基于潜变量增长混合模型的高龄产妇产后创伤后应激障碍发展轨迹的研究

Trajectory of postpartum post-traumatic stress disorder in women of advanced maternal age based on latent growth mixture model

目的探讨高龄产妇产后创伤后应激障碍(PP-PTSD)的发展轨迹及其影响因素。方法采用便利抽样法,选取2021年9月—2023年3月在浙江省台州医院妇产科分娩的高龄产妇为研究对象,分别在产后1周、1个月、6个月和12个月采用一般资料调查表、创伤后应激障碍量表-平民版、社会资本量表、中文版10条目心理韧性量表对产妇进行调查。使用潜变量增长混合模型分析PP-PTSD发展轨迹。结果本研究共发放问卷467份,回收有效问卷456份,问卷有效回收率为97.64%。高龄产妇PP-PTSD发展轨迹存在4种类型,分别为无PP-PTSD型(71.27%,325/456)、早发-渐愈型(12.06%,55/456)、早发-迁延型(9.21%,42/456)、迟发-风险型(7.46%,34/456)。单因素分析结果显示,分娩方式、妊娠期并发症、社会资本和心理弹性是高龄产妇PP-PTSD发展轨迹潜在类别的影响因素(P<0.05)。结论高龄产妇PP-PTSD发展轨迹存在群体异质性,建议医护人员动态监测高龄产妇PP-PTSD水平,早期识别其轨迹类型并根据分型制定精准的干预措施。

ObjectiveTo explore the trajectory of postpartum post-traumatic stress disorder(PP-PTSD)in women of advanced maternal age and its influencing factors.MethodsFrom September 2021 to March 2023,convenience sampling was used to select women of advanced maternal age in the Department of Gynecology and Obstetrics at Taizhou Hospital of Zhejiang Province as participants.Parturients were surveyed at one week,one month,six months,and 12 months after delivering using General Information Questionnaire,Post-traumatic Stress Disorder Check-list-civilian Version,Social Capital Scale,and 10-item Connor-Davidson Resilience Scale.The latent growth mixture model was used to analyze the trajectory of PP-PTSD.ResultsA total of 467 questionnaires were distributed,and 456 valid questionnaires were collected,with a valid rate of 97.64%.There were four types of PP-PTSD trajectories in women of advanced maternal age,namely non PP-PTSD type(71.27%,325/456),early onset-gradual recovery type(12.06%,55/456),early onset-prolonged type(9.21%,42/456),and late onset-risk type(7.46%,34/456).Univariate analysis showed that delivery mode,pregnancy complications,social capital,and psychological resilience were potential categories of influencing factors for the trajectory of PP-PTSD in women of advanced maternal age(P<0.05).ConclusionsThere is population heterogeneity in the trajectory of PP-PTSD among women of advanced maternal age.It is recommended that medical and nursing staff dynamically monitor the PP-PTSD of women of advanced maternal age,identify their trajectory types early,and develop precise intervention measures based on classification.