup\u003e**\u003c/sup\u003ep\u0026lt;.01\u003c/p\u003e\n\u003cp\u003eMediation analysis of anxiety on the relationship between preoccupied attachment style and Internet use for negative emotions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlt text\u0026nbsp;: \u003c/strong\u003eThis figure illustrates a mediation analysis with preoccupied attachment as the independent variable (IV), anxiety (MV), and Internet use for negative emotions (DV). The diagram shows arrows indicating the direct path from preoccupied attachment to Internet use for negative emotions and the indirect path through anxiety. The arrow from preoccupied attachment to anxiety and the arrow from anxiety to Internet use for negative emotions represent the mediated effect.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6278475/v1/05d5df266756f0574e6a8f96.png"},{"id":79320790,"identity":"338594a5-9b36-4f52-81c9-0fc14c953a6b","added_by":"auto","created_at":"2025-03-27 04:24:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25791,"visible":true,"origin":"","legend":"\u003cp\u003eMediation analysis of well-being during the pandemic on fearful attachment style and Internet use to seek information.\u003c/p\u003e\n\u003cp\u003eNote. \u003csup\u003e*\u003c/sup\u003ep \u0026lt;.05; \u003csup\u003e**\u003c/sup\u003ep\u0026lt;.01;\u003csup\u003e ***\u003c/sup\u003ep\u0026lt;.001\u003c/p\u003e\n\u003cp\u003eMediation analysis of well-being during the pandemic on fearful attachment style and Internet use to seek information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlt text\u0026nbsp;: \u003c/strong\u003eThis figure illustrates a mediation analysis with fearful attachment as the independent variable (IV), well-being during the pandemic (MV), and Internet use to seek information (DV). The diagram shows arrows indicating the direct path from fearful attachment to Internet use to seek information and the indirect path through well-being during the pandemic. The arrow from fearful attachment to well-being during the pandemic and the arrow from well-being during the pandemic to Internet use to seek information represent the mediated effect.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6278475/v1/74b3eaa91bac7bc8cc4299d6.png"},{"id":79320804,"identity":"7193103e-bdce-4579-baf4-c540d0c26aec","added_by":"auto","created_at":"2025-03-27 04:24:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":27545,"visible":true,"origin":"","legend":"\u003cp\u003eNote. \u003csup\u003e*\u003c/sup\u003ep \u0026lt;.05; \u003csup\u003e**\u003c/sup\u003ep\u0026lt;.01.\u003c/p\u003e\n\u003cp\u003eMediation analysis of well-being during the pandemic on preoccupied attachment style and Internet use to seek information\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlt text\u0026nbsp;: \u003c/strong\u003eThis figure illustrates a mediation analysis with preoccupied attachment as the independent variable (IV), well-being during the pandemic (MV), and Internet use to seek information (DV). The diagram shows arrows indicating the direct path from preoccupied attachment to Internet use to seek information and the indirect path through well-being during the pandemic. The arrow from preoccupied attachment to well-being during the pandemic and the arrow from well-being during the pandemic to Internet use to seek information represent the mediated effect.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6278475/v1/f859ec13af0dbb5d367d6187.png"},{"id":79321548,"identity":"a202b482-e337-4e51-b4bf-223ebcef4971","added_by":"auto","created_at":"2025-03-27 04:32:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022996,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6278475/v1/e0d8edc9-2f17-4862-9f36-9d1f035e63f9.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAttachment Style, Pregnancy-Related Internet Use And Mental Health Of Primiparous Pregnant Women During COVID-19 Pandemic\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003ePregnancy is considered as a developmental crisis (Reeves \u0026amp; Wendland, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Researches on adult attachment promoted understanding of women\u0026rsquo;s psychological and relational adjustment during pregnancy (Luz et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Attachment styles influence adaptation to stress (Rusconi \u0026amp; Suardi, 2011), with pregnancy being a unique stressor linked to concerns about relationships (Reeves \u0026amp; Wendland, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Secure attachment serves as a protective factor, while insecure attachment increases vulnerability to anxiety and depression (Mazzeschi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), particularly pregnancy-related anxiety (Reeves \u0026amp; Wendland, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and perinatal depression. Specifically, preoccupied attachment is significantly associated with depressive and anxiety symptoms during pregnancy (Feeney et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Pesonen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Attachment style also influences social relationships (Berlin et al., 2008). Insecure individuals have negative models of self and/or others (Bartholomew \u0026amp; Horowitz, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1991\u003c/span\u003e), perceive less support, and struggle with relationships (Mallinckrodt \u0026amp; Wei, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Pesonen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Simpson et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e1992\u003c/span\u003e). They experience less effective support seeking (Simpson et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) and less perceived support (Simpson \u0026amp; Rholes, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), especially during pregnancy (Rini et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and may turn to alternative sources like the Internet (Danet \u0026amp; Miljkovitch, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lin et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Preoccupied individuals use social media more frequently when experiencing anxiety and loneliness (Oldmeadow et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), whereas avoidant individuals are less likely to seek online support (Arseneault, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInternet is widely use for health purposes. Jacobs et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that 95.6% pregnant women used it daily for pregnancy-related reasons, primarily to seek information (Gleeson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This motivation