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Spoken language production involves selecting and assembling words and syntactic structures to convey one's message. Here we probe this process by analyzing natural language productions of individuals with primary progressive aphasia (PPA) and healthy individuals. Based on prior neuropsychological observations, we hypothesize that patients who have difficulty producing complex syntax might choose semantically richer words to make their meaning clear, whereas patients with lexicosemantic deficits may choose more complex syntax. To evaluate this hypothesis, we first introduce a frequency-based method for characterizing the syntactic complexity of naturally produced utterances. We then show that lexical and syntactic complexity, as measured by their frequencies, are negatively correlated in a large (n = 79) PPA population. We then show that this syntax-lexicon trade-off is also present in the utterances of healthy speakers (n = 99) taking part in a picture description task, suggesting that it may be a general property of the process by which humans turn thoughts into speech.
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Lenguaje , Habla , Afasia Progresiva Primaria/fisiopatología , Humanos , Habla/fisiologíaRESUMEN
To understand language, we need to recognize words and combine them into phrases and sentences. During this process, responses to the words themselves are changed. In a step toward understanding how the brain builds sentence structure, the present study concerns the neural readout of this adaptation. We ask whether low-frequency neural readouts associated with words change as a function of being in a sentence. To this end, we analyzed an MEG dataset by Schoffelen et al. (2019) of 102 human participants (51 women) listening to sentences and word lists, the latter lacking any syntactic structure and combinatorial meaning. Using temporal response functions and a cumulative model-fitting approach, we disentangled delta- and theta-band responses to lexical information (word frequency), from responses to sensory and distributional variables. The results suggest that delta-band responses to words are affected by sentence context in time and space, over and above entropy and surprisal. In both conditions, the word frequency response spanned left temporal and posterior frontal areas; however, the response appeared later in word lists than in sentences. In addition, sentence context determined whether inferior frontal areas were responsive to lexical information. In the theta band, the amplitude was larger in the word list condition â¼100 milliseconds in right frontal areas. We conclude that low-frequency responses to words are changed by sentential context. The results of this study show how the neural representation of words is affected by structural context and as such provide insight into how the brain instantiates compositionality in language.SIGNIFICANCE STATEMENT Human language is unprecedented in its combinatorial capacity: we are capable of producing and understanding sentences we have never heard before. Although the mechanisms underlying this capacity have been described in formal linguistics and cognitive science, how they are implemented in the brain remains to a large extent unknown. A large body of earlier work from the cognitive neuroscientific literature implies a role for delta-band neural activity in the representation of linguistic structure and meaning. In this work, we combine these insights and techniques with findings from psycholinguistics to show that meaning is more than the sum of its parts; the delta-band MEG signal differentially reflects lexical information inside and outside sentence structures.
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Encéfalo , Lenguaje , Humanos , Femenino , Encéfalo/fisiología , Lingüística , Psicolingüística , Mapeo Encefálico , SemánticaRESUMEN
Large-scale collection of lexical-semantic norms for words in a given language has been instrumental in the progress of psycholinguistic research. However, such norms tend to be collected from speakers of the dominant variant or dialect. This research aims to determine if there may be differences across speakers of various dialects of English in the humor of individual words. Engelthaler and Hills (2018, Behavior Research Methods, 50[3], 1116-1124) observed that their humor ratings were most strongly correlated with inverse word frequency: Less frequent words tended to be rated as more humorous. We hypothesized that words that are less frequently occurring in a given English dialect should be perceived as more humorous by speakers of the same dialect. We selected words of relatively higher and lower frequencies across various corpora of North American, British, or Singapore English, and presented these words to participants who were native English speakers of North American, British, or Singapore English. Study 1 compared humor ratings of North Americans and Singaporeans; Study 2 compared humor ratings of North Americans and the British. Analyses of participants' random slope coefficients of frequency extracted from cumulative link mixed-effects models indicated that humor ratings were more strongly (and inversely) associated with the word's frequency in the corpora that aligned with the rater's English dialect. These results provide evidence that people are sensitive to the statistics of their specific language environment, and importantly suggest that creators of lexical-semantic norm databases should consider how the cultural, historical, or sociopolitical context of raters might influence the nature of their ratings.
