产后母亲抑郁症状变化对儿童行为功能的影响

Effect of changes in postpartum maternal depressive symptoms on child behavioral function

目的 探讨产后母亲抑郁症状变化对儿童行为功能的影响。方法 收集2017年1月至2019年5月在青海红十字医院接受产前检查的270名妊娠中期(孕14~27周)孕妇(母亲)及其所生子女(儿童)作为研究对象。按照母亲抑郁的不同轨迹,将其分为无抑郁症状组(n=174)、产前抑郁症组(n=23)、产后抑郁症组(n=30)、持续性抑郁症组(n=43)。在儿童36个月时,应用儿童行为量表(CBCL)评估其行为;在母亲妊娠17周、32周,以及产后6周、6个月、12个月和36个月时,应用爱丁堡产后抑郁量表(EPDS)、抑郁自评量表(DSRS)评估其抑郁症状。分析母亲产前抑郁症、产后抑郁症、持续性抑郁症与儿童行为问题之间的关系。结果 在不同抑郁轨迹组中,母亲的年龄(F=8.263)、怀孕时长(F=18.506)、产后连结(F=16.033),以及阴道分娩(χ^(2)=9.076)、大学教育(χ^(2)=12.462)、就业(χ^(2)=14.873)、伴侣暴力经历(χ^(2)=10.375)、至少吸烟1次(χ^(2)=17.246)、压力大的生活事件(χ^(2)=8.850)、伴侣对儿童的支持很少或没有(χ^(2)=4.871)、抑郁症史(χ^(2)=34.906)的比例比较差异均有统计学意义(P<0.05);儿童的CBCL评分(总问题、内化问题和外化问题)比较差异也均有统计学意义(F值分别为23.892、20.573、28.390,P<0.05)。加入产后连结后,母亲产前抑郁症与儿童CBCL总问题得分、外化问题得分有关联(B值分别为2.975、1.834,P<0.01,模型3);母亲年龄与儿童CBCL总问题(B值分别为-0.199、-0.197)、内化问题(B值分别为-0.064、-0.064)、外化问题(B值分别为-0.131、-0.129)得分有关联(P<0.05,模型2和模型3);产后连结与儿童CBCL总问题(B=0.469)、内化问题(B=0.130)、外化问题(B=0.286)得分有关联(P<0.001,模型3)。产后连结的中介分析显示,母亲产后抑郁症和持续性抑郁症对儿童CBCL量表(总问题、内化问题、外化问题)都显示出相对较高的间接影响,而母亲产前抑郁症对其都显示出强烈的直接影响。结论 母亲产后抑郁症的发作类型和持续时间可能对儿童的行为功能发展有不同的影响。

Objective To investigate the effects of changes in postpartum maternal depressive symptoms on child behavioral function.Methods A total of 270 pregnant women in the middle of pregnancy(14-27 gestation weeks) and their children who underwent antenatal checkups at the Qinghai Red Cross Hospital from January 2017 to May 2019 were collected as study subjects.According to the different types of maternal depression,they were divided into the group with no depressive symptoms(n=174),the group with antenatal depression(n=23),the group with postnatal depression(n=30),and the group with persistent depression(n=43).Children's behavior was assessed using the Child Behavioral Checklist(CBCL) at 36 months of age.Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale(EPDS),and the Depression Self-rating Scale(DSRS) at 17 and 32 weeks of gestation,and at 6 weeks,6 months,12 months and 36 months postnatally.The relationships between maternal antenatal depression,postnatal depression,persistent depression and behavioral problems in children were analyzed.Results In different depression track groups,maternal age(F=8.263),pregnancy duration(F=18.506),postpartum bonding(F=16.033),vaginal delivery(χ^(2)=9.076),college education(χ^(2)=12.462),occupation(χ^(2)=14.873),partner violence experience(χ^(2)=10.375),smoking at least once(χ^(2)=17.246),stressful life events(χ^(2)=8.850),little or no support for the children(χ^(2)=4.871),and depression history(χ^(2)=34.906) were all statistically significant(P<0.05).The differences in the CBCL scores(total,internalizing,and externalizing problems) were also statistically significant(F=23.892,20.573,and 28.390,respectively,P<0.05).In model 3,after including postpartum bonding,maternal prenatal depression was associated with CBCL total and externalizing question scores(B=2.975 and 1.834,respectively,P<0.01).In both model 2 and model 3,maternal age was associated with CBCL total(B=-0.199 and-0.197,respectively),internalizing(B=-0.064 and-0.064,respectively),and externalizing(B=-0.131 and-0.129,respectively) question scores(all P<0.05).In model 3,postpartum bonding was associated with CBCL total,internalizing,and externalizing question scores(B=0.469,0.130,and 0.286,respectively,P<0.001).Mediated analyses of the postpartum bonding showed that both maternal postnatal depression and persistent depression showed relatively high indirect effects on CBCL scores(total questions,internalizing questions,externalizing questions),whereas maternal antenatal depression showed a strong direct effect on all of them.Conclusion Different episode types and durations of maternal depression may have different effects on the children's behavioral development.