初产妇剖宫产后抑郁的心理状况及影响因素研究

Psychological status and influential factors of postpartum depression in primiparae after cesarean section

目的研究初产妇剖宫产后抑郁的心理状况及影响因素,为初产妇剖宫产后抑郁的预防及干预提供指导。方法对杭州市第七人民医院2016年1月至2020年1月剖宫产初产妇288例进行心理状态调查,应用抑郁自评量表(SDS)和爱丁堡产后抑郁自测量表(EPDS)进行评价,分析宫产后抑郁的影响因素。结果初产妇剖宫产后抑郁发生率为25.00%,其中存在抑郁状态的产妇SDS评分为(61.23±7.83)分,EPDS评分为(12.47±3.14)分,无抑郁状态的产妇SDS评分为(41.39±3.21)分,EPDS评分为(8.39±1.22)分,抑郁状态产妇SDS评分和EPDS评分均显著高于无抑郁状态产妇(t_(1)=15.30,P<0.001;t_(2)=15.87,P<0.001)。单因素分析显示,初产妇剖宫产后抑郁心理状况在产妇教育水平、家庭关系、婆媳关系、心理健康宣教、孕期抑郁状态、产时心理状态及配偶教育水平等方面比较,差异均有统计学意义(均P<0.05)。logistic回归分析显示,初产妇剖宫产后抑郁心理状况与家庭关系、婆媳关系、孕期抑郁状态、产时心理状态及配偶教育水平有关,其是导致初产妇剖宫产后抑郁心理状况的独立危险因素(P<0.05)。结论初产妇剖宫产后抑郁发生率高,家庭关系和配偶文化水平是影响抑郁的主要因素,应加强以家庭为中心的早期心理干预,提供更多的孕期疏导,促进产妇心理健康。

Objective To investigate the psychological status and the influential factors of postpartum depression in primiparae subjected to cesarean section and provide evidence for the prevention and treatment of postpartum depression in primiparae.Methods A total of 288 primiparae underwent a psychological status survey in Hangzhou Seventh People's Hospital from January 2016 to January 2020 and were included in this study.We evaluated their psychological status using the Self-rating Depression Scale(SDS)and the Edinburgh Postnatal Depression Scale(EPDS).The factors that affect postpartum depression were analyzed.Results The incidence of depression post-cesarean section was 25.00%in primiparae.The scores of SDS and EPDS were(61.23±7.83)points and(12.47±3.14)points in primiparae with a depressive status,which were significantly higher than those in primiparae without a depressive status[(41.39±3.21)points,(8.39±1.22)points,t_(1)=15.30,P<0.001;t_(2)=15.87,P<0.001).Univariate analysis results showed there was a significant difference in postpartum depressive psychological status in terms of maternal education level,family relationship,mother-in-law and daughter-in-law relationship,mental health education,depressive status during pregnancy,intrapartum psychological status,and spouse's education level(all P<0.05).Logistic regression analysis results showed that postpartum depressive status in primiparae was related to family relationships,mother-in-law/daughter-in-law relationships,the depressive status during pregnancy,intrapartum psychological status,and spouse's education level are independent risk factors for postpartum depression in primipara after cesarean section(P<0.05).Conclusion The incidence of postpartum depression is high in primiparae subjected to cesarean section.Family relationships and spouse's education level are the influential factors of depression.Family-oriented early psychological intervention should be strengthened to provide more counseling during pregnancy and promote maternal mental health.