产后早期抑郁筛查阳性的影响因素  

Influencing factors for positive results in early postpartum depression screening

作　　者：周冬[1] 肖梅[1] 孙国强[1] 程瑶 甘泉 Zhou Dong;Xiao Mei;Sun Guoqiang;Cheng Yao;Gan Quan(Department of Obstetrics,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China;Department of Critical Care Medicine,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)

机构地区：[1]湖北省妇幼保健院产科,武汉430070 [2]湖北省妇幼保健院重症医学科,武汉430070

出　　处：《中华围产医学杂志》2022年第11期829-837,共9页Chinese Journal of Perinatal Medicine

基　　金：武汉中青年医学骨干人才培养工程(第八批,武卫通【2020】55号);湖北省卫生计生委科研基金(WJ2018H0159)。

摘　　要：目的探讨产后早期抑郁筛查阳性的影响因素。方法选取2021年3月1日至4月30日在湖北省妇幼保健院产科住院分娩的产前抑郁筛查阴性产妇2889例,在产后5~7 d进行爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评分、家庭关怀指数量表(Adaptation Partnership Growth Affection Resolve,APGAR)评分及相关生活习惯的横断面调查。根据产后5~7 d EPDS评分是否<13分分为抑郁筛查阴性组2354例和抑郁筛查阳性组535例,采用χ^(2)检验或趋势χ^(2)检验、秩和检验进行单因素分析,采用二分类logistic回归分析抑郁筛查阳性的影响因素。结果单因素分析提示本人性格、夫妻关系、家庭功能、孕期睡眠、孕期吸烟、孕期饮酒、产前EPDS评分、分娩方式、是否中转剖宫产、是否产钳助产及阴道分娩总产程、产妇转重症监护病房、新生儿转新生儿重症监护病房、前置胎盘、双胎妊娠、胎位异常、早产、产后出血及合并症/并发症≥3个在2组间差异均有统计学意义(P值均<0.05)。二分类logistic回归分析提示本人性格外向(OR=0.483,95%CI:0.369~0.632)、夫妻关系和睦(OR=0.540,95%CI:0.442~0.691)和孕期睡眠好(OR=0.340,95%CI:0.245~0.471)是产后早期抑郁筛查阳性的保护因素,本人性格内向(OR=1.632,95%CI:1.275~2.088)、夫妻关系差(OR=3.495,95%CI:1.946~6.276)、家庭功能中度障碍(OR=4.038,95%CI:2.667~6.114)和严重障碍(OR=20.234,95%CI:2.446~167.364)、孕期吸烟(OR=2.071,95%CI:1.315~3.263)、饮酒(OR=1.924,95%CI:1.142~3.243)、双胎妊娠(OR=2.680,95%CI:1.435~5.005)、前置胎盘(OR=2.567,95%CI:1.316~5.009)、合并症/并发症≥3个(OR=1.876,95%CI:1.316~2.674)、产钳助产(OR=3.043,95%CI:1.185~7.816)、中转剖宫产(OR=1.917,95%CI:1.232~2.982)、产后出血(OR=1.668,95%CI:1.069~2.604)及产后转重症监护病房(OR=2.601,95%CI:1.112~6.086)是产后早期抑郁筛查阳性的高危因素。结论孕妇应保持良好的生活习惯,保持身心愉悦;Objective To investigate the risk factors associated with the positive results of early postpartum depression screening.Methods This study involved 2889 women who were negative in prenatal depression screening and delivered in the Maternal and Child Health Hospital of Hubei Province from 1 March to 30 April 2021.The Edinburgh Postnatal Depression Scale(EPDS)score,Adaptation Partnership Growth Affection Resolve(APGAR)score,and related living habits of the enrolled subjects were investigated on the 5th to 7th day after delivery.All patients were divided into two groups with 2354 in the negative group(EPDS score<13)and 535 in the positive group(EPDS score≥13),based on the EPDS scores at 5 to 7 days postpartum.Chi-square test,trend Chi-square test,and rank-sum test were used for univariate analysis.Risk factors associated with positive depression screening were analyzed using binary logistic regression.Results Univariate analysis suggested that there were statistically significant differences between the two groups in maternal personality,marital relationship,family functioning,sleep quality during pregnancy,smoking and drinking habits during pregnancy,prenatal EPDS score,mode of delivery,whether or not to have intrapartum cesarean section and forceps delivery,duration of labor in vaginal delivery,the proportions of puerperae and neonates who were transferred to intensive care unit(ICU),twin pregnancy,placenta previa,abnormal fetal position,premature birth,postpartum hemorrhage,and having three or more complication(all P<0.05).Binary logistic regression analysis suggested that extravertion(OR=0.483,95%CI:0.369-0.632),good marital relations(OR=0.540,95%CI:0.422-0.691)and good sleep during pregnancy(OR=0.340,95%CI:0.245-0.471)were protective factors for early postpartum depression,while introversion(OR=1.632,95%CI:1.275-2.088),poor marital relations(OR=3.495,95%CI:1.946-6.276),moderate family dysfuntion(OR=4.038,95%CI:2.667-6.114)and severe family dysfunction(OR=20.234,95%CI:2.446-167.364),smoking(OR=2.071,95%CI:1.31

关 键 词：抑郁症 产后 影响因素分析 精神病状态评定量表 适应 心理学 社会支持 

分 类 号：R749.4[医药卫生—神经病学与精神病学]