围产期情绪障碍发生状况及相关因素分析:前瞻性队列研究

Incidence and risk factors of peripartum mood disorder:a prospective cohort study

目的调查围产期情绪障碍的流行、发生状况及其危险因素,为临床预防和干预措施的制定提供参考。方法基于前瞻性队列研究设计,于2016年10月1日至2017年12月31日在北京市大兴区妇幼保健院募集孕早期(<13周)孕妇入组,使用宗氏焦虑自评量表和宗氏抑郁自评量表于孕中、晚期分别对孕妇的焦虑及抑郁状况进行评估,同时收集孕期生活方式、社会和环境因素暴露情况。采用t检验、Mann-Whitney U检验、χ^2检验及多因素logistic回归分析围产期情绪障碍的危险因素。结果(1)共有478例孕妇入组,460例(96.2%)孕妇完成孕中期随访,431例(90.2%)孕妇完成孕晚期随访[其中413例(86.4%)孕妇同时完成孕中、晚期随访]。(2)孕中期焦虑患病率为7.1%(30/425),抑郁患病率为13.9%(59/425);孕晚期焦虑患病率为11.2%(44/392),抑郁患病率为21.5%(84/390)。孕晚期焦虑发病率为7.7%(26/336),抑郁发病率为9.6%(30/313)。(3)横向数据分析:孕中期看电视时间长是孕中期焦虑筛查阳性的危险因素(OR=1.216,95%CI:1.055~1.402),运动是保护因素(OR=0.238,95%CI:0.105~0.541);睡眠时间长是孕中期抑郁筛查阳性的保护因素(OR=0.725,95%CI:0.554~0.950)。孕晚期看电视时间长是孕晚期焦虑筛查阳性的危险因素(OR=1.166,95%CI:1.044~1.303),运动是保护因素(OR=0.432,95%CI:0.212~0.879);运动也是孕晚期抑郁筛查阳性的保护因素(OR=0.450,95%CI:0.252~0.803)。(4)纵向数据分析:孕中期看电视时间长为孕晚期焦虑(OR=1.264,95%CI:1.117~1.432)及抑郁筛查阳性(OR=1.119,95%CI:1.005~1.246)的危险因素。结论孕晚期焦虑及抑郁的患病率均高于孕中期,孕晚期抑郁发病率高于焦虑发病率。孕中期看电视时间长是孕晚期焦虑及抑郁的危险因素。

Objective To investigate the incidence and risk factors of peripartum mood disorder(PPMD)in order to improve clinical prevention and intervention of this condition.Methods This was a prospective cohort study recruiting first-trimester pregnant women(<13 gestational weeks)from Beijing Daxing Maternal and Child Care Hospital from October 1,2016 to December 31,2017.Zung Self-rating Anxiety Scale(SAS)and Zung Self-rating Depression Scale(SDS)were used to evaluate the anxiety and depression status in the second and third trimesters,respectively.Their life styles,social and environmental factors exposure during pregnancy were also collected.Statistical analysis was conducted using Chi-square test,student's t test,Mann-Whitney U test and multivariate logistic regression.Results(1)A total of 478 subjects were enrolled in early pregnancy and 460(96.2%)and 431(90.2%)of them completed SAS and SDS assessment in the second and third trimesters,respectively,and 413(86.4%)of the subjects finished both assessments on two occasions.(2)The prevalence of anxiety and depression was 7.1%(30/425)and 13.9%(59/425)in the second trimester,and 11.2%(44/392)and 21.5%(84/390)in the third.The incidence of anxiety and depression in the third trimester was 7.7%(26/336)and 9.6%(30/313).(3)Cross-sectional data analysis showed that prolonged television watching was a risk factor of anxiety in the second(OR=1.216,95%CI:1.055-1.402)and third(OR=1.166,95%CI:1.044-1.303)trimester,while exercise was a protect factor(OR=0.238,95%CI:0.105-0.541;OR=0.432,95%CI:0.212-0.879).Pregnant women with longer sleeping time had lower risks of depression in the second trimester(OR=0.725,95%CI:0.554-0.950);those who did exercise had lower risks of depression in the third trimester(OR=0.450,95%CI:0.252-0.803).(4)Longitudinal-data analysis revealed that longer television watching time in the second trimester was a risk factor for anxiety(OR=1.264,95%CI:1.117-1.432)and depression(OR=1.119,95%CI:1.005-1.246)in the third trimester.Conclusions The prevalence of anxiety and depression in the third trimester is higher than that in the second trimester.The incidence of depression is higher than that of anxiety in the third trimester.Prolonged television viewing time in the second trimester is a risk factor for both anxiety and depression in the third trimester.