is stronger among primiparous women, who have less knowledge about pregnancy, childbirth, and childcare (Gleeson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Jacobs et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Internet also facilitates social networking and experience-sharing, offering broader support than local communities (Pantic, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and reducing loneliness (Gleeson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePregnant women also use Internet to develop their social network through exchanges and share experiences. Internet also facilitates social networking and experience-sharing, offering broader support than local communities (Pantic, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2014\u003c/span\u003e) and reducing loneliness for mothers (Gleeson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, it provides reassurance (Gleeson et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and allows emotional expression, which helps reduce anxiety and depression (Pantic, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). As insecure pregnant women are less satisfied with their social support (Rini et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2006\u003c/span\u003e), insecure attachment in pregnant women may be associated with pregnancy-related Internet use in order to seek information and find support (Lin et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic disrupted life habits, impacting pregnancy monitoring due to health measures and mothers' fear of SARS-CoV-2 exposure (Doncarli et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Online resources helped compensate for reduced exchanges with health professionals (Yuksel \u0026amp; Cakmak, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). However, difficulties in finding reliable pregnancy-related information affected well-being (Durankuş \u0026amp; Aksu, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Forum discussions centered on concerns about COVID-19\u0026rsquo;s risks for pregnancy, the baby, and the hospital environment (Basu et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Chivers et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As a consequence, pregnancy-related Internet use during the pandemic may be associated with lower well-being and higher anxio-depressive symptoms in pregnant women.\u003c/p\u003e \u003cp\u003eAs previously mentioned, attachment styles influence adjustment and perception of social support during pregnancy and are linked to pregnancy-related Internet use outside the pandemic (Danet, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The pandemic increased anxiety-depressive symptoms and stress in women (Davenport et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lebel et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), which can reactivate attachment representations and shape perceptions and behaviors (Miljkovitch, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) The perinatal period is also a time of vulnerability (Hamelin-Brabant et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Consequently, studying the prepartum period during COVID-19 in relation to attachment, particularly in primiparous women, is relevant.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to: 1) replicate previous findings in a larger population, including the second trimester (unlike Danet (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) which focused on the third) and in a context of heightened stress; 2) examine links between attachment, pregnancy-related Internet use, social support, and anxiety-depressive symptoms in the context of pandemic-related stress in relation to well-being experienced specifically during the pandemic period. We hypothesized that insecure attachment, particularly fearful attachment, would be linked to pregnancy-related Internet use. Specifically, we expected: 1) avoidant attachment to correlate with information-seeking online; 2) preoccupied attachment to relate to pregnancy-related Internet use to seek advices in case of negative emotions; 3) fearful attachment to associate with both information-seeking and the perceived effect on emotions of pregnancy-related Internet use.\u003c/p\u003e \u003cp\u003eConceptual frameworks of insecure attachment style as a vulnerable factor during pregnancy and Internet use to seek support and information have emphasized the importance of understanding the interplay between the individual components (perceived social support, anxiety-depressive symptoms, sense of well-being experienced specifically during the pandemic period). Fearful and preoccupied attachment styles may be related with the experience of more negative emotions and well-being in stressful period. Negative emotions and well-being have been found to be linked with media use in order to search for information and cope with negative feeling. Individuals with a fearful or preoccupied attachment style may be unsatisfied by the social support provided by relative ones, which may lead to seek another source of support. Thus, we hypothesized a mediation of the associations between: 1) preoccupied attachment styles and pregnancy-related Internet use to seek advices in case of negative emotions; 2) fearful attachment style and pregnancy-related Internet use to search for information, by individual components (perceived social support, anxiety-depressive symptoms, sense of well-being experienced specifically during the pandemic period).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA quantitative and prospective study was conducted from July 15 to September 31, 2020. It has been approved by the ethics committee of University of [blinded for peer-review] \u0026ndash; n\u0026deg;[blinded for peer-review]. Online self-questionnaires on the Lime Survey\u0026reg; were sent to participants. The questionnaires were designed to assess socio-demographic characteristics, term, anxiety and depression symptoms, well-being during COVID-19 pandemic, Internet use related to pregnancy, attachment style and social support. Pregnant women were invited to participate during pregnancy follow-up consultations and on social networks. The participants consented online. Completion time was estimated to be 20 minutes on average.