自然流产女性精神健康问题的相关危险因素分析

Analysis of related risk factors of mental health problems of women with spontaneous abortion

目的:探讨自然流产(SA)育龄女性精神健康问题的相关影响因素。方法:选择2021年7月1日至12月31日在四川大学华西第二医院急诊科就诊,并既往发生确诊为SA的130例女性为研究对象。采用爱丁堡产后抑郁量表(EPDS)评估抑郁症状及程度,状态焦虑量表(SAI)评估焦虑症状和程度,围产期悲伤量表(PGS)评估围产期悲伤程度,婚姻适应量表(DAS)中的婚姻满意度(DS)子量表评估婚姻满意程度,普莱斯基尼(PG)量表评价对医疗和护理满意程度。通过调查问卷收集这113例SA女性的个人基本信息、精神健康问题(抑郁、焦虑和悲伤),婚姻及就医满意度等资料,并分析其相关影响因素。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。结果:①113例SA女性中,55.8%(63/113)存在抑郁可能(EPDS抑郁评分≥10分)、43.4%(49/113)存在明显悲伤(PGS悲伤评分>90分),SAI、DAS及PG评分平均值分别为31.7分、40.7分及48.8分。②Spearman相关性分析结果显示,EPDS抑郁评分与SAI焦虑评分呈正相关关系(r=0.306,P=0.001)。③单因素分析结果显示,PGS悲伤评分在不同学历、有无子女间比较,差异有统计学意义(P<0.05);既往SA总次数为1次者的SAI焦虑评分显著高于≥2次者,并且差异有统计学意义(P<0.05);EPDS抑郁评分在有无子女和未来有无妊娠计划间比较,差异有统计学意义(P<0.05)。④多重线性回归分析结果显示,无子女及有未来妊娠计划是EPDS抑郁评分增加的主要危险因素,高学历(本科及以上)及无子女是PGS悲伤评分增加的主要危险因素。结论:精神健康问题在SA女性中普遍存在,既往单次SA、无子女、有未来妊娠计划、高学历是导致SA女性精神健康问题发生和加重的危险因素。

ObjectiveTo explore the mental health problems of women with spontaneous abortion (SA) and analyze its related influencing factors.MethodsA total of 130 women who were diagnosed as SA in the Department of Emergency of West China Second University Hospital, Sichuan University from July 1 to December 31, 2021 were enrolled in the study. Edinburgh Postpartum Depression Scale (EPDS), State Anxiety Scale (SAI), Perinatal Sadness Scale (PGS), Marriage Satisfaction Scale (DS) in Marriage Adaptation Scale (DAS) and Preskini Scale (PG) were used to evaluate the symptoms and degrees of depression. The general information, mental health problems (depression, anxiety and sadness), marriage and medical satisfaction of these 113 SA women were collected through questionnaires, and the related influencing factors were analyzed. The procedures followed in this study were in accordance with the Helsinki Declaration of the World Medical Association revised in 2013.Results① A total of 113 women with SA were included, of which 55.8% (63 / 113) had the possibility of depression (EPDS depression score ≥ 10 points), 43.36% (49 / 113) had obvious sadness (PGS sadness score>90 points), and the average score of SAI, DAS and PG were 31.7, 40.7, and 48.8 points. ②Spearman correlation analysis showed that EPDS depression score was positively correlated with SAI anxiety score (r=0.306, P=0.001). ③The results of univariate analysis were as follows. PGS score was statistically significant (P<0.05) compared with different educational qualifications, and the presence or absence of children, and SAI anxiety score of those who had SA once in the past was significantly higher than those who had SA twice or more, and the difference was statistically significant (P<0.05). The difference in EPDS depression score was statistically significant between the presence or absence of children and the planned future pregnancy (P<0.05). ④ The results of multiple linear regression analysis showed that childlessness and future pregnancy plans were the main risk factors for the increase of EPDS depression score, and advanced education (bachelor degree or above) and childlessness were the main risk factors for the increase of PGS sadness score.ConclusionsMental health problems are prevalent among SA women. Previous SA, childlessness, future pregnancy plans, and high education level are risk factors for the occurrence and aggravation of mental health problems in women with SA.