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This study investigated Korean-English second language (L2) speakers' recognition of high- and low-frequency English words and compared two individual difference measures in their role of representing lexical quality in L2: cloze test scores and inverse efficiency scores (IES; response latency corrected for the amount of errors committed), obtained from lexical decision on a separate set of words. Cloze test scores aimed to assess general L2 proficiency, whereas IES was purported to measure lexical processing efficiency. 109 adult Korean-English L2 speakers participated in the study. Results showed significant main effects of word frequency, cloze test scores, and IES on lexical decision times, replicating previous findings and confirming the predictions of the lexical quality hypothesis. Crucially, IES was revealed to be a better measure of individual differences in L2 lexical quality than were cloze test scores. These findings suggest that lexical quality (which can be operationalized in terms of online lexical processing efficiency) comprises a distinct subdomain of language skills on its own, which cannot be measured in full using conventional language proficiency tests.
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Multilingüismo , Adulto , Humanos , Individualidad , Lenguaje , Reconocimiento en Psicología , Tiempo de ReacciónRESUMEN
There is an absent systematic analysis or review that has been conducted to clarify the topic of nomenclature history and terms misuse about Chiari malformations (CMs). We reviewed all reports on terms coined for CMs for rational use and provided their etymology and future development. All literature on the nomenclature of CMs was retrieved and extracted into core terms. Subsequently, keyword analysis, preceding and predicting (2023-2025) compound annual growth rate (CAGR) of each core term, was calculated using a mathematical formula and autoregressive integrated moving average model in Python. Totally 64,527 CM term usage was identified. Of these, 57 original terms were collected and then extracted into 24 core-terms. Seventeen terms have their own featured author keywords, while seven terms are homologous. The preceding CAGR of 24 terms showed significant growth in use for 18 terms, while 13, three, three, and five terms may show sustained growth, remain stable, decline, and rare in usage, respectively, in the future. Previously, owing to intricate nomenclature, Chiari terms were frequently misused, and numerous seemingly novel but worthless even improper terms have emerged. For a very basic neuropathological phenomenon tonsillar herniation by multiple etiology, a mechanism-based nosology seems to be more conducive to future communication than an umbrella eponym. However, a good nomenclature also should encapsulate all characteristics of this condition, but this is lacking in current CM research, as the pathophysiological mechanisms are not elucidated for the majority of CMs.
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Malformación de Arnold-Chiari , Humanos , Malformación de Arnold-Chiari/cirugía , Descompresión Quirúrgica , Encefalocele/cirugía , Imagen por Resonancia MagnéticaRESUMEN
This study investigates the contribution of receptive collocational competence and receptive vocabulary knowledge to L2 general language proficiency, and how well collocational knowledge develops in relation to knowledge of single-word items. To achieve this aim, measures tapping receptive collocation knowledge, receptive vocabulary knowledge and general language proficiency were administered to 86 Arabic-speaking learners of English at the university level. Results showed positive significant correlations of collocational competence (r = .78) and vocabulary knowledge (r = .70) with general language proficiency. Regression analysis revealed that collocational knowledge predicted the largest variance in general language proficiency, over and above, the prediction value of vocabulary knowledge. The results also showed that collocational knowledge develops as vocabulary knowledge increases, and that learners appear to first acquire collocations of items from more frequent word bands. Furthermore, the results indicated that knowledge of collocations and individual words within the third and fifth frequency levels predicted the largest variance in L2 general language proficiency. The findings of the study have important implications for the teaching and learning of L2 collocations and development of a learner's vocabulary knowledge, as these two variables appear to be determinant factors of L2 general language proficiency.