\u003c/p\u003e\u003cp\u003eThe inclusion criteria were primiparous pregnant women in the second and third trimesters of pregnancy, i.e., beyond the 15th week of amenorrhea. The decision to exclude first-trimester pregnant women was based on the variability of the term of pregnancy diagnosis and the higher risk of perinatal loss. Furthermore, the first-trimester corresponds to the psychic stage of pregnancy acceptance during which women recognize the pregnancy, accept its reality and adapt their behaviors to this new reality (Luz et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). To study behaviors specifically related to pregnancy, it therefore seemed more suitable to focus on pregnant women beyond the 15th Week of Amenorrhea. Exclusion criteria were age\u0026thinsp;\u0026lt;\u0026thinsp;18 and women who did not read French.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMaterials\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe questionnaire collected the following variables:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSocio-demographic variables: Age, level of education, marital status, socio-professional category, occupation, term, perception of place on the social scale (assessed by the MacArthur Scale of Subjective Social Status (Adler et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Snibbe et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2007\u003c/span\u003e), with the lowest corresponding at the most disadvantaged people (the least money, least education and least respected jobs, or no jobs at all) in the country).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHospital Anxiety and Depression Scale (HADS) is a 14-items questionnaire providing an anxiety score (7 items), a depression score (7 items), and a total score assessing symptoms of anxiety and depression (Langevin et al., 2011). The items are rated from 0 to 3. HADS is the most suitable for jointly measuring anxiety and depressive symptoms in an obstetrical context (Bocquet \u0026amp; Deruelle, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWarwick-Edinburgh Mental Well-Being Scale (WEMWBS) (Trousselard et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) was use to assess well-being in COVID-19 pandemic context. The instruction was modified to state: \"since the beginning of the pandemic\u0026rdquo; instead of: \"during the last two weeks\". The WEMWBS contained a 14-items rated from 1 to 5 and has displayed good reliability during COVID-19 pandemic (Gray et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuestions were also asked about whether participants had been infected or likely to have been exposed to COVID-19 through contact or occupation and whether they lived in an area more (red) or less (green) affected by the virus, defined as COVID-zone in our analysis to follow French government classification.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePregnancy-Related Internet Use questionnaire consists of 27 questions rated on a Likert scale ranging from 1 (never) to 5 (always) (Danet, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The items, rated from 1 to 5, were designed to specifically assess pregnancy-related use and the reasons for this use. The questionnaire is divided into four subscales which measured: Internet Use (IU) to seek advice in case of negative effects (5 items), Internet use to seek information (10 items), Internet use to share your experience (9 items) and perceived effect on emotions of Internet use (3 items). In a previous study, each subscale displayed a good reliability (Danet, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRelationship Scale Questionnaire (RSQ) (Gu\u0026eacute;deney et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) was used to assess attachment styles. The RSQ, widely used in research (Kurdek, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), was chosen because the attachment styles it measures refer to a wider range of relationships than others (e.g., romantic relationships: Experiences in Close Relationships (ECR)(Brennan et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e1998\u003c/span\u003e)). The RSQ is a 30-items questionnaire assessing experiences of friendships and romantic relationships, and providing a score for each attachment style by combining the two dimensions assessed, model of the self and model of others: secure (positive model of self and others), preoccupied (negative model of self and positive model of others), avoidant (positive model of self and negative model of others) and fearful (negative model of self and others). The French version of the RSQ has good psychometric qualities (Gu\u0026eacute;deney et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Items are rated on a 5-point Likert scale, from 1 to 5.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSarason Social Support Questionnaire (SSQ6) (Bruchon-Schweitze et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) assesses two aspects of perceived social support \"Availability\" (i.e., number of people who can provide support or help - social network \u0026ndash; in 6 situations/item) and \"Satisfaction\u0026rdquo; (degree of satisfaction. i.e., match between perceived need and support received). Availability score is obtained by summing the number of people indicated for each item and ranges from 0 to 54. Satisfaction score is obtained by summing each of the 6 items score (from 1\u0026thinsp;=\u0026thinsp;Very dissatisfied to 6\u0026thinsp;=\u0026thinsp;Very satisfied) and ranges from 6 and 36. The SSQ6 \"has been validated and is used in the gestational period during prenatal consultations\" (Bocquet \u0026amp; Deruelle, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eSociodemographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. [Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here].The mean age of the pregnant women (n\u0026thinsp;=\u0026thinsp;99) was 28.4 years (4.6). These data are comparable to those presented in the last French perinatal survey of 2016 (Blondel et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The mean term was 25.6 weeks (SD\u0026thinsp;=\u0026thinsp;7.4), corresponded to the middle of the 6th month of pregnancy.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;standard deviation) or Number (frequency in %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin \u0026ndash; max\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.4 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u0026nbsp;:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98 (99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u0026nbsp;:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor or equivalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (21.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s or equivalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePh D or equivalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnployement status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (80.