上海孕产妇焦虑和抑郁现状及相关因素:一项基于健康生态学模型的多中心研究  

The prevalence and related factors of maternal anxiety and depression in Shanghai:a multicenter study based on health ecology model

作　　者：朱婷玉 王子文[2] 熊晨菡 沈晔 顾婷婷 金龙妹 顾春怡[6] 王丽萍[7] 黄凌[8] 施云美 吴建凤 谢震宇 蒋泓 ZHU Tingyu;WANG Ziwen;XIONG Chenhan;SHEN Ye;GU Tingting;JIN Longmei;GU Chunyi;WANG Liping;HUANG Ling;SHI Yunmei;WU Jianfeng;XIE Zhenyu;JIANG Hong(Department of Maternal,Child and Adolescent Health,School of Public Health,Fudan University,Key Laboratory of Health Technology Evaluation(National Health Commission),Shanghai 200032,China;Department of Maternal Care,Shanghai Jiading District Maternal and Child Health Care Hospital,Shanghai 201821,China;Maternal Mental Health Clinic,Maternal and Child Health Care Hospital of Shanghai Pudong New Area,Shanghai 201206,China;Department of Maternal Health,Maternal and Child Health Care Center of Pudong New Area in Shanghai,Shanghai 201399,China;Department of Maternal Health,Minhang District Maternal and Child Health Hospital,Shanghai 201102,China;Department of Nursing,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Health Education,International Peace Maternal and Child Health Hospital,Shanghai 200030,China;Department of Obstetrics and Gynecology,Shanghai Sixth People′s Hospital,Shanghai 200233,China;Maternal and Child Health Centre,Changning Maternity and Infant Health Hospital,Shanghai 200050,China;Department of Obstetrics and Gynecology,Fengxian District,Fengcheng Hospital,Shanghai 201411,China;Department of Prevention and Health Care,Maternal and Child Health Care Hospital of Shanghai Pudong New Area,Shanghai 201206,China)

机构地区：[1]复旦大学公共卫生学院妇幼与儿少卫生教研室,国家卫生健康委员会卫生技术评估重点实验室,上海200032 [2]上海市嘉定区妇幼保健院妇保科,上海201821 [3]上海市浦东新区妇幼保健院孕产妇心理保健门诊,上海201206 [4]上海市浦东新区妇幼保健中心妇女保健科,上海201399 [5]上海市闵行区妇幼保健院妇女保健科,上海201102 [6]复旦大学附属妇产科医院护理部,上海200011 [7]中国福利会国际和平妇幼保健院健康教育科,上海200030 [8]上海市第六人民医院妇产科,上海200233 [9]上海市长宁区妇幼保健院妇幼所,上海200050 [10]上海市奉贤区奉城医院妇产科,上海201411 [11]上海市浦东新区妇幼保健院预防保健科,上海201206

出　　处：《中华疾病控制杂志》2024年第1期46-55,共10页Chinese Journal of Disease Control & Prevention

基　　金：复旦大学公共卫生学院-嘉定区卫生健康委公共卫生高质量发展重点学科、重点专项(GWGZLXK-2023-04);上海市妇女联合会(2022年);上海市加强公共卫生体系建设三年行动计划(2023-2025年)重点学科(GWVI-11.1-32);上海市公共卫生体系建设三年行动计划学科带头人计划(GWV-10.2-XD10)。

摘　　要：目的了解上海孕产妇焦虑和抑郁现状,并基于健康生态学模型系统分析其相关因素。方法采用多阶段分层抽样,于2022年11月―2023年4月在上海开展多中心、横断面调查。使用7项广泛性焦虑障碍量表和患者健康问卷抑郁量表评价上海孕期及产后妇女焦虑、抑郁症状检出现状,并基于健康生态学模型分析孕产期焦虑、抑郁症状的相关因素及其效应量。结果共收集到有效问卷1941份,孕期891份,产后1050份。孕期焦虑和抑郁症状检出率分别为19.5%(95%CI:0.169~0.221)、30.4%(95%CI:0.274~0.334);产后焦虑和抑郁症状检出率分别为18.2%(95%CI:0.159~0.205)、23.2%(95%CI:0.207~0.258)。二分类logistic回归分析模型分析显示,处于孕早期、怀孕次数≥2次、有精神疾病史、孕期及产后有负性事件、身体活动较少、睡眠质量较差、性格内向、生活满意度低、社会支持程度低、孕产相关知识了解程度较差、孩子性别不符合期望、产后休养条件满意程度较低的孕产妇焦虑或抑郁症状检出风险增高(均P<0.05)。结论上海孕产妇焦虑、抑郁症状检出率较高。焦虑、抑郁症状的影响因素是多维度的,产前和产后检查时可根据危险因素确定高危人群,开展有针对性的心理健康保健服务。Objective To understand the prevalence of maternal anxiety and depression in Shanghai and to explore the factors associated with them based on the Health ecology model.Methods Multistage stratified sampling method was used.A multicenter,cross⁃sectional survey was conducted from November 2022 to April 2023 in Shanghai.Generalized anxiety disorder⁃7(GAD⁃7)and patient health questionnaire⁃9(PHQ⁃9)were used to evaluate anxiety and depression symptoms of pregnant women.Related factors and their effect size were analyzed based on the health ecology model.Results A total of 1941 valid questionnaires were collected.Among these subjects,891 were during pregnancy and 1050 were during postpartum.The detection rate of anxiety and depression during pregnancy were 19.5%(95%CI:0.169-0.221)and 30.4%(95%CI:0.274-0.334),respectively.The detection rate of postpartum anxiety and depression symptoms were 18.2%(95%CI:0.159-0.205)and 23.2%(95%CI:0.207-0.258),respectively.The binary logistic regression model analysis showed that being in the first trimester,gravidity≥2,with history of mental illness,negative events during and after pregnancy,inactive physical activity,worse sleep quality,introversion,lower life satisfaction,less social support,poorer pregnancy related knowledge,unfavorite baby gender,and dissatisfaction with postpartum rest conditions were significantly associated with anxiety or depression symptoms during pregnancy or postpartum(all P<0.05).Conclusions The detection rate of anxiety and depression in pregnant and postpartum women in Shanghai are relatively high.The factors associated with anxiety and depression are multidimensional.During prenatal and postpartum examinations,close attention should be paid to women with these risk factors and targeted mental health care services should be provided.

关 键 词：孕产妇 焦虑 抑郁 健康生态学模型 相关因素 

分 类 号：R173[医药卫生—妇幼卫生保健]