初诊孕妇心理健康状况筛查和中高危人群干预分析

Screening and intervention of psychological moderate and high risk pregnant women

目的:了解初诊登记时的孕妇焦虑抑郁症状发生率、主要危险因素、参加干预比例和医务人员干预感受。方法:自2018年1月开始在医院产前门诊对初诊登记的孕妇开展试点干预,运用广泛性焦虑量表、患者健康问卷作为焦虑和抑郁症状的筛查工具,并进行危险因素筛查。对筛查出的心理中高危风险人群进行干预,由产科医务人员联合心理精神卫生人员开展,并对干预提供人员进行质性访谈。结果:分析了9488名孕妇,其中中度焦虑症状检出率3.0%,重度焦虑症状检出率1.4%;中度抑郁症状检出率18.1%,重度抑郁症状检出率5.2%;焦虑抑郁症状共病率3.4%。焦虑症状前3项危险因素依次为:有过月经前紧张症、过分担心胎儿在宫内生长健康状况、既往异常孕产史;抑郁症状前3项危险因素依次为:有过月经前紧张症、既往异常孕产史、本次怀孕来之不易;焦虑抑郁症状共病前3项危险因素依次为:有过月经前紧张症、过分担心胎儿在宫内生长健康状况、过分担心生产过程不顺利。心理中危风险孕妇中,有19.1%预约参加助产士和心理咨询师的联合门诊,有1.7%预约参加产科医生和心理专科护士的联合门诊;心理高危风险孕妇中,有2.2%预约参加心理多科会诊;有1.7%预约转诊外院精神科。访谈心理保健服务人员,认为需进一步加强心理干预能力,心理筛查评估工具改进有待商榷,孕妇寻求的问题涉及生理、心理、社会3个方面,影响孕妇就诊依从性包括多重因素。结论:开展的孕期心理保健服务具有可行性,但心理筛查量表有待进一步检验,产科医务人员的心理保健能力尚需加强,孕妇对心理保健服务依从性有待提高。

Objective To find out the occurrence of anxiety and depressive symptoms,and the major risk factors,and the participation rate,as well as the experience of medical personnel who are involved in the intervention.Methods Since January 2018,a pilot intervention had been carried out on pregnant women registered in the antenatal clinic.The Generalized Anxiety Disorder Scale and the Patient Health Questionnaires were used as screening tools for anxiety and depression symptoms,and risk factors were screened too.Interventions were carried out on the psychological moderate and high risk women by obstetric medical staff and mental health personnel.A qualitative interview was conducted on the intervention providers.Results A total of 9488 pregnant women were included,and the positive rate of moderate anxiety symptoms was 3.0%,the positive rate of severe anxiety symptoms was 1.4%;the positive rate of moderate depression symptoms was 18.1%,and the positive rate of severe depressive symptoms was 5.2%;the comorbidity rate of anxiety and depression symptoms was 3.4%.The first three risk factors for pregnant women with anxiety symptoms were:once had premenstrual stress symptom,excessive fear of fetal growth,previous abnormal maternal history;the first three risk factors for pregnant women with depressive symptoms:once had premenstrual stress symptom,previous abnormal maternal history,this pregnancy was cherished;the first three risk factors for pregnant women with moderate and above anxiety combined with depression were:once had premenstrual stress symptom,excessive fear of fetal growth,and fear the delivery process is not successful.Among the psychological moderate risk pregnant women,19.1%participated in the midwife joint counselor clinic,and 1.7%participated in the obstetrician joint psychological specialist nurse clinic,2.2%of the pregnant women with high risk participated in the psychological multidisciplinary consultation,and 1.7%referred to the psychiatric department.From the interviews,providers believed that it was necessary to further strengthen the ability of psychological intervention capacity,and the psychological screening tools needed to be improved,and the problems sought by pregnant women involved in physical,psychological and social aspects,and the influence of pregnant women's treatment compliance included multiple factors.Conclusions The psychological health care service during pregnancy was feasible,but the screening scales needed further examination.The mental health care ability of obstetric medical staff needed to be strengthened,and the compliance of pregnant women with mental health services needed to be improved.