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocio-professional categories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiberal profession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer. forester. fisherman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTradesman. craftsman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompany director\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral manager or senior manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExecutive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic employees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOffice worker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (25.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther employees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupervisor / Foreman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.8 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive statistics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eData were analyzed using R software (R Development Core Team, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Our main outcomes are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. [Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here].A majority of pregnant women (80.8%) used the Internet in regards to their pregnancy \u0026laquo; often \u0026raquo; or \u0026laquo; very often \u0026raquo;. In our sample, 21.2% and 7% of women endorsed significant anxiety and depressive symptoms, respectively.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of scores on the Internet Use (IU), Attachment Style (RSQ), Social Support, Anxiety and depressive disorder (HADS) and COVID-19 health context variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (\u0026plusmn;\u0026thinsp;standard deviation) or Number (frequency in %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMin \u0026ndash; max\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIU negative emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50 (.\u0026nbsp;82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.16\u0026ndash;4.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIU to seek information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.28 (.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026ndash;4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIU to share your experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.77 (.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1-4.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIU on emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.78 (.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecure attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.95 (.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u0026ndash;4.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAviodant attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.34 (.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFearful attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.24 (.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25-5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreocuppied attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.02 (.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.5\u0026ndash;4.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support- availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.84 (9.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026ndash;51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial support Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.71 (4.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.16 (3.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.37 (2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026ndash;16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHADS-total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13.52 (4.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovid-exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (41.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCovid-contamination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eZone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (52.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (47.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWEMWBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.40 (7.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u0026ndash;66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eNotes. IU: Internet use; HADS : Hospital Anxiety and Depression Scale; WEMWBS : Warwick-Edinburh Mental Well-Being Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMain hypothesis – correlational analyses\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eCorrelations between Internet use, attachment style, social support, anxiety-depressive symptoms, and health context are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. [Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here]. The results showed significant correlations between Internet use to seek information and attachment styles (fearful, preoccupied, detached). Results also showed a significant correlation between Internet use to seek support for negative affect and fearful, preoccupied attachment styles.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation matrix between the variables Internet use, attachment style, social support, HADS, and WEMWBS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c14\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1- IU negative affects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2- IU to seek information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.72***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3- IU to share your experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.40***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.45***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4- IU on emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.57***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.51***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5- Secure attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.22*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6- Avoidant attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.23*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7- Fearful attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.30**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.27**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.43***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.56***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8- Preocuppied attachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.18**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.22*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.23*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9- Social support- availability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10- Socialsupport-Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.20*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.26**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.35***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11- HADS-depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.27**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.30**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.45***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.21*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12- HADS-anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.28**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.31**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13- HADS-total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.36***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.40***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.40***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e.82***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e.76***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14- WEMWBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.31**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.22**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.26*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.32*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.33**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.34***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.55***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.30**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c14\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.54***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"14\" nameend=\"c14\" namest=\"c1\"\u003e \u003cp\u003eNotes. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05; \u003csup\u003e**\u003c/sup\u003e\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e01; \u003csup\u003e***\u003c/sup\u003e\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;.\u003c/em\u003e001. IU: Internet use; HADS : Hospital Anxiety and Depression Scale; WEMWBS : Warwick-Edinburh Mental Well-Being Scale.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSecondary hypothesis \u0026ndash; regression and mediation analyses\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003e \u003cem\u003eRelationship between preoccupied attachment style and Internet use for negative emotions.\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePreoccupied attachment style was predictive of Internet use to seek support for negative emotions (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.29, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.07, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.004). As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e, this relationship was mediated by anxiety symptoms (direct effect\u0026thinsp;=\u0026thinsp;.29 ; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.006 ; indirect effect\u0026thinsp;=\u0026thinsp;.07; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.038). [Figure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e near here].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRelationship between fearful attachment style and use of the Internet to seek information\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFearful attachment style was predictive of Internet use to seek support for negative emotions (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.30, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.11, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001), to seek information (\u003cem\u003eβ\u003c/em\u003e=-.25, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.09, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003), and for an affect on emotions (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.26, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.072, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.007). Results also showed an association between fearful attachment and social support satisfaction (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.33, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001) but no association between social support satisfaction and Internet use to seek information (\u003cem\u003er\u003c/em\u003e=-.10, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.06) or when experiencing negative emotions (\u003cem\u003er\u003c/em\u003e=-.07 ; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.24).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eRelationship between avoidant attachment style and Internet use\u003c/h3\u003e\n\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA linear regression model specified the interaction between Internet use to seek information and avoidant attachment style. Avoidant attachment style predicted Internet use for information seeking (\u003cem\u003eβ\u0026thinsp;=\u003c/em\u003e\u0026thinsp;.21, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.05, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.025).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEffect of the COVID-19 pandemic on the relationship between attachment style and Internet use\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe COVID residence area was the most predictive variable for Internet use in negative affect regardless of attachment style (secure: \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.55, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; avoidant: \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.53, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001; fearful: \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.49, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.22, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01; preoccupied: \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.51, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.21, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). The WEMWB-COVID well-being scale was the most predictive variable for information-seeking Internet use (secure: \u003cem\u003eβ\u003c/em\u003e = \u0026minus;\u0026thinsp;.02, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.018; avoidant: \u003cem\u003eβ\u003c/em\u003e= \u0026minus;\u0026thinsp;.02, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.004; fearful: \u003cem\u003eβ\u003c/em\u003e=-.02, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.025; preoccupied: \u003cem\u003eβ\u003c/em\u003e= \u0026minus;\u0026thinsp;.02, \u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.01).