四川经济欠发达地区围产期抑郁症状检出率及影响因素

Perinatal Depression Symptom Detection Rate and Influencing Factors in Economically Underdeveloped Areas of Sichuan

目的:调查四川经济欠发达地区围产期女性不同时期抑郁症状发生情况及影响因素。方法:选取2022年10月—2023年9月于自贡市和南充市4所医疗机构建卡产检或住院的孕产妇。收集患者人口学及临床资料,利用爱丁堡产后抑郁量表(EPDS)进行抑郁筛查,采用Logistic回归分析围产期5个时期[妊娠早期(<14周)、妊娠中期(14~27+6周)、妊娠晚期(≥28周)、产后1周和产后6周]抑郁症状发生的影响因素。结果:共纳入3 696例孕产妇,围产期5个时期抑郁症状检出率波动在26.39%~35.38%。Logistic回归分析显示,不同围产期抑郁症状的危险因素有所不同,妊娠早期为非计划妊娠、有家族精神病史、妊娠前1年持续2周情绪低落及末次月经期间情绪低落或紧张;妊娠中期为有家族精神病史、现居农村、妊娠前1年持续2周及末次月经期间情绪低落或紧张;妊娠晚期为有家族高血压、糖尿病、肿瘤史、妊娠前1年持续2周情绪低落或紧张及末次月经期间情绪紧张;产后1周为有家族精神病、高血压、糖尿病、肿瘤史、妊娠前1年持续2周情绪低落及末次月经期间情绪紧张;产后6周为初产妇、现居农村、有家族精神病史和妊娠前1年持续2周情绪紧张。结论:南充及自贡地区围产期抑郁症状检出率整体处于较高水平,建议围产保健者从妊娠早期启动抑郁筛查,重点关注不同时期存在危险因素的孕产妇,必要时重复筛查,对围产期抑郁症(perinatal depression,PND)隐患人群给予及时的心理访谈和专科治疗,减少母婴不良事件的发生。

Objective:To investigate the occurrence of depressive symptoms and influence factors among perinatal women at different stages in economically underdeveloped areas of Sichuan province,China.Methods:Pregnant women receiving prenatal care or hospitalized for delivery at four medical institutions in Zigong and Nanchong cities from October 2022to September 2023 were selected.Sociodemographic and clinical data were collected,and the Edinburgh Postnatal Depression Scale(EPDS) was utilized for depression screening.Logistic regression analysis was conducted to identify factors influencing depression symptoms during five perinatal periods [early pregnancy(<14 weeks),mid-pregnancy(14-27+6weeks),late pregnancy(≥28 weeks),1 week postpartum,and 6 weeks postpartum].Results:A total of 3 696 pregnant women were included,with depression symptom detection rates ranging from 26.39% to 35.38% during the five perinatal periods.Logistic regression analysis revealed different risk factors for depressive symptoms among different perinatal periods.Risk factors included unplanned pregnancy,family history of psychiatric illness,experiencing 2 weeks of depressed mood in the year before pregnancy,and experiencing low mood or anxiety during the last menstrual period in early period of pregnancy;family history of psychiatric illness,current rural residence,experiencing 2 weeks of low mood or anxiety in the year before pregnancy,and experiencing low mood or anxiety during the last menstrual period in mid-pregnancy;family history of hypertension,diabetes,or cancer,experiencing 2 weeks of low mood or anxiety in the year before pregnancy,and experiencing anxiety during the last menstrual period in late pregnancy;family history of psychiatric illness,hypertension,diabetes,or cancer,experiencing 2 weeks of low mood in the year before pregnancy,and experiencing anxiety during the last menstrual period in the first week postpartum;being a primipara,current rural residence,family history of psychiatric illness,and experiencing 2 weeks of anxiety in the year before pregnancy in the sixth week postpartum.Conclusions:The detection rate of depressive symptoms among perinatal women in Nanchong and Zigong areas is relatively high level.It is recommended that perinatal health care providers initiate depression screening from early stage of pregnancy,focus on pregnant women with risk factors at different stages,repeat screening when if necessary,provide timely psychological interviews and specialized treatment to individuals at risk of hidden perinatal depression,and reduce the occurrence of adverse maternal and infant events.