Pregnancy stressors and postpartum symptoms of depression and anxiety:the moderating role of a cognitivebehavioural therapy(CBT)intervention

Background Little is known about the association between stressors(especially positive stressors)during pregnancy and postpartum depression and anxiety.Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive behavioural therapy(CBT)had a regulatory effect.Methods Participants were 621 pregnant Pakistani women with mild anxiety.Using the Pregnancy Experience Scale-Brief Version,six scores were created to assess positive and negative stressors.We performed a multivariate linear regression to examine whether these six scores,measured both at baseline and in the third trimester,were associated with postpartum anxiety and depressive symptoms.The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.Results Hassles frequency measured in the third trimester was positively associated with depression(B=0.22,95%confidence interval(Cl):0.09 to 0.36)and anxiety(B=0.19,95%Cl:0.08to 0.30).At the same timepoint,uplifts intensity was negatively associated with symptoms of depression(B=-0.82,95%Cl:1.46 to-0.18)and anxiety(B=-0.70,95%Cl:-1.25 to-0.15),whereas hassles intensity was positively related to symptoms of depression(B=1.02,95%Cl:0.36 to 1.67)and anxiety(B=0.90,95%Cl:0.34 to 1.47).The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression(B=1.40,95%Cl:0.59 to 2.20)and anxiety(B=1.26,95%Cl:0.57 to 1.96).The intervention strengthened the overall positive effects of uplfts and the negative effects of hassles.Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression.The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes.Programmes that promote positive experiences and reduce negative experiences,especially in late pregnancy,may mitigate postpartum mental health consequences.

Applicability Evaluation of Simplified Cognitive Behavioral Therapy

背景:我们在国内较早开展并研发了针对焦虑症的结构化认知行为治疗操作手册,本研究在前期研究基础上对简化认知行为治疗的适宜性进行评价。目的:通过多中心临床对照实验,评价简化认知行为治疗(Simplified Cognitive Behavioral Therapy,SCBT)的适宜性。方法:通过来自不同级别的精神卫生专科医疗机构和综合医院精神科等多个中心,对广泛性焦虑患者进行SCBT的临床对照研究,分为3组:SCBT组,SCBT+药物组和药物组。比较三组脱落率,接受SCBT患者对治疗满意度以及治疗师对SCBT评价。结果:(1)三组脱落率差异没有统计学意义。(2)接受SCBT的两组患者仅在治疗时间和次数上差异有统计学意义,SCBT组比SCBT+药物组患者治疗满意度高。(3)18名SCBT实施人员均认为操作手册内容容易理解、易于操作,并到达治疗目标。结论:SCBT对广泛性焦虑患者适宜性较强,有望成为在不同级别医疗机构应用推广的心理治疗方法。