枣庄市某医院产后抑郁横断面调查及危险因素分析

Cross-sectional survey and risk factors analysis of postpartum depression in a hospital in Zaozhuang City

目的调查枣庄市某医院产后抑郁(PPD)的发病率及其危险因素。方法选取2016年1月至2020年2月于本院咨询或就诊的2649名已分娩产妇作为研究对象,收集产妇临床资料与实验室检查资料,采用爱丁堡产后抑郁量表(EPDS)评估产妇PPD发生情况,统计PPD发病率,分析PPD发生的影响因素。结果最终纳入2543名已分娩产妇,排除106名,采纳率为96.00%;其中发生PPD 619例(纳入PPD组),发病率为24.34%(619/2543);未发生PPD 1924例(纳入非PPD组)。PPD组与非PPD组年龄、体重指数、吸烟史、文化程度、婚姻状态、家庭月收入、育儿知识了解程度、新生儿照护方式、对胎儿性别态度、配偶关系、婆媳关系、受孕方式、孕龄、产次、不良孕产史、分娩方式、抑郁症个人或家族史、孕期并发症、产前焦虑、母乳喂养自我效能量表(BSES)评分及血清游离甲状腺素(FT_(4))、总甲状腺素(TT_(4))、去甲肾上腺素(NE)、促甲状腺激素(TSH)、谷氨酸(Glu)、γ-氨基丁酸(GABA)、P物质、多巴胺(DA)、5-羟色胺(5-HT)、神经肽Y(NPY)水平比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,大专及以上学历、月嫂照护、亲密的配偶关系、BSES评分高及血清NE、TSH、GABA、DA、5-HT、NPY高水平是PPD发生的保护因素(OR<1,P<0.05);婆媳关系差、产前焦虑及血清Glu、P物质高水平是PPD发生的危险因素(OR>1,P<0.05)。结论产后抑郁发生率较高,其影响因素较多,其中婆媳关系差、产前焦虑及血清Glu、P物质高水平是PPD发生的危险因素,重视产前焦虑和抑郁筛查、做好产后母乳喂养培训与指导、给予专业性的产后护理对降低产后抑郁的发生具有积极意义,还应重视家庭因素对产后抑郁的影响;此外,NE、TSH、Glu、GABA、DA、P物质、5-HT、NPY水平在产后抑郁的早期预测中可能具有重要的临床意义,值得进一步研究探讨。

Objective To investigate the incidence and risk factors of postpartum depression(PPD)in a hospital in Zaozhuang City.Methods A total of 2649 pregnant women who delivery and consulted or treated in our hospital from January 2016 to February 2020 were selected as the research subjects,the clinical data and laboratory examination data of the puerperae were collected,and the Edinburgh Postpartum depression scale(EPDS)was used to evaluate the incidence of maternal PPD of the puerperae,the incidence of PPD was calculated and the influencing factors of PPD were analyzed.Results 2543 pregnant were finally included,106 pregnant were excluded,and the adoption rate was 96.00%;among them,619 cases of PPD occurred(included in the PPD group),and the incidence rate was 24.34%(619/2543);924 cases without PPD(included in the non-PPD group).There were significant differences in age,body mass index,smoking history,education level,marital status,monthly household income,knowledge of parenting,neonatal care methods,gender attitudes toward the fetus,relationship between spouses,relationship between mother-in-law and daughter-in-law,and method of conception,gestational age,parity,adverse maternal history,mode of delivery,personal or family history of depression,pregnancy complications,prenatal anxiety,breastfeeding self-efficacy scale(BSES)score and serum free thyroxine(FT_(4)),total thyroxine(TT_(4)),norepinephrine(NE),thyroid stimulating hormone(TSH),glutamate(Glu),gamma-aminobutyric acid(GABA),substance P,dopamine(DA),5-hydroxytryptamine(5-HT)and neuropeptide Y(NPY)levels between the PPD group and the non-PPD group(P<0.05).Multivariate Logistic regression analysis showed that college education and above,confinement care,close spousal relationship,high BSES score and high levels of serum NE,TSH,GABA,DA,5-HT,and NPY were protective factor for the occurrence of PPD(OR<1,P<0.05);poor relationship between mother-inlaw and daughter-in-law,prenatal anxiety and high levels of serum Glu,substance P were risk factors for the occurrence of PPD(OR>1,P<0.05).Conclusion The incidence of postpartum depression is high,and there are many influencing factors,poor relationship between mother-in-law and daughter-in-law,prenatal anxiety and high levels of serum Glu and P substances are risk factors for the occurrence of PPD,pay attention to prenatal anxiety and depression screening,doing postpartum breastfeeding training and guidance,and giving professional postpartum care have positive significance in reducing the incidence of postpartum depression,and the influence of family factors on postpartum depression should also be emphasized;in addition,NE,TSH,Glu,GABA,DA,substance P,5-HT,and NPY levels may have important clinical significance in the early prediction of postpartum depression,which deserves further research.