高危妊娠女性创伤后应激障碍现状及影响因素

Status quo and its influencing factors of posttraumatic stress disorder in high-risk pregnant women

[目的]探讨高危妊娠女性创伤后应激障碍现状,以及疾病不确定感、应对方式与创伤后应激障碍之间的关系及作用路径,建立三者的关系模型。[方法]采用一般资料调查表、创伤后应激障碍清单平民版、Mishel疾病不确定感量表和特质应对问卷对南京市某三级甲等综合医院待产的306例高危妊娠女性进行调查。[结果]高危妊娠女性的创伤后应激障碍阳性率为16.3%,低学历、非独生女、无固定工作、存在疾病史或创伤史、双胎妊娠及睡眠质量不满意的高危妊娠女性得分较高(P<0.05)。疾病不确定感可以直接或通过不同的应对方式间接影响创伤后应激障碍水平,应对方式在疾病不确定感与创伤后应激障碍症状之间能够起到完全或部分中介作用。[结论]建议加强对高危妊娠女性心理需求的理解和支持,借助产科护理门诊提供高危妊娠人群的集中管理,给予与疾病相关的充足且具有实际指导意义的信息,以降低疾病不确定感,帮助调节孕期不良情绪反应,通过强化积极正向的应对方式缓解应激症状。

Objective:To investigate the status quo of post-traumatic stress disorder in high-risk pregnant women,and to probe into the correlations and acting paths among disease uncertainty,coping style and post-traumatic stress disorder,so as to establish a relationship model of the three.Methods:A total of 306 high-risk pregnant women waiting for delivery in a Tertiary Grade A hospital in Nanjing were investigated by using the general data questionnaire,PTSD Checklist-Civilian version(PCL-C),Mishel's Uncertainty in Illness Scale(MUIS)and Coping Style Questionnaire(CSQ).Results:The positive incidence of post-traumatic stress disorder in high-risk pregnant women was 16.3%.High-risk pregnant women with lower education level,non-one-child female,unfixed work,the history of illness or trauma,twin pregnancy and poor sleep quality,scored higher than others(P<0.05).Uncertainty in illness could directly affect the level of post-traumatic stress disorder or indirectly work through different coping styles.The coping style played a full or partial mediator between the disease uncertainty and the symptoms of post-traumatic stress disorder.Conclusions:It is suggested to strengthen the understanding and support of the psychological needs of high-risk pregnant women.It is recommended to provide centralized management of high-risk pregnant people by mean of obstetric nursing clinics,and to provide sufficient and practical guidance information related to diseases in order to reduce the uncertainty of disease.Thus,to help regulate adverse emotional reactions during pregnancy.Medical staff could relieve pregnant women stress symptoms by strengthening their positive coping styles.