不安全依恋、述情障碍对产后抑郁的影响研究

Relationship of postpartum depression to alexithymia and unsure attachment in postpartum women

目的探讨分娩前后述情障碍、不安全依恋和抑郁变化以及三者之间的关系。方法选取安阳市人民医院就诊的孕期≥28周的525名孕妇为研究对象,采用爱丁堡产后抑郁量表（EPDS）、依恋方式问卷[ASQ,包括安全型依恋（Attachment-secure）、焦虑/矛盾型依恋（Insecure-ambivalent）、回避型依恋（Insecure-avoidant）3个分量表]、多伦多述情障碍量表（TAS-20）进行测评。结果分娩后产妇焦虑/矛盾型依恋因子得分低于产前[（47.78±9.61）vs.（46.03±8.48）],差异有统计学意义（P〈0.05）。产妇EPDS得分与回避型依恋因子得分、焦虑/矛盾型依恋因子得分、TAS-20得分呈正相关（r=0.31~0.39,P均〈0.01）。逐步多元线性回归分析显示,产后EPDS得分与TAS-20得分、焦虑/矛盾型依恋得分呈正相关（β=0.24~0.28）,焦虑型依恋得分×TAS-20得分、回避型依恋×TAS-20得分与EPDS得分回归关系成立（β=0.15~0.32,P均〈0.05）。结论产妇焦虑型依恋分娩后降低,产后不安全依恋直接或间接与述情障碍相互作用于抑郁情绪。

Objective To explore the variation of depression, alexithymia ,unsure attachment of women who were in antenatal and postpartum, the relationship between postpartum depression, alexithymia and unsure attachment. Methods Totally 525 pregnant women were selected and followed-up. They were assessed with the Edinburgh Postnatal Depression Scale（ EPDS） to evaluate post-partum depression,assessed with the 20-item Toronto Alexithymia Scale （TAS-20） to evaluate alexithymia,assessed with the Attach-ment Style Questionnaire（ ASQ） consisting of the sub-scales of Attachment-secure, Insecure-ambivalent and Insecure-avoidant to evaluate insecure attachment. Results The scores of Insecure-ambivalent were lower in women after delivery than before [（47. 78 ＆#177; 9. 61）vs. （46. 03 ＆#177; 8. 48）, P〈0. 05]. The EPDS scores were positively correlated with the TAS-20 scores, Attachment-secure scores, Insecure-ambivalent scores（r=0. 31~0. 39,P〈0. 001） in postpartum women. Regression analysis showed that the EPDS scores were positively correlated with the TAS-20 scores and Insecure-ambivalent scores （β=0. 24~0. 28, P〈0. 05）. Regression analysis also revealed a dependency between the EPDS scores and the score of Insecure-ambivalent multiplied by TAS-20 , and In-secure-avoidant multiplied by TAS-20 （β=0. 15~0. 32, P〈0. 05）. Conclusion It suggests that alexithymia t may play a media-ting role between unsure attachment and postpartum depressions.