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Multilingüismo , Vocabulario , Humanos , Lenguaje , AprendizajeRESUMEN
The quality of tests in psychological and educational assessment is of great scholarly and public interest. Item difficulty models are vital to generating test result interpretations based on evidence. A major determining factor of item difficulty in knowledge tests is the opportunity to learn about the facts and concepts in question. Knowledge is mainly conveyed through language. Exposure to language associated with facts and concepts might be an indicator of the opportunity to learn. Thus, we hypothesize that item difficulty in knowledge tests should be related to the probability of exposure to the item content in everyday life and/or academic settings and therefore also to word frequency. Results from a study with 99 political knowledge test items administered to N = 250 German seventh (age: 11-14 years) and tenth (age: 15-18 years) graders showed that word frequencies in everyday settings (SUBTLEX-DE) explain variance in item difficulty, while word frequencies in academic settings (dlexDB) alone do not. However, both types of word frequency combined explain a considerable amount of the variance in item difficulty. Items with words that are more frequent in both settings and, in particular, relatively frequent in everyday settings are easier. High word frequencies and relatively higher word frequency in everyday settings could be associated with higher probability of exposure, conceptual complexity, and better readability of item content. Examining word frequency from different language settings can help researchers investigate test score interpretations and is a useful tool for predicting item difficulty and refining knowledge test items.
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Lenguaje , Reconocimiento en Psicología , Humanos , Niño , Adolescente , AprendizajeRESUMEN
This study used an eye-tracking method to examine whether Chinese translation equivalents activated by English prime words can continue to activate their Chinese homophones. With 30 English prime words, and 60 Chinese target words as materials, the experiment used a Tobii eye-tracking device to collect data from 30 university students while completing an English-Chinese lexical semantic-judgment task, aimed at investigating whether (1) when Chinese English learners see the English words, they can activate the homophones of Chinese translation equivalents; and (2) there is a word frequency effect in cross-language lexical activation, i.e., Chinese translation equivalents with different word frequencies have different effects on the activation speed. Compared with low-frequency Chinese translation equivalents, high-frequency Chinese equivalents can facilitate the activation faster and easier. The two research hypotheses were confirmed on several eye movement indicators, supporting the cross-language lexical activation as well as word-frequency effect of Chinese translation equivalents. This is also the first verification of cross-language dual-link lexical activation which engage both semantics and phonology, indicating that L2-L1 semantic activation has strong stability for further phonological activation.
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Movimientos Oculares , Multilingüismo , Humanos , Pueblos del Este de Asia , Lenguaje , Semántica , LingüísticaRESUMEN
Diglossia in Arabic describes the existence and the use of two varieties of the same language: spoken Arabic (SA) and literary Arabic (LA). SA, the dialect first spoken by Arabic native speakers, is used in non-formal situations for everyday conversations, and varies from one region to another in the Arabic world. LA, acquired later in life when the children learn to read and write at school, is used for formal purposes such as media, speeches in public and religious sermons. Previous research showed that, in the auditory modality, SA words are processed faster than LA ones. In the visual modality, written LA words are processed faster than SA ones, the latter comparing with low-frequency words. This study analysed event-related potentials (ERPs) during the processing of high-frequency (LAHF), LA low-frequency (LALF) and SA high-frequency words (SAHF) in a visual lexical decision task. Faster reaction times were observed for LAHF, followed by SAHF and then by LALF. ERPs showed a modulation of the early components starting from the P100 component and of the late P600 component, supposedly related to memory processes. These findings, indicating that processing written SAHF words was largely comparable with processing of LALF, are discussed in the context of Arabic diglossia.
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Lenguaje , Procesamiento de Texto , Niño , Electroencefalografía , Potenciales Evocados , Humanos , Tiempo de Reacción , Lectura , Habla/fisiologíaRESUMEN
Dominant theories of language production suggest that word choice-lexical selection-is driven by alignment with the intended message: To talk about a young feline, we choose the most aligned word, kitten. Another factor that could shape lexical selection is word accessibility, or how easy it is to produce a given word (e.g., cat is more accessible than kitten). To test whether producers are also influenced by word accessibility, we designed an artificial lexicon containing high- and low-frequency words whose meanings correspond to compass directions. Participants in a communication game (total N = 181 adults) earned points by producing compass directions, which often required an implicit decision between a high- and low-frequency word. A trade-off was observed across four experiments; specifically, high-frequency words were produced even when less aligned with messages. These results suggest that implicit decisions between words are impacted by accessibility. Of all the times that people have produced cat, sometimes they likely meant kitten.
