角色转换视角下产后抑郁发生发展模型的解释性案例研究  

A Developmental Model of Postpartum Depression from the Perspective of Role Transition:an Explanatory Case Study

作　　者：林宇萍 周天纯 周慧欣 朱新丽 丁焱[2] Simone Schwank LIN Yuping;ZHOU Tianchun;ZHOU Huixin;ZHU Xinli;DING Yan;Simone Schwank(School of Nursing,Fudan University,Shanghai 200032,China;Nursing Department,Obstetrics and Gynaecology Hospital of Fudan University,Shanghai 200090,China;Department of Obstetrics,Obstetrics and Gynaecology Hospital of Fudan University,Shanghai 200090,China;Department of Clinical Science,Karolinska Institute,Stockholm 17177,Sweden)

机构地区：[1]复旦大学护理学院,上海市200032 [2]复旦大学附属妇产科医院护理部,上海市200090 [3]复旦大学附属妇产科医院产科门诊,上海市200090 [4]17177 Sweden,Department of Clinical Science,Karolinska Institute

出　　处：《中国全科医学》2024年第1期105-110,117,共7页Chinese General Practice

基　　金：国家自然科学基金资助项目(71874030)。

摘　　要：背景产后抑郁(PPD)是全球产后女性常发生的健康问题之一,也是女性生育期最具致残性的疾病,会对母婴身心健康及其家庭产生不良影响。目的分析产妇出现PPD症状的原因,以验证或修订前期理论假设“角色转换视角下PPD发生发展的自我-人际模型”,为构建有效的PPD预防干预方案提供干预靶点。方法采用解释性案例研究的方法,基于前期理论假设,采用理论抽样法,并遵循“复制法则”,选取2022年11月—2023年1月在复旦大学附属妇产科医院产后康复门诊进行产后常规检查的15名经历过PPD症状的产妇作为案例,对其进行面对面、半结构式个人深入访谈,运用Max QDA 2022质性资料分析软件协助整理文本信息,采用建构性解释的分析方法,将每个案例结果与预设的理论假设进行比较分析。结果本研究中产妇PPD症状的发生原因未超出前期理论假设中的自我和人际方面,可进一步归纳为“不能照顾好自己”“不能照顾好婴儿”“不能处理好与配偶的关系”及“不能处理好与重要他人的关系”4个方面的压力因素。结论前期理论假设“角色转换视角下PPD发生发展的自我-人际模型”得到了验证与具化,鉴于此,未来开发PPD预防干预方案可将其中的4个方面的压力因素作为干预靶点,从而预防PPD的发生。Background Postpartum depression(PPD)is one of the most common health problems among postpartum women worldwide,and it is also the most disabling disorder in reproductive period of women,which has a negative impact on the physical and mental health of mothers,infants and their families.Objective To analyze the causes of PPD,validate or revise the previous theoretical hypothesis"self-interpersonal model of PPD from the perspective of role transition",and provide intervention targets for the construction of effective prevention programs.Methods Using the explanatory case study method,based on the previous theoretical hypothesis,15 women who experienced PPD symptoms and underwent routine postpartum checkups in the postpartum rehabilitation clinic of Obstetrics and Gynaecology Hospital of Fudan University from November 2022 to January 2023 were selected as the cases using the theoretical sampling method and following the"replication logic",who were interviewed by face-to-face,semi-structured in-depth personal interviews.Max QDA 2022 qualitative data analysis software was used to summarize the textual information,analytical method of constructive interpretation was used to analyze the results of each case in comparison to the previous theoretical hypotheses.Results The causes of maternal PPD symptoms in this study did not go beyond the self and interpersonal aspects of the previous theoretical hypotheses and could be further summarized as four types of stressors,including"cannot take care of oneself""cannot take care of the baby""cannot manage the relationship with spouse""cannot manage relationships with significant others".Conclusion The previous theoretical hypothesis of the"self-interpersonal model of PPD from the perspective of role transition"has been validated and concretized,in view of this,the four types of stressors can be used as targets for the development of PPD prevention programs to prevent PPD in the future.

关 键 词：抑郁症 产后 精神卫生 角色转换 解释性案例研究 

分 类 号：R714.46[医药卫生—妇产科学]