孕期心理干预对产后焦虑、抑郁的影响

Prenatal Psychological Prevention Trial on Postpartum Anxiety and Depression

目的:探讨孕期心理干预能否减少产后焦虑、抑郁的发生。方法:采用随机对照研究设计。于2005年3月至2006年2月部分连续抽取800例孕16～20周的孕妇,随机分配至干预组(n=386)和对照组(n=414)。干预组在常规孕妇保健的基础上给予集体心理干预(5次孕妇+1次丈夫)课程,对照组予常规孕妇保健。对所有对象每月采用综合性医院焦虑/抑郁量表(Hospital Anxiety and Depression scale,HAD)自评,产后3天、42天和3月采用HAD和爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EP-DS)双重自评,并采用DSM-IV-TR轴I障碍临床定式检查(研究版)中文版(Structured Clinical Interview For DSM-IV-TR Axis I Disorders,Research Version;SCID-I)分层盲法临床诊断。采用意向性分析(Intention-To-Treat,ITT)原则分析资料。结果:(1)在符合方案数据集(Per-protocol sets,PPs)中,孕妇心理干预可以明显减轻产后的焦虑情绪,干预组HAD的A项分从产后3天的0-2-4(四分位数)下降到产后3月的0-2-3,而对照组从产后3天的0-2-4下降到产后3月的0-2-3.5;在产后三个月中,干预组焦虑症状的比例3.2%(5/158)明显低于对照组的比例7.8%(30/383)(χ2=4.029,P=0.045)。但HAD或EPDS评估都未能发现干预对产后抑郁情绪降低具有明显效果。(2)采用SCID-I诊断,在产后三个时点重性抑郁障碍的发生率(调整发生率)干预组分别为4.04%、14.92%、7.85%,对照组分别为3.61%、18.12%、5.39%,两组差异无统计学意义。结论:孕期心理干预对预防产后的焦虑情绪具有作用,对产后抑郁作用不明显。

Objective： To explore the efficacy of prenatal psychological intervention in anxiety and depression in postpartum period. Methods： A randomized controlled trial design was used in this study. A total of 800 pregnant women at 16 - 20 weeks gestation were selected continually from clinic. All the women were randomly divided into intervention group （n = 386） or control group （n = 414 ） . The intervention consisted of six sessions （five sessions for the pregnant women ＋ one session for the husbands ） . Both of the two groups attended the normal hospital education equally. All the subjects were evaluated with the Hospital Anxiety and Depression scale （ HAD） once a month prenatally, and with the Edinburgh Postnatal Depression Scale （ EPDS ） additionally at 3 days, 42 days, and 3 month postpartum. The SCID-I Chinese version 2004 （ Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version） was used for clinical diagnosis. Analysis of the mental health outcomes, by intention-to-treat, was adjusted for the correlated structure of the data. Results： （ 1 ） According to the HAD score changes, in the per-protocol sets （ PP sets ）, the intervention could relieve the anxious emotion in postpartum period. The ＂ anxiety＂ item scores of HAD in intervention group dropped from 0 - 2 - 4 （ quartile ） at 3 days postpartum to 0 - 2 - 3 at 3 months postpartum, while that in control group dropped from 0 - 2 - 4 to 0 - 2 - 3. 5. During 3 months postpartum, the rate of anxiety in intervention group was significantly lower than that in control group （ 3.2% vs. 7.8%, P =0. 045 ） . However, the intervention had no efficacy on depressive emotion according to neither HAD or EPDS. （ 2） In SCID-I interview, there was no significantly difference in incidence of major depressive disorder between the two groups at each time-point postpartum. Conclusion： The prenatal psychological intervention can prevent postpartum anxious emotion to some extent. How to prevent the postpartum depression needs to be studied further.