产后抑郁症及其产科因素相关性探讨

Study on Postpartum Depression and the Related Obstetrical Factors

目的调查产后抑郁症的发病情况;探讨与产后抑郁症相关的产科因素.方法采用分层整群抽样方法,抽取长沙市2所三级甲等医院和2所二级甲等医院从2004年9月～2005年1月在这4所医院进行产后6周复查的300例初产妇,并对其进行问卷调查.调查问卷包括Edinburgh产后抑郁量表(EPDS)、自编产妇一般资料及产科因素调查问卷.采用Epidata3.02软件建立数据库,所有资料均采用SPSS11.5统计软件处理.统计方法包括描述性的统计分析、χ2检验、单因素和多因素非条件Logistic分析.结果1.300例产妇中,EPDS总分≥13分抑郁阳性并确诊为抑郁症者52例,产后抑郁症的发病率为17.30%.2.多因素非条件Logistic回归分析结果显示:第一产程时间(P=0.024)、顺产(P=0.003)、阴道助产(P=0.000)、新生儿畸形(P=0.000)、母乳喂养(P=0.037)与产后抑郁症相关,有统计学意义.其OR值分别为:2.269、0.151、49.767、28.386、0.299.结论1.一部分妇女在产后6周内出现不同程度的抑郁性障碍,应引起高度重视.2.产后抑郁症相关的产科危险因素有阴道助产、新生儿畸形、第一产程时间长;保护性因素有顺产、母乳喂养.3.针对影响因素,采取相应的干预措施,有助于预防其发生.

Objective To investigate the incidence of postpartum depression and the related obstetrical factors. Methods The study was carried out in four hospitals selected by stratified sampling in Changsha City. Three hundred nullipara women who met the designed inclusion criteria 6 weeks postpartum were recruited by cluster sampling from the 4 hospitals from September, 2004 through January, 2005. Participants were evaluated by the Edinburgh Postpartum Depression Scale （EPDS） by using a domestic-designed demographic and obstetrical factors questionnaires. The database was established in the statistics soft package Epidata, version 3.02. All statistic analyses were performed by the SPSS program, version ] 1.5. Descriptive analyses, Chisquare test, simple and multiple factor non - conditional logistic regression analyses were performed. Results 1. The incidence of depressive symptoms was 17.3 % （52/300） during the 6 weeks postpartum period. 2. Multiple factor non-condition logistic regression showed that the time of the first stage of labor （P= 0.024）, normal delivery （P= 0.003）, instrumental delivery （P= 0.000）, birth defect （P = 0. 000）, breast - feeding （P = 0. 037） were significantly associated with postpartum depression. Their odds ratios were 2. 269, 0. 151, 49.767, 28. 386, and 0.299 respectively. Conclusion The 6 - week period after childbirth appears to be a time of heightened vulnerability for the development of depression in a subgroup of women. Depression in the postpartum period needs special attention as it can have severe consequences not Only for the mother, but also for the infant and the whole family. The study suggests that there are three obstetrical risk factors identified, including the time of the first stage of labor, instrumental delivery, and birth defect; and also two protective factors, i.e., the normal delivery and breast- feeding. In addition, preventive intervention should be taken actively to against postpartum depression.