胎儿畸形孕妇引产病耻感对引产前抑郁症状的影响效应及路径

Effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly

目的:探讨胎儿畸形孕妇引产病耻感对引产前抑郁症状的影响效应及作用路径。方法:基于文献回顾,采用自制一般人口学资料调查表、爱丁堡产后抑郁量表、个体水平引产病耻感量表、接纳与行动问卷第2版、认知融合分问卷中文版、社交性应激反应问卷、领悟社会支持量表对在长沙市三级综合医院和妇幼专科医院住院的胎儿畸形孕妇进行引产前抑郁症状调查,建立引产前抑郁症状影响因素的假设模型,应用结构方程模型分析方法对假设模型进行验证。结果:结构方程模型显示:引产病耻感直接或间接通过心理灵活性、社会支持和应激反应中的逃避应对正向影响引产前抑郁症状,其总效应值为0.55(P<0.05),其中直接效应值为0.22(P<0.05),总间接效应值为0.33(P<0.05)。在各中介效应中,心理灵活性与社会支持具有保护性中介效应,而逃避应对具有危害性中介效应。结论:引产病耻感对胎儿畸形孕妇引产前抑郁症状的危害较大,其中以间接危害为主。临床工作中采取有效措施降低胎儿畸形孕妇病耻感,提高其心理灵活性,改善社会支持和应对方式将会对预防和减轻引产前抑郁症状产生重要影响。

Objective:To explore the effect and pathway of abortion stigma on depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly.Methods:Based on literature review,a self-made general demographic information questionnaire,the Edinburgh Postnatal Depression Scale,the Individual Level Abortion Stigma Scale,the Acceptance and Action Questionnaire-II,the Cognitive Fusion Questionnaire-Fusion,the Responses to Stress Questionnaire and the Perceived Social Support Scale were used to investigate pregnant women with fetal anomaly before abortion in tertiary general hospitals and specialist maternity hospitals in Changsha,to develop a hypothesis model of the factors influencing depressive symptoms before terminating the pregnancy.The hypothesis model was verified by applying structural equation modelling analysis.Results:The structural equation model showed that the stigma directly or indirectly influenced depressive symptoms before terminating the pregnancy via psychological flexibility,social support and avoidance coping.The total effect value was 0.55(P<0.05),the direct effect value was 0.22(P<0.05),and the indirect effect value was 0.33(P<0.05).Psychological flexibility and social support had protective mediating effects,while avoidance coping had harmful mediating effects.Conclusion:Abortion stigma has large positive effect on the depressive symptoms before terminating the pregnancy in pregnant women with fetal anomaly.Among direct and indirect effect,the indirect effect is major.Effective measures to reduce the stigma,increase psychological flexibility,improve social support and coping style will have an important influence on the prevention and reduction of depressive symptoms before terminating the pregnancy.