初产妇分娩前后焦虑抑郁状况及其影响因素

Status of anxiety-depression and the influencing factors in primipara before and after delivery

目的:探讨初产妇分娩前后心理状况、焦虑抑郁状况及其相关的因素,为提出相应的干预措施提供理论依据。方法:对山东省千佛山医院产科病房的200例健康初产妇采用自制问卷、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)分别于产前、产后1周进行评定。结果:分娩前有抑郁症状的71例(35.5%);有焦虑症状的62例(31.0%);分娩后有焦虑的51例(25.0%);有抑郁的58例(29.0%)。HAMA总分在产前、产后差异均有显著性意义(t=2.076,P=0.038)。分娩前后产妇心理状况与父母关系、情绪控制、陪同分娩、新生儿性别、产后出血、新生儿哭闹、丈夫对婴儿态度及对产妇的关心、产后亲友支持等因素存在明显相关性(r=0.143～0.224,P均<0.05)。结论:分娩前焦虑抑郁较分娩后的发生率高,分娩前有焦虑抑郁的产妇,产后出现焦虑抑郁的危险性明显增加;针对易感因素作好孕产期的心理咨询与指导,予以早期干预,会明显的降低孕产期及其产后精神症状的发生率。

AIM:To investigate the mental state and the status of anxiety depression,and the relevant factors in primipara before and after delivery,so as to provide theoretical evidence for the suggestion of corresponding intervention measures. METHODS:Totally 200 healthy primipara in the obstetrical wards of the Qianfoshan Hospital of Shandong Province were evaluated with self designed questionnaire, Hamilton depression rating scale(HAMD) and Hamilton anxiety rating scale(HAMA) before and 1 week after delivery respectively. RESULTS:There were 71 cases(35.5%) and 62 cases(31.0%) suffering from depression and anxiety before delivery;while 51 cases(29.0%) and 58 cases(25.0%) suffered from depression and anxiety after delivery.There was significant difference in the total score of HAMA before and after delivery(t=2.076,P=0.038).The mental state of primipara was associated with parents' relationship,emotional control,accompany delivery,gender of baby, postpartum hemorrhage,cry of the baby,attitude of husband towards the baby and husband's care about the primipara, and family's support after delivery(r=0.143 to 0.224,P< 0.05). CONCLUSION:The incidence rate of anxiety depression before delivery is higher than that after delivery,the risk of occurrence of anxiety depression is obviously increased after delivery in the primipara who had anxiety depression before delivery.Proper psychological counseling and instruction, and early intervention according to predisposing factor during pregnancy can obviously reduce the incidence rate of psychiatric symptoms during pregnancy and after delivery.