剖宫产后抑郁症发病机制及其相关因素的研究

Investigation on Development and Factors Related to Depression After Cesarean Delivery

目的:探讨剖宫产后抑郁症的发生率及其产后抑郁症发病机制。方法:用自制生活量表及社会支持问卷、抑郁和焦虑自评量表、爱丁堡产后抑郁量表对200例产妇进行问卷测查,同时于产后48h抽血检测孕酮及雌二醇。结果:产后抑郁症的发生率为14%,剖宫产后抑郁症的发生率21%(P<0.05)。抑郁组产后孕酮值低于对照组(P<0.05);剖宫产组产后孕酮值与对照组比较无显著性差异。抑郁组比对照组有较多不良的心理体验和负性生活事件;生活压力大、家庭问题复杂在剖宫产组比顺产组多。结论:剖宫产后抑郁症的发生率比顺产高;产后血孕酮明显降低可能是产后抑郁症发生的生物学基础,而不良的心理因素是其心理学基础,负性生活事件是其促进因素。

Objective：To explore the incidence of postpartum depression with cesarean delivery and the development of depression on postpartum. Method：200 cases of randomly selected postpartum women in our hospital were investigated by test - paper. It included Self - Ration Depression Scale （ SDS ） , Self - Ration Anxiety Scale（ SAS）, Edinburgh Postnatal Depression Scale （ EPDS） and Selfmade Living Incidents and Social Support Scale （ SLISS ）. Serum estradiol （ E2 ） and progesterone （ P ） concentration were assayed on 48th hours of postpartum. Result：The incidence of postpartum depression was about 14%, and the incidence of postpartum depression in cesarean delivery was 21%. Serum progesterone （ P ） concentration was signifi- cantly higher in depressed group compared with undepressed group. There was no significant difference in serum progesterone between the cesarean group and vaginal group. More negative factors were showed in the depressed group compared with undepressed group. And bad family economic condition and stress on family were observed in cesarean delivery more than in vaginal delivery. Conclusion： The incidence of postpartumdepression is higher in cesarean group compared with vaginal one. Lower serum P after delivery may be the biological cause of depression. Adverse personelity is the psychological facters, and the main promoter are some stress living incidents.