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Lenguaje , HumanosRESUMEN
There is debate regarding whether most articulatory planning occurs offline (rather than online) and whether the products of off-line processing are stored in a separate articulatory buffer until a large enough chunk is ready for production. This hypothesis predicts that delayed naming conditions should reduce not only onset RTs but also word durations because articulatory plans will be buffered and kept ready. We have tested this hypothesis with young control speakers, an aphasic speaker , and an age and education-matched speaker, using repetition, reading and picture-naming tasks. Contrary to the off-line hypothesis, delayed conditions strongly reduced onset RTs, but had no benefit for word durations. In fact, we found small effects in the opposite direction. Moreover, frequency and imageability affected word durations even in delayed conditions, consistent with articulatory processing continuing on-line. The same pattern of results was found in CS and in control participants, strengthening confidence in our results. There is debate regarding whether most articulatory planning occurs offline (rather than online) and whether the results of off-line processing are stored in a separate articulatory buffer until a large enough chunk is ready for production. This hypothesis predicts that delayed naming conditions should reduce not only onset RTs but also word durations because articulatory plans will be buffered and kept ready. We have tested young control speakers, an aphasic speaker, and an age and education matched speaker, using repetition, reading and picture naming tasks. Contrary to the off-line hypothesis, delayed conditions strongly reduced onset RTs, but had no benefit for word durations. In fact, we found small effects in the opposite direction. Moreover, frequency and imageability affected word durations even in delayed conditions, consistent with articulatory processing continuing on-line. The same pattern of results was found in CS and in control participants, strengthening confidence in our results.
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Afasia , Humanos , LecturaRESUMEN
Bilinguals frequently juggle competing representations from their two languages when they interact with their environment (i.e., nonselective activation). As a result, both first (L1) and second language (L2) communication may be impeded when words share orthographic form but not meaning (i.e., interlingual homographs; e.g., CRANE, a machine in English, a skull in French). Similarly, bilinguals' reduced exposure to each known language makes bilingual lexical processing more vulnerable to larger frequency effects. While much is known about processes within the language system, less is known about how the bilingual language system interacts with the visual system, specifically in the context of image processing. We investigated this by testing whether commonly observed semantic (homograph interference) and lexical (frequency) effects extend to a visual word-image matching task. We tested 48 bilinguals, who were asked to determine whether an image corresponded to a written word that was presented immediately beforehand. By modulating the complexity of visual referents and the semantic (Analysis 1) or lexical (Analysis 2) complexity of word cues, we simultaneously burdened the visual and language systems. The results showed that both semantic and lexical factors modulated response accuracy and correct reaction time on the word-image matching task. Crucially, we observed an interaction between the image factor (visual complexity) with the semantic (homograph status) but not the lexical factor (word frequency). We conclude that it is possible for the language and image processing systems to interact, although the extent to which this occurs depends on the degree of linguistic processing involved.
