上海市闸北区孕产妇焦虑、抑郁症状发生率及相关因素

The Prevalence of Anxiety and Depression in Late Pregnant Women before and after Childbirth

目的:了解孕产妇焦虑、抑郁症状的发生情况及其相关因素。方法:采用综合医院用焦虑抑郁量表(HAD)、爱丁堡产后抑郁量表(EPDS)、产后抑郁筛查量表(PDSS)和孕晚期甲状腺素TT4、FT4测定对1238例孕产妇在孕晚期、产后1周、4周、8周、12周进行随访评估。结果:①五个时点HAD的焦虑发生率为5.2%、5.12%、4.95%、3.9%、2.53%;抑郁发生率:4.07%、10%、9.48%、6.23%、1.85%。②EPDS评估产后四个时点抑郁发生率为:10.08%、9.98%、8.64%、2.36%。③PDSS评估产后四个时点抑郁发生率为:9.84%、9.48%、7.48%、2.11%。④35岁以上高龄孕妇在孕晚期及产后1周、产后4周时抑郁、焦虑症状的比例明显高于35岁以下的产妇。⑤孕晚期有焦虑或抑郁症状的孕妇,在产后1周、4周、8周、12周发生抑郁的比例明显高于同期非焦虑或抑郁症状的孕妇。⑥孕晚期及产后1周、4周、8周、12周有抑郁症状孕产妇孕晚期TT4、FT4值均明显低于同期非抑郁症状的孕产妇,且低于正常范围。⑦孕晚期焦虑/抑郁症状相关的主要危险因素为夫妻感情、孕前是否有抑郁症史和对分娩育儿知识的了解情况。⑧产后抑郁的主要危险因素为夫妻感情、对分娩育儿知识的了解情况、工作学习压力、产妇本人是否有性别歧视、孕前是否有抑郁症史、孕期是否有持续两周以上的焦虑、烦躁、孕期是否有持续两周以上的情绪低落。结论:孕晚期及产后均有一定比例的焦虑和抑郁症状。孕晚期和产后焦虑/抑郁症状相关的危险因素不同。

Objective： To investigate the prevalence of anxiety and depression and their related factors in the late preg- nant women（LPW） before and after childbirth. Methods： 1238 LPW from Zhabei central hospital and tongji hospital were enrolled in this study. Hospital Anxiety and Depression Scale（HAD）, Edinburgh Postnatal Depression Scale（EPDS） and Postpartum Depression Screening Scale（PDSS） were used to evaluate anxiety and depressive symptoms, and the thyroxine TT4 and FT4 were measured during the late pregnancy, and after delivering 1 week, 4 weeks, 8 weeks and 12 weeks. Re- suits： （~）According to HAD, the prevalence of anxiety in different five time points was 5.2%, 5.12% ,4.95%, 3.9% and 2.53%, and the prevalence of depression was 4.07%, 10% ,9.48% ,6.23% and 1.85%. （~）The prevalence of depression was significantly higher in women over 35 years old than those of women less 35 years old during late pregnancy, and after deliv- ery lweek and 4 weeks. （~）Compared with the women without depression and anxiety, those with depression and anxiety at the late pregnancy had higher prevalence of depression or anxiety and TF4 scores, and lower FT4 scores after laboring 1 week, 4 weeks, 8 weeks, 12 weeks. （~The major related risk factors for anxiety and depression during late pregnancy includ- ed husband and wife relationship, history of depression and parenting knowledge for delivery; while after delivery, the major risk factors for anxiety and depression included husband and wife relationship, child care knowledge for delivery situation, working and studying pressure, maternal fetal gender discrimination, the history of depression, anxiety or depressive mood with more than two weeks during the pregancy. Conclusion： The findings suggest that more clinical attention need to be paid to the anxiety and depression in the late-pregnant women. Specially, the different risk factors for the late-pregnant and lying-in women suggest different ways of prevention and intervention in the pregnant women before and after childbirth.