母亲创伤后应激障碍及焦虑在早产儿临床特征和母亲照护反应间的中介作用

The mediating role of maternal post-traumatic stress disorder and anxiety between clinical characteristics of preterm infants and maternal care responses

目的调研校正1月龄新生儿重症监护室(NICU)出院早产儿临床特征、母亲创伤后应激障碍(PTSD)、焦虑和母亲照护反应现状,定量分析母亲PTSD、焦虑在早产儿临床特征和母亲照护反应之间的中介作用。方法回顾性分析上海市第一妇婴保健院2016年4月至2019年7月收治的256例早产儿及其母亲的临床资料,包括围生期特征问卷、母亲PTSD问卷、焦虑自评量表和4个照护反应问卷,各变量之间进行相关性分析,并通过结构方程模型分析中介效应。结果早产儿母亲的产后PTSD、焦虑发生率分别为29.7%和15.6%。Pearson相关性分析显示,出生胎龄和母亲PTSD、焦虑呈负相关(r=-0.598、-0.526,P<0.01),母亲PTSD、焦虑和母亲照护能力呈负相关(r=-0.516、-0.495,P<0.01),和照护困难各维度呈正相关(r=0.420~0.605,P均<0.01)。结构方程模型显示,就母亲的照护能力而言,母亲PTSD、焦虑均对母亲照护能力发挥消极的直接效应(β_(direct)=-0.245、-0.225),出生胎龄对母亲照护能力有积极的直接效应(β_(direct)=0.356),并通过母亲PTSD、焦虑发挥积极的间接效应(效应量为0.189)。就母亲的照护困难而言,母亲焦虑对母亲照护困难起到积极的直接效应(β_(direct)=0.224),出生胎龄对母亲照护困难有消极的直接效应(β_(direct)=-0.277),并通过母亲PTSD、焦虑发挥消极的间接效应(效应量为-0.264)。结论母亲PTSD和焦虑越严重,母亲照护能力越弱,对早产儿照护困难的感知越明显,该情绪困扰在早产儿出生胎龄和母亲照护反应之间起到中介作用。医疗卫生机构可从加强早产儿母亲心理健康的支持和干预,特别是针对产后PTSD和焦虑的预防和治疗,以帮助母亲提高照护能力,改善不良照护反应。

Objective To investigate the clinical characteristics of preterm infants after being discharged from the neonatal intensive care unit(NICU),post-traumatic stress disorder(PTSD),maternal anxiety and the current status of maternal care responses,and to analyze the mediating effects of PTSD and maternal anxiety between the clinical characteristics of preterm infants and maternal care responses.Methods A hospital-based study was conducted at Shanghai First Maternal and Infant Hospital from April 2016 to July 2019 for preterm infants and their mothers who participated in outpatient follow-up after discharge from the NICU.The clinical data from 256 preterm infants and their motherswere retrospectively analyzed using the Post-traumatic Stress Disorder Questionnaire,the Self-rating Anxiety Scale,and four care responses questionnaires.Correlations among variables were analyzed,and the mediating effects were examined using structural equation modeling.Results The prevalence of postnatal PTSD and anxiety among mothers of preterm infants was 29.7%and 15.6%,respectively,and Pear‑son's correlation analyses showed that gestational age at birth was significantly negatively correlated with PTSD and maternal anxiety(r=-0.598,-0.526,P<0.01),and that PTSD,maternal anxiety and maternal caregiving capacity were significantly negatively correlated(r=-0.516,-0.495,P<0.01)and positively correlated with all dimensions of caregiving difficulties(r=0.420~0.605,P<0.01).Structural equation modeling showed that in terms of maternal caregiving capacity,maternal PTSD and anxiety had a significant negative direct effect on maternal caregiving capacity(β_(direct)=-0.245,-0.225),while gestational age at birth had a positive direct effect on maternal caregiving capacity(β_(direct)=0.356),and a significant positive indirect effect through maternal PTSD and anxiety(effect size of 0.189).In terms of mothers'caregiving difficulties,maternal anxiety had a positive direct effect on mothers'caregiving difficulties(β_(direct)=0.224),birth gestational age had a negative direct effect on mothers'caregiving difficulties(β_(direct)=-0.277),and significantly exerted a negative indirect effect through mothers'PTSD,and anxiety(effect size of-0.264).Conclusions This study identified the more severe the mother's PTSD and anxiety,the weaker the mother's caregiving capacity and the more pronounced the perceived difficulties in caring for the preterm infant,and this emotional distress mediates the relationship between the preterm infant's birth gestational age and maternal care response.Healthcare providers can benefit from enhanced mental health support and interventions for mothers of preterm infants,especially prevention and treatment for postpartum PTSD and anxiety,to help mothers improve their caregiving capacity and adverse care responses.