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the regression coefficients and R\u003csup\u003e2\u003c/sup\u003e coefficients of determination for the 16 multiple regression models testing the relationship between attachment style and Internet use. [Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e near here].Thus, controlling for the effect of the WEMWBS and area of residence variables, only the link between Internet use and information seeking and avoidant attachment style remained significant.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of regression coefficient \u0026beta; (coefficient of determination R\u003csup\u003e2\u003c/sup\u003e) of multiple regression models of attachment model on Internet use controlling for WEMWBS, area of residence\u003c/p\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAvoidant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFearful\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePreoccuppied\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1- IU negative emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.11 (.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.13 (.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.17 (.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.17 (.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2- IU to seek informations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.15 (0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e.18 (.17)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.15 (.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.11 (.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3- IU to share your experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02 (.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.07 (.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.018 (.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.07 (.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4- IU on emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24 (0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.17 (.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.16 (.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.08 (.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eNote. \u003csup\u003e*\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05. IU: Internet Use\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRelationship between insecure attachment, well-being and Internet use to seek information during the pandemic\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe linear regression coefficients between fearful attachment style and information-seeking Internet use and the regression coefficient between health-related well-being and information-seeking Internet use were significant. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e, this effect was mediated by well-being during Covid-19 pandemic (direct effect\u0026thinsp;=\u0026thinsp;.25 ; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.003 ; indirect effect\u0026thinsp;=\u0026thinsp;.07 ;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.016). [Figure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here].\u003c/p\u003e \u003cp\u003eThe linear regression coefficients between preoccupied attachment style and information-seeking Internet use and the regression coefficient between health context-related well-being and information-seeking Internet use were significant. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e3\u003c/span\u003e, this effect was mediated by well-being during Covid-19 pandemic (direct effect\u0026thinsp;=\u0026thinsp;.21 ; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.03 ; indirect effect\u0026thinsp;=\u0026thinsp;.06 ;\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.018). [Figure \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e3\u003c/span\u003e near here].\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe aim of this study was to explore the link between prenatal Internet use and insecure attachment styles by accounting for anxiety-depressive symptoms, social support, and COVID-19 health context. Consistent with our primary hypothesis, we found significant associations between Internet use and insecure attachment styles. Specifically, the results suggested that preoccupied attachment style was a significant predictor of Internet use for negative emotions and for seeking information. Fearful attachment appeared to be a significant predictor of Internet use for negative affect and seeking information. Finally, avoidant attachment was significantly predictive of Internet use for information seeking.\u003c/p\u003e \u003cp\u003eThe results showed that anxiety mediated the link between preoccupied attachment and Internet use for emotional support. This aligns with findings that preoccupied pregnant women experience the most anxiety in relation to their pregnancy and display compulsive support-seeking (Pazzagli et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Their ambiguous attitude toward others\u0026mdash;seeing them positively but viewing themselves negatively\u0026mdash;may lead them to seek support while avoiding face-to-face emotional expression (Bartholomew \u0026amp; Horowitz, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). The anonymity and asynchrony of Internet use (Danet \u0026amp; Miljkovitch, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) seem to enable them to seek support while managing their fear of social rejection.\u003c/p\u003e \u003cp\u003eResults suggest that the COVID-19 pandemic altered the relationship between attachment style and Internet use during the pregnancy. Regardless of attachment style, women in heavily affected areas used the Internet more for emotional support. The pandemic disrupted in-person prenatal care\u0026mdash;consultations were merged with ultrasounds (HAS, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), support centers closed, and home visits shifted online (Delet et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Birth classes were often unavailable (Evrard, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), reducing key support opportunities (Chivers et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This decline in face-to-face interactions in the most affected areas likely increased social media use for pregnancy-related concerns (Wang et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), providing advice and emotional support (Chivers et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur