不良妊娠对产妇心理影响及心理干预效果评价

Effect of adverse pregnancy on maternal mentality and evaluation of psychological intervention

目的:引产可能是一个难以应付的事件,并可能导致心理障碍的发展。这项研究的目的是评估和预测引产后的创伤后应激障碍(PTSD)症状,并探讨心理干预后的效果。方法:2014年12月-2017年5月期间温州医科大学附属第二医院接收了344名不良妊娠产妇。分别在引产后数小时内(T1)、第4周(T2)和第7周(T3)完成了几项调查问卷:事件量表修订版(IES-R),社会支持多维量表(MSPSS),创伤分离经验问卷(PDEQ),创伤情绪表(PEL),医院焦虑和抑郁量表(HADS)和围产期悲伤量表(PGS)。在引产后第4周对需要紧急治疗的妇女采取心理干预。结果:引产后4周,33%的妇女发现具有潜在的PTSD,焦虑症状显著增多。与引产后4周相比,产妇在引产后第7周的创伤后分离、抑郁和焦虑、精神情绪和丧亲之痛评分均显著降低(P <0. 05)。分层多元回归分析显示,心理干预、创伤分离、消极情绪是PTSD症状的影响因子。Sobel检验结果显示,创伤后分离、消极情绪、焦虑和抑郁症状是心理干预和PTSD症状之间关系的重要介质(Sobel-Z=2. 17、2. 39、2. 48,均P <0. 01)。结论:不良妊娠给产妇的心理造成不同程度的影响,需要为女性提供心理支持,并制定预防策略。

Objective Abortion can be a difficult event to cope with and can lead to the development of psychological disturbance. The aim of this prospective and longitudinal study was to assess and predict posttraumatic stress disorder（PTSD）symptoms following abortion. Moreover,this study aimed to explore the effect of psychological intervention. Methods During the period from December 2014 to May 2017,344 pregnant women were approached a few hours（T1） after the abortion and then 4（T2）,7 weeks（T3） later. Several questionnaires were completed： the Impact of Event Scale Revised（IES-R）,the Multidimensional Scale of Social Support（MSPSS）,the Peritraumatic Dissociative Experience Questionnaire（PDEQ）,the Peritraumatic Emotions List（PEL）,the Hospital Anxiety and Depression Scale（HADS）,and the Perinatal Grief Scale（PGS）. Four weeks after the abortion,psychological intervention was taken for women who needed emergency treatment. Results Four weeks after abortion,a potential PTSD was found in 33% of the women,with a significant increase in anxiety symptoms. Compared with the fourth week after abortion,the scores of posttraumatic separation,depression and anxiety,mental and bereavement pain in the seventh week after abortion were significantly decreased（P〈0. 05）. The stratified multivariate regression analysis showed that psychological intervention,trauma separation and negative emotion were the factors affecting the symptoms of PTSD. Sobel test showed that post-trauma separation,negative emotions,anxiety and depression were important mediators between psychological intervention and PTSD symptoms（Sobel-Z = 2. 17,2. 39,2. 48,all P〈0. 01）.Conclusions By providing evidence on some of the main risk factors,this study highlights the need for psychological support for women and strategies of prevention to be developed.