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Multilingüismo , Semántica , Adulto , Humanos , Lenguaje , Tiempo de Reacción/fisiología , VocabularioRESUMEN
Contextual diversity modifies word frequency by ignoring the repetition of words in context (Adelman, Brown, & Quesada, 2006, Psychological Science, 17(9), 814-823). Semantic diversity modifies contextual diversity by taking into account the uniqueness of the contexts that a word occurs in when calculating lexical strength (Jones, Johns, & Recchia, 2012, Canadian Journal of Experimental Psychology, 66, 115-124). Recent research has demonstrated that measures based on contextual and semantic diversity provide a considerable improvement over word frequency when accounting for lexical organization data (Johns, 2021, Psychological Review, 128, 525-557; Johns, Dye, & Jones, 2020a, Quarterly Journal of Experimental Psychology, 73, 841-855). The article demonstrates that these same findings generalize to word-level episodic recognition rates, using the previously released data of Cortese, Khanna, and Hacker (Cortese et al., 2010, Memory, 18, 595-609) and Cortese, McCarty, and Schock (Cortese et al., 2015, Quarterly Journal of Experimental Psychology, 68, 1489-1501). It was found that including the best fitting contextual diversity model allowed for a very large increase in variance accounted for over previously used variables, such as word frequency, signalling commonality with results from the lexical organization literature. The findings of this article suggest that current trends in the collection of megadata sets of human behavior (e.g., Balota et al., 2007, Behavior Research Methods, 39(3), 445-459) provide a promising avenue to develop new theoretically oriented models of word-level episodic recognition data.
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Reconocimiento en Psicología , Semántica , Canadá , Humanos , Tiempo de ReacciónRESUMEN
Word frequency is one of the best predictors of language processing. Typically, word frequency norms are entirely based on natural-language text data, thus representing what the literature typically refers to as purely linguistic experience. This study presents Flickr frequency norms as a novel word frequency measure from a domain-specific corpus inherently tied to extra-linguistic information: words used as image tags on social media. To obtain Flickr frequency measures, we exploited the photo-sharing platform Flickr Image (containing billions of photos) and extracted the number of uploaded images tagged with each of the words considered in the lexicon. Here, we systematically examine the peculiarities of Flickr frequency norms and show that Flickr frequency is a hybrid metrics, lying at the intersection between language and visual experience and with specific biases induced by being based on image-focused social media. Moreover, regression analyses indicate that Flickr frequency captures additional information beyond what is already encoded in existing norms of linguistic, sensorimotor, and affective experience. Therefore, these new norms capture aspects of language usage that are missing from traditional frequency measures: a portion of language usage capturing the interplay between language and vision, which - this study demonstrates - has its own impact on word processing. The Flickr frequency norms are openly available on the Open Science Framework (https://osf.io/2zfs3/).
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We present Shabd, a psycholinguistic database in Hindi. It is based on a corpus of 1.4 billion words from electronic newspapers and news websites. Word frequencies and part of speech information have been derived and are made available in a cleaned list of 34 thousand hand-selected words, and a list of 96 thousand words observed with a frequency of more than 100 times in the corpus. Next to the Shabd database, we also make a list with all 2.3 million word types available and a list with the 2.5 million most frequent word pairs (word bigrams). The quality of the word frequency measure was tested in two lexical decision tasks. We observed that the Shabd word frequencies outperform existing frequencies based on smaller corpora of newspapers but not the Worldlex word frequencies based on an analysis of blogs. We also observed that word frequency accounts for as much variance as contextual diversity (operationalized as the number of documents in which the words were observed). The Shabd database is freely available for research.
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Lenguaje , Psicolingüística , Blogging , Bases de Datos Factuales , Humanos , HablaRESUMEN
In recent years large datasets of lexical processing times have been released for several languages, including English, French, Spanish, and Dutch. Such datasets have enabled us to study, compare, and model the global effects of many psycholinguistic measures such as word frequency, orthographic neighborhood (ON) size, and word length. We have compiled and publicly released a frequency and ON dictionary of 64,546 words and 1800 plausible NWs from a language that has been relatively little studied by psycholinguists: Persian. We have also collected visual lexical decision reaction times for 1800 Persian words and nonwords. Persian offers an interesting psycholinguistic environment for several reasons, including that it has few long words and has resultantly dense orthographic neighborhoods. These characteristics provide us with an opportunity to contrast how these factors affect lexical access by comparing them to several other languages. The results suggest that sensitivity to word length and orthographic neighbourhood may reflect the statistical structure of a particular language, rather than being a universal element of lexical processing. The dictionary and LDRT data are available from https://osf.io/tb4m6/ .