study suggested that women's well-being may have been affected differently based on attachment style, with more insecurity linked to a greater negative impact of COVID-19. Additionally, women most affected by the health crisis reported increased Internet use for information-seeking. Well-being in this context mediated the link between preoccupied and fearful attachment styles and information-seeking online. These women, more vulnerable to stress, may have relied on the Internet more than secure individuals. Pregnant women had concerns including contamination and effects on baby (Chivers et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Pregnant women with fearful and preoccupied attachment styles may have been more vulnerable to stress and more likely to need support during pregnancy. Reduced professional contact limited access to information (Evrard, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). leading women to seek multiple sources, despite inconsistencies (Chivers et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFinally, the results showed well-being in the health context did not influence the link between avoidant attachment and Internet use for information-seeking. Avoidant pregnant women tend to feel invulnerable, regulating their attachment system to control behavior and emotions in stressful situations (Reeves \u0026amp; Wendland, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Unlike preoccupied and fearful individuals, they were less likely to adapt their behaviors to the context (Moccia et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Insecure pregnant women are more likely to use the Internet than secure women and are more psychologically vulnerable (Feeney et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Pesonen et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Reeves \u0026amp; Wendland, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Since some rely on online recommendations for decisions (Dekker et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Gao et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), which may impact their health (Wang et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), guided Internet use by perinatal professionals could help them make informed choices and adopt healthier behaviors (\u0026Aring;hman et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Sanders \u0026amp; Crozier, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOf the 281 questionnaires initiated, only 39.5% were completed, possibly due to the time required for the extensive variables, which could be a study limitation. The health context also made it difficult for perinatal professionals to recruit participants. However, the introduction of a QR code allowed for contactless questionnaire completion. Regarding sample representativeness, 69% of women had secondary education, higher than the 55.4% of pregnant women in France. Other sociodemographic variables were similar to the 2016 national perinatal survey (Blondel et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Lastly, the cross-sectional design of the study limited causal conclusions.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement:\u003c/strong\u003e The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of University of [blinded for peer-review] \u0026ndash; n\u0026deg;[blinded for peer-review]-419-S82).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement:\u003c/strong\u003e Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclarations of interest:\u003c/strong\u003e The authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdler NE, Epel ES, Castellazzo G, Ickovics JR (2000) Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy, White women. 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Int J Gynecol Obstet 150(2):189\u0026ndash;193. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/ijgo.13246\u003c/span\u003e\u003cspan address=\"10.1002/ijgo.13246\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Université de Lille","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Internet Use, Pregnancy, Attachment insecurity, anxiety, COVID-19, social support","lastPublishedDoi":"10.21203/rs.3.rs-6278475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6278475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003eTo explore the relationship between pregnancy-related Internet use during pregnancy and attachment style, social support, anxio-depressive symptoms and well-being during COVID- 19 pandemic.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e 99 pregnant women, recruited online and through perinatal professionals, completed an online questionnaire assessing attachment style, pregnancy-related Internet use, anxio-depressive symptoms, social support, and well-being in COVID-19 pandemic context. Linear regression analyses were performed to determine the relationship between Internet use and pregnant women attachment styles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eInsecure, preoccupied, and fearful attachment styles were predictive of Internet use in case of negative emotions. The relationship between preoccupied attachment and Internet use in case of negative emotion was mediated by anxiety. Preoccupied, fearful and dismissing attachment styles were predictive of Internet use for information seeking. The COVID-19 pandemic has increased Internet use during pregnancy, particularly for information seeking and in case of negative emotions. The link between fearful and preoccupied attachment styles was mediated by well-being in the pandemic context.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThis study showed a link between attachment style, anxiety, well-being in COVID-19 pandemic context and Internet use during pregnancy. Perinatal professionals, by taking an interest on digital education and participating in the development of quality online resources, could prevent misinformation and reduce anxiety symptoms of insecure pregnant women.\u003c/p\u003e","manuscriptTitle":"Attachment Style, Pregnancy-Related Internet Use And Mental Health Of Primiparous Pregnant Women During COVID-19 Pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-27 04:24:44","doi":"10.21203/rs.3.rs-6278475/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e133fb6b-9ae5-4132-be7b-a7b30d49c56a","owner":[],"postedDate":"March 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-27T04:24:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-27 04:24:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6278475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6278475","identity":"rs-6278475","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}