哈尔滨市高危妊娠孕产妇抑郁状况及社会心理相关因素分析

Study on the status and related socio-psychological factors of maternal depression among high-risk pregnancy women in Harbin city

目的了解哈尔滨市高危妊娠孕产妇的抑郁状况及其社会心理因素。方法2010年9月至2011年6月，以哈尔滨市某医院的42例高危妊娠孕产妇和40名正常孕产妇为研究对象，对其进行随访。随访时点为孕32～36周、产前1周、产后1周及产后6周。随访期间调查孕产妇基本情况，应用自制社会心理因素调查表及抑郁自评量表评估产前抑郁情绪状况，应用爱丁堡产后抑郁（EPDS）量表于产后1周筛查产后抑郁症状，应用单因素分析及多因素非条件logistic回归分析高危妊娠孕产妇抑郁的社会心理相关因素。结果42例高危妊娠孕产妇年龄为（31．0±5．6）岁，40名正常孕产妇年龄为（30．5±3．8）岁（t=0．169，P〉0．05）。高危孕产妇孕期抑郁情绪检出率（45．2％，19／42）高于正常孕产妇（25．0％，10／40）（x2=3．671，P=0．045）。高危孕产妇孕32～36周、产前1周、产后1周及产后6周各时点抑郁情绪检出率分别为30．9％（13／42）、42．9％（18／42）、23．8％（10／42）、26．2％（11／42）；正常孕产妇分别为25．0％（10／40）、15．0％（6／40）、20．0％（8／40）、17．5％（7／40），两组孕产妇产前1周抑郁情绪检出率差异有统计学意义（x2=7．680，P〈0．01），孕32～36周（x2=0．133，P=0．80）、产后1周（x2=0．174，P=0．79）及产后6周（x2=0．903，P=0．43）的抑郁情绪检出率差异均无统计学意义。高危妊娠孕产妇产后1周、产后6周的抑郁症状检出率分别为12．5％（4／32）、30．4％（7／23），正常孕产妇分别为8．3％（3／36）、22．9％（8／35），差异均无统计学意义（x2值分别为0．319、0．416，P值均〉0．05）。高危妊娠及正常孕产妇产前1周抑郁情绪与产后6周抑郁症状相关（r值分别为0．824、0．677，P值均〈0．05）。多因素非条件logistic回归显示，待产准备不足（OR=2．73，P〈0．01）和担心分娩安全（OR=2．89，P〈0．01）是高危妊娠孕产妇抑郁情绪的危险因素。结论高危妊娠孕产妇抑郁情绪检出率较高，且在产前1周时最明显，待产准备不足和担心分娩安全是高危妊娠孕产妇抑郁情绪的危险因素。

Objective This study aimed to investigate the depression status among high-risk pregnancy women, and to analyze its relevant social and psychological factors. Methods A total of 42 high- risk pregnancy women and 40 normal pregnancy women in a teaching hospital in Harbin city were followed up at time points of 32 - 36 weeks pregnancy, one week before labor, one week postpartum, and six weeks postpartum, respectively. During follow-up, the basic situation, social psychosocial factors of pregnancy women were collected and the depression of pregnancy women was measured by self-designed questionnaire and self-rating depression scale. The Edinburgh Postnatal Depression Scale （EPDS） was applied at timepoint of one week postpartum. Single factor analysis and the unconditional multivariate logistic regression were applied for analyzing the on the related social-psychosocial factors among high-risk pregnancy women. Results The age of high- risk pregnancy women was （ 31. 0 -＋ 5.6 ） , and the age of normal pregnancy women was （ 30. 5 -＋ 3.8 ） （ t = 0. 169, P 〉 0. 05 ）. The results showed that the depression rate in high-risk pregnancy women was 45.2% （19/42） , which was 25.0% （10/40） in normal pregnancy women, the difference was significant（ x2 = 3. 671, P = 0. 045 ）. The depression rates at different time points were 30. 9% （ 13/42 ）, 42. 9% （ 18/42 ）, 23.8% （ 10/42 ）, 26. 2% （ 11/42 ） in high-risk pregnancy women respectively, and 25.0% （ 10/40 ）, 15.0% （ 6/40 ）, 20. 0% （ 8/40 ）, 17. 5% （ 7/40 ） in the control group respectively, the difference of the depression rates among groups at one week before labor was significant （ X2 = 7. 680, P 〈 0. 01 ）, the difference among groups at 32 - 36 weeks pregnancy （x2 = 0. 133, P = 0. 80 ）, at one week postpartum （ x2 = 0. 174, P = 0. 79 ） and at six weeks postpartum （ x2 = 0. 903, P = 0. 43 ） were not significant. At one week postpartum and six weeks postpartum periods, the EPDS depression rate were 12. 5% （4/32）, 30. 4% （7/23） in case group respectively, 8.3% （3/36）, 22. 9% （8/35） in control group respectively, the difference were not significant （ X2 = 0. 319, 0. 416, P = 0. 573, 0. 519 ） . There were significantly associations between the depression mood of one week before labor and the depressive symptoms of six weeks postpartum in both groups （ r = 0. 824,0. 677, both P values were 〈 0. 05 ）. The risk factors for maternal depression among high-risk pregnancy women were not ready for production（ OR = 2. 73, P 〈 0. 01 ） and fearing of childbirth safety （ OR = 2. 89, P 〈 0. 01 ）. Conclusion The depression date of high-risk pregnancy was high, especially at the time point one week before labor. Risk factors of maternal depression among high-risk pregnancy were ＂not ready for production＂ and ＂fear of childbirth safety＂.