孕期和产后焦虑、抑郁的随访及社会心理因素分析

Follow-up study of anxiety and depression with analysis of socio-psychological factors in pregnant and postpartum periods

目的通过对孕产妇的随访了解孕、产期焦虑、抑郁的发生情况,并进一步分析相关危险因素。方法符合入组及排除标准的满16孕周的孕妇307例,随访时间为产后2～3d,产后42d、3个月,予填写相关危险因素调查表和综合性医院焦虑/抑郁情绪量表(HAD量表),产后增加爱丁堡产后抑郁量表(EPDS量表)筛查产后抑郁。结果孕期(HAD量表)焦虑发生率为5.5%,抑郁发生率为4.9%;产后(EPDS量表)2～3d抑郁发生率为7.5%,产后42d为13.5%,产后3个月为9.8%。产后2～3dHAD与EPDS量表抑郁检出率的差异无显著性(P=0.345),但产后42d和产后3个月的差异有显著性(P=0.019,P=0.001);各时点两量表的内部一致性均较差。孕期焦虑对产后2～3d的抑郁具有预测意义,孕期抑郁对产后42d的抑郁具有预测意义。初潮年龄、担忧孩子患遗传性疾病是孕期焦虑情绪的主要危险因素,既往胎儿/婴儿死亡、营养和担忧孩子喂养是孕期抑郁情绪的主要危险因素。产后抢救、产后饮食、产前思想准备和产前洁癖是产后2～3d抑郁的主要危险因素,住房设备是产后42d抑郁的主要危险因素,住房环境、有无请保姆和有无烦恼事件是产后3个月抑郁的主要危险因素。结论孕、产期焦虑、抑郁情绪是客观存在的,产后不同时期抑郁发生率并不完全相同,且不同时期焦虑、抑郁的危险因素也不完全一致,孕期的不良情绪会直接导致产后抑郁的发生。故保健工作应在确认怀孕后及时开展。

Objective To investigate the prevalence of anxiety and depression releating socio-psychological factors, through follow up for women from pregnancy to postpartum. Methods 307 women pregnant for at least 16 weeks meeting the included and excluded criteria, were followed up to postpartum 2 - 3 days, 42 days and 3 monthes. At each period they had to answer the hospital anxiety and depression scale （ HAD, for anxiety and depression） , fill the form of related risk factors, and further use the Edinghurgh postnatal depression scale （EPDS） for judgement of the postpartum depression. Results The HAD anxiety rate was 5.5% and the depression rate was 4. 9% in the pregnant period. The EPDS depression rate was 7. 5% in 2 - 3 days postpartum, 13.5% on 42nd day postpartum, and 9. 8% in 3rd month postpartum. There had been no significant difference between HAD and EPDS in the 2- 3 days postpartum. The inherent coherence Kappa value between the two scales was less than 0. 4 at any postpartum period. The anxiety during pregnancy was related to postparturn depression in 2 - 3 days, and the depression of pregnancy was related to the postpartum depression on 42nd day . The first menstrual age and the worrying for heritable disease of baby were the major factors of pregnancy anxiety. The past history of infant death, nutrition and worrying for infant-feeding were the major factors of pregnancy depression, The postpartum salvage, diet and the prepartum preparation and clean-hobby were major factors of postpartum depression in 2 - 3 days, the house furniture equipment was the major factor of the postpartum depression on 42nd day; the house environment, baby-sitter and life-events were the major factors of the postpartum depression at 3rd month. Conclusions The anxiety and depression in pregnancy or postpartum period are objectively present. The prevalence of depression is different in each postpartum period, and the risk factors of anxiety and depression are not the same in different periods. The morbid emotion of pregnancy earl lead direedy to the occurrence of post-partum depression. The primary health care work should be developed not only at postpartum, but also at prepar-tum.