不明原因复发性流产患者生育压力与抑郁症状间的关系:心理弹性的中介作用

Relationship between fertility pressure and depressive symptoms in patients with unexplained recurrent spontaneous abortion:Mediating role of psychological resilience

目的:研究不明原因复发性流产(URSA)患者生育压力与抑郁症状间的关系以及心理弹性的中介作用。方法:以2017年12月至2020年12月间某院236例URSA患者为样本进行问卷调查,采用生育问题调查问卷(FPI)评估生育压力,医院焦虑抑郁量表(HADS)评估抑郁症状,采用心理弹性量表(CD-RISC)评估心理弹性,然后采用Pearson积差系数分析URSA患者生育压力、心理弹性以及抑郁症状间的相关性,采用Hayes编制的SPSS Process组件检验中介模型,采用偏差校正的Bootstrap法检验回归系数并计算95%置信区间。结果:本次共发放问卷236份,回收有效问卷219份(92.80%),其中FPI评分52~206(136.68±34.15)分,CD-RISC评分26~89(61.81±13.02)分,HADS评分1~16(7.72±2.38)分;Pearson积差系数分析显示,URSA患者生育压力、心理弹性及抑郁症状间两两均具有明显相关性(r=-0.141,0.398,-0.423;P<0.05);将年龄和受教育程度作为控制变量放入分层回归分析第1层,结果显示为影响URSA患者抑郁症状的重要因素,可解释15.8%抑郁症状变化(P<0.001),第2层加入变量FPI评分后可解释变异量为28.2%,额外增加12.4%(P<0.001),第3层加入中间变量CD-RISC后可解释抑郁症状变异量为37.5%,额外增加了9.3%(P<0.001);将抑郁症状作为因变量,生育压力和心理弹性分别为自变量和中介变量,采用SPSS Process组件Model 4分析中介效应,其Bootstrap检验95%CI区间均不包含0,表明中介效应具有统计学意义(P<0.001),且直接效应在总效应中占比占比为85.71%,心理弹性中介效应占比14.29%。结论:URSA患者存在明显抑郁症状,其中生育压力是引起抑郁症状的重要影响因素,且心理弹性在其中发挥重要中介作用。

Objective:To study the relationship between fertility pressure and depressive symptoms in patients with unexplained recurrent spontaneous abortion(URSA)and the mediating role of psychological resilience.Methods:A questionnaire survey was conducted among 236 patients with URSA in our hospital from December 2017 to December 2020.Fertility Problem Inventory(FPI)was used to assess the fertility pressure,and Hospital Anxiety and Depression Scale(HADS)was applied to evaluate the depressive symptoms.Connor-Davidson Psychological Resilience Scale(CD-RISC)was used to assess the psychological resilience,and Pearson product-moment coefficient was applied to analyze the correlation between fertility pressure,psychological resilience and depressive symptoms in patients with URSA.SPSS Process component compiled by Hayes was used to test the mediating model,and bias-corrected Bootstrap method was applied to test the regression coefficient and calculate the 95%confidence interval.Results:A total of 236 questionnaires were issued this time,and 219 valid questionnaires were recovered,with an effective rate of 92.80%.The FPI score was 52~206 points with an average of(136.68±34.15)points,and the CD-RISC score was 26~89 points with an average of(61.81±13.02)points,and the HADS score was 1~16 points with an average of(7.72±2.38)points.Pearson product-moment coefficient analysis showed that there was a significant correlation between any two of fertility pressure,psychological resilience and depressive symptoms among patients with URSA(r=-0.141,0.398,-0.423;P<0.05).Age and educational level were put into the first layer of the stratified regression analysis as control variables,showing that they were important factors affecting the depressive symptoms of patients with URSA,which could explain 15.8%of the changes in depressive symptoms(P<0.001).Adding the variable FPI score in the second layer explained the variation of 28.2%,with an additional 12.4%increase(P<0.001),and adding the intermediate variable CD-RISC in the third layer explained variation of the depressive symptoms of 37.5%,with an additional 9.3%increase(P<0.001).Taking depressive symptoms as the dependent variables,fertility pressure as an independent variable and psychological resilience as a mediating variable,SPSS Process component Model 4 was used to analyze the mediating effect,and its Bootstrap test 95%CI interval didn’t not contain 0,indicating that the mediating effect was statistically significant(P<0.001),and the direct effect accounted for 85.71%of the total effect and the mediating effect of psychological resilience accounted for 14.29%.Conclusion:There are obvious depressive symptoms among patients with URSA.Fertility pressure is an important influencing factor of depressive symptoms,and psychological resilience plays an important mediating role.