浙江大学医学院附属妇产科医院初产妇社会资本对产前抑郁的影响

Effect of social capital on antenatal depression among primiparous women in Women's Hospital,School of Medicine,Zhejiang University

目的探讨社会资本与初产妇产前抑郁的关系,为基层妇幼保健机构管理和提高孕产妇健康水平提供依据。方法在浙江大学医学院附属妇产科医院随机调查1 471名初产妇,采用问卷调查获取一般人口学资料、社会资本得分、抑郁得分。比较产前抑郁与非产前抑郁组社会资本得分的差异;通过在文献研究及前期课题组研究结果的基础上,构建初产妇社会资本对产前抑郁影响的理论模型。利用结构方程模型拟合调查数据并对模型进行修正,验证初产妇社会资本与产前抑郁的关系及影响程度。结果结构方程模型拟合较好,城市模型的拟合指数χ~2=8.609、RMSEA=0.033、GFI=0.996;农村模型的拟合指数χ~2=0.289、RMSEA=0.033、GFI=1.000。初产妇认知性社会资本与结构性社会资本对产前抑郁影响的标准化路径系数分别为:城市-0.29和-0.17,农村-0.43和-0.12。认知性社会资本中社会互惠对产前抑郁的标准化总效应最大(P<0.01)。结论初产妇社会资本与产前抑郁呈显著负相关,其中认知性社会资本对产前抑郁的影响作用明显大于结构性社会资本。基层妇幼保健机构孕产妇健康管理服务可从社会资本的角度来预防产前抑郁的发生风险,提高孕产妇健康管理水平。

Objective To explore the relationship between social capital and antenatal depression of primiparous women,provide a basis for maternal and child health care institutions management at basic level and improve the level of maternal health. Methods A total of1 471 primiparous women were randomly collected from Women＇s Hospital,School of Medicine,Zhejiang University,the demographic information,social capital and antenatal depression scores were obtained by questionnaire survey,the scores of social capital in antenatal depression group and non-antenatal depression group were compared. Based on document research and the previous results of research group,a theoretical model about effect of social capital on antenatal depression among primiparous women was constructed,then the model was modified using overfitting survey data of structural equation model to verify the relaitonship between social capital and antenatal depression among primiparous women and the effect degree. Results Structural equation model presented a good fitting,urban fitting index： χ2= 8. 609,RMSEA = 0. 033,GFI = 0. 996; rural fitting index： χ2= 0. 289,RMSEA = 0. 033,GFI = 1. 000. The standardized path coefficients of effects of cognitive social capital and structural social capital on antenatal depression were-0. 29 and-0. 17（ urban area）,-0. 43 and-0. 12（ rural area）,respectively. The standardized total effect of influence of social reciprocity on antenatal depression was the highest among cognitive social capital（ P 0. 01）. Conclusion Social capital is significantly negatively correlated with antenatal depression among primiparous women,the effect of cognitive social capital on antenatal depression is significantly larger than those of structural social capital. The risk of antenatal depression can be prevented from the aspect of social capital in maternal health management service in maternal and child health care institutions at basic level to improve health management level of pregnant women.