产妇新型冠状病毒肺炎疫情相关心理应激的调查与分析

Investigation and analysis of maternal psychological stress during COVID-19 epidemic period

目的探讨产妇新型冠状病毒肺炎疫情相关心理应激的影响因素和预防策略。方法选择2020年2月1日—2020年5月31日在中日友好医院产科分娩的所有产妇,按照横断面调查的样本量计算公式计算得到最小样本量为421例。考虑到存在一定的不应答率,将样本量设定为450例。产妇于分娩后第2~3天自行填写问卷[内容包括病案号、创伤后应激障碍自评量表(PCL-C)和应对策略3部分]。记录所有研究对象的基本情况、PCL-C筛查得分和3个维度得分,比较创伤后应激障碍(PTSD)筛查阳性组与PTSD筛查阴性组产妇和新生儿的情况。采用Spearman相关性分析检验产妇各应对策略得分与PCL-C筛查得分的相关性,多因素logistic回归分析检验PTSD发生的影响因素。结果450例产妇中,除外分娩双胎、早产儿或低体重儿、新生儿窒息的产妇后,共计430例纳入本研究。产妇PCL-C筛查得分为(29.07±9.53)分,回避、再体验、高警觉症状得分分别为(11.24±4.00)、(7.82±3.47)、(10.00±4.00)分。根据PCL-C筛查得分,将患者分为TPSD筛查阳性组(74例,17.2%)和PTSD筛查阴性组(356例,82.8%)。PTSD筛查阳性组产妇年龄显著小于PTSD筛查阴性组(P<0.05),男性新生儿比例、纯母乳喂养比例、初产妇比例均显著高于PTSD筛查阴性组(P值均<0.05),丈夫陪护比例、应对策略总分均显著低于PTSD筛查阴性组(P值均<0.05)。Spearman相关性分析结果显示,PCL-C筛查得分与戴口罩、重视手卫生、注意饮食卫生、保证睡眠充足、口罩按规定丢弃、监测体温、增加亲友线上联系、分享防护知识呈负相关(r值分别为-0.100、-0.162、-0.126、-0.251、-0.281、-0.164、-0.136、-0.147,P值均<0.05)。多因素logistic回归分析结果显示,初产妇(OR=2.991,95%CI为1.304~4.791)、应对策略得分(OR=0.925,95%CI为0.892~0.980)、自然分娩(OR=0.102,95%CI为0.323~0.950)、纯母乳喂养(OR=1.886,95%CI为1.267~4.092)、产后丈夫陪护(OR=0.422,95%CI为0.159~0.700)是PTSD发生的影响因素(P值均<0.05)。结论初产妇和非自然分娩、纯母乳喂养、产后无丈夫陪护的产妇在疫情期间PTSD发生风险较高,应有针对性地帮助产妇建立保护性应对策略,保障其产后健康。

Objective To explore the influencing factors and prevention strategies of maternal psychological stress during COVID-19 epidemic period.Methods All women who delivered in Department of Obstetrics of China-Japan Friendship Hospital from February 1,2020 to May 31,2020 were selected.According to the sample size formula of cross-sectional survey,the minimum sample size calculated was 421.Considering that there was a non-response rate,the sample size was set to 450.All subjects filled out the questionnaire(including medical record number,the post-traumatic stress disorder[PTSD]checklist-civilian version[PCL-C]and coping strategies)on the second or third day after delivery.The basic information and PCL-C screening score of all subjects were recorded.Medical data of maternal and neonatal conditions were compared between PTSD positive group and negative group.Spearman correlation analysis was used to analyze the correlation between the scores of coping strategies and PCL-C screening scores.Multivariate logistic regression analysis was used to analyze the influencing factors of psychological stress.Results A total of 430 parturients were enrolled in this study,except those who delivered twins,premature or low birth weight infants and neonatal asphyxia.The score of PCL-C screening was(29.07±9.53).The score of avoidance,re-experience and high alert symptoms were 11.24±4.00,7.82±3.47 and 10.00±4.00,respectively.According to the PCL-C screening score,the parturients were divided into PTSD positive group(74 cases,17.2%)and PTSD negative group(356 cases,82.8%).The parturients in the PTSD positive group were significantly younger than those in the PTSD negative group(all P<0.05).The proportions of male newborns,exclusive breast-feeding and primipara in the PTSD positive group were significantly higher than those in the PTSD negative group(all P<0.05).The proportion of husband in attendance after delivery and the total score of coping strategies in the PTSD positive group were significantly lower than those in the PTSD negative group(both P<0.05).Spearman correlation analysis showed that the PCL-C screening score was negatively correlated with wearing masks,paying attention to hand hygiene,paying attention to food hygiene,keeping enough sleep,discarding masks by rules,monitoring body temperature regularly,more online contact with relatives and friends,and sharing protection knowledge(r=-0.100,-0.162,-0.126,-0.251,-0.281,-0.164,-0.136,-0.147,all P<0.05).Multivariate logistic regression analysis showed that primipara(OR=2.991,95%CI:1.304-4.791),coping strategy score(OR=0.925,95%CI:0.892-0.980),vaginal delivery(OR=0.102,95%CI:0.323-0.950),exclusive breast-feeding(OR=1.886,95%CI:1.267-4.092),and husband in attendance after delivery(OR=0.422,95%CI:0.159-0.700)were the influencing factors of PTSD(all P<0.05).Conclusion There is high risk of PTSD in primipara and in women experiencing unnatural childbirth,exclusive breast-feeding,and without husband's accompanying after delivery.Measures should be taken to help new mothers establish protective coping strategies for postpartum health.