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Lenguaje , Psicolingüística , Humanos , Tiempo de ReacciónRESUMEN
According to the item/order hypothesis, high-frequency words are processed more efficiently and therefore order information can be readily encoded. In contrast, low-frequency words are processed less efficiently and the focus on item-specific processing compromises order information. Most experiments testing this account use free recall, which has led to two problems: First, the role of order information is difficult to evaluate in free recall, and second, the data from free recall show all three possible patterns of results: memory for high-frequency words can be better than, the same as, or worse than that for low-frequency words. A series of experiments tested the item/order hypothesis using tests where the role of order information is less ambiguous. The item/order hypothesis predicts better performance for high- than low-frequency words when pure lists are used in both immediate serial recall (ISR) and serial reconstruction of order (SRO) tests. In contrast, when mixed (alternating) lists are used, it predicts better performance for low- than for high-frequency words with ISR tests, but equivalent performance with SRO tests. The experiments generally confirm these predictions, with the notable exception of a block order effect in SRO tasks: When a block of low-frequency lists preceded a block of high-frequency lists, a high-frequency advantage was observed but when a block of high-frequency lists preceded a block of low-frequency lists, no frequency effect was observed. A final experiment provides evidence that this block order effect is due to metacognitive factors.
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Metacognición , Aprendizaje Seriado , Humanos , Memoria a Corto Plazo , Recuerdo MentalRESUMEN
Both comprehension and production exposures to words facilitate spoken production of the same words in picture-naming tasks performed several minutes later. Three experiments examined the mechanisms by which different types of comprehension exposures to words facilitate spoken production. Both overt and silent reading and listening tasks elicited substantial priming in picture naming at 10-minute but not 1-week retention intervals. Relative to silent conditions, encoding conditions that involved speaking the target word overtly elicited stronger priming effects in both RT and accuracy and larger frequency effects in RT. Frequency effects were not reliable in accuracy priming or silent-encoding RT priming. Articulatory suppression did not diminish priming effects relative to silent reading/listening, and priming effects did not depend on whether presentations at encoding were visual or auditory. Together, the results indicate that a common modality-general lemma representation is accessed in comprehension and production, that both lemma and phonological retrieval contribute to repetition priming in production, and that phonological retrieval is sensitive to word frequency. These results are consistent with a theory based on transfer-appropriate processing if word comprehension elicits top-down processing or feedback from the concept to the lemma.
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Comprensión , Memoria Implícita , Percepción Auditiva , Humanos , SemánticaRESUMEN
Previous research has speculated that semantic diversity and lexical ambiguity may be closely related constructs. Our research sought to test this claim in respect of the semantic diversity measure proposed by Hoffman et al. (2013). To this end, we replicated the procedure described by Hoffman et al., Behavior Research Methods, 45(3), 718-730 (2013) for computing multidimensional representations of contextual information using Latent Semantic Analysis, and from these we derived semantic diversity values for 28,555 words. We then replicated the facilitatory effect of semantic diversity on word recognition using existing data resources and observed this effect to be greater for low-frequency words. Yet, we found no relationship between this measure and lexical ambiguity effects in word recognition. Further analysis of the LSA-based contextual representations used to compute Hoffman et al. (2013) measure of semantic diversity revealed that they do not capture the distinct meanings of ambiguous words. Instead, these contextual representations appear to capture general information about the topics and types of written material in which words occur. These analyses suggest that the semantic diversity metric previously proposed by Hoffman et al. (2013) facilitates word recognition because high-diversity words are likely to have been encountered no matter what one has read, whereas many participants may not have encountered lower-diversity words simply because the topics and types of written material in which they occur are more restricted.
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Lectura , Semántica , Humanos , EscrituraRESUMEN
BACKGROUND: The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment. OBJECTIVE: The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19. METHODS: A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included "COVID," "corona," and "pandemic." A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations. RESULTS: The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including "worried" (n=165, 19.9%), "risk" (n=143, 17.2%), "anxiety" (n=98, 11.8%), "concerns" (n=74, 8.8%), and "stress" (n=69, 8.3%). CONCLUSIONS: Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.