论文部分内容阅读
目的:了解孕产妇在孕产期不同阶段的抑郁状况与各时点的自然转归情况，分析其影响因素。方法:中国疾病预防控制中心妇幼保健中心联合北京市海淀区妇幼保健院、山西省妇幼保健院、吉林省妇幼保健院、广东省珠海市妇幼保健院和广东省深圳市妇幼保健院5家妇幼保健机构共同构建了中国孕产妇心理健康队列研究，于2015年8月1日至2016年10月31日对孕产妇进行招募后开展了孕产期7个时点心理状况的随访追踪，利用自填式问卷和爱丁堡产后抑郁量表（EPDS）调查获得孕产妇一般人口学特征和抑郁状况等相关信息，并对其孕产期抑郁状况及自然转归情况进行分析。结果:共招募1 284人，将完成产后42 d随访且至少完成6次随访的调查对象纳入分析，共计1 210人。采用孕13周EPDS得分代表孕早期抑郁状况，采用孕17周和孕24周的平均分代表孕中期抑郁状况，采用孕31周和孕37周的平均分代表孕晚期抑郁状况，采用产后3 d和产后42 d的平均分代表产后抑郁状况。孕早、中、晚期和产后抑郁人数（%）分别为321人（26.5%）、218人（18.0%）、189人（15.6%）和219人（18.1%），孕早、中、晚期和产后抑郁状况均呈正相关（n P<0.001），其中孕早期和孕中期（n r=0.678）、孕中期和孕晚期（n r=0.771）以及产后和孕晚期（n r=0.706）相关性较强。在孕早期抑郁的孕产妇中，26.2%的孕产妇在整个研究过程均抑郁，42.7%的孕产妇出现产后抑郁。多因素分析结果显示，孕产妇文化程度本（专）科及以上（n OR=0.437，95%n CI：0.212~0.900，n P=0.025）、孕期运动锻炼（n OR=0.586，95%n CI：0.348~0.987，n P=0.044）、婚姻满意度高（n OR=0.370，95%n CI：0.221~0.620，n P<0.001）和体质指数（BMI）正常（n OR=0.516，95%n CI：0.270~0.985，n P=0.045）降低抑郁发生风险；对居住环境不满意（n OR=1.807，95%n CI：1.074~3.040，n P=0.026）增加抑郁发生风险。n 结论:我国孕产妇孕早期的抑郁检出率最高，孕中、晚期有所下降，产后抑郁检出率再次提高；且孕早期抑郁检出阳性者在孕中、晚期和产后多保持同样趋势。运动、BMI、文化程度、居住环境满意度和婚姻满意度会影响孕产妇抑郁的发生。“,”Objective:To investigate the depression status of pregnant and perinatal women in early, medium-term, late pregnancy and postpartum period in China and the outcomes of depression in each period, analyze the influential factors of depression status.Methods:By using the pregnant and perinatal women mental health cohort established by National Center for Women and Children\'s Health of Chinese Center for Disease Control and Prevention, Haidian District Maternal and Child Health Hospital of Beijing, Women Health Center of Shanxi, Jilin Women and Children Health Hospital, Zhuhai Center for Maternal and Child Health Care and Shenzhen Maternity and Child Healthcare Hospital of Guangdong province, a follow up study was conducted at 7 time points during pregnancy and perinatal period in pregnant and perinatal women in Beijing, Shanxi, Jilin and Guangdong from August 1, 2015 to October 31, 2016. The self-filled questionnaire and Edinburgh Postpartum Depression Scale (EPDS) were used to obtain the general demographic information and depression status of the pregnant and perinatal women, and the depression status and natural outcomes of the pregnant and perinatal women were analyzed.Results:A total of 1 284 pregnant and perinatal women were recruited. In this study, a total of 1 210 subjects who completed follow-up at least 6 times and postpartum 42 day follow up were included in the final analysis. The EPDS depression score at the gestation week 13 was used to indicate the depression status in early pregnancy, the average EPDS score of gestation week 17 and 24 were used to indicate the depression status in medium-term pregnancy, and the average EPDS score of gestation week 31 and 37 were used to indicate depression in late pregnancy. The average EPDS score of postpartum day 3 and 42 were used to indicate postpartum depression status. A total of 321 (26.5%), 218 (18.0%), 189 (15.6%) and 219 (18.1%) pregnant and perinatal women were found to have depression, respectively, in early, medium-term and late pregnancy and in postpartum period. The depression status in early, medium-term and late pregnancy and postpartum period were positively correlated (n P<0.001), the correlation between early and middle pregnancy was strong (n r=0.678), the correlation between medium-term and late pregnancy was strong (n r=0.771), and the correlation between postpartum period and late pregnancy was strong (n r=0.706). Among the pregnant women with depression in early pregnancy, 26.2% were depressed during the whole study period, 42.7% were depressed during postpartum period, and the results of multifactorial analysis showed that the education level of college or above of the pregnant and perinatal women (n OR=0.437, 95%n CI: 0.212-0.900, n P=0.025), exercise during pregnancy (n OR=0.586, 95%n CI: 0.348-0.987, n P = 0.044), high marital satisfaction (n OR = 0.370, 95%n CI: 0.221-0.620, n P<0.001), normal body mass index (BMI) (n OR=0.516, 95%n CI: 0.270-0.985, n P=0.045) reduced the risk for depression. Unsatisfactory living environment (n OR=1.807, 95%n CI: 1.074-3.040, n P=0.026) increased the risk for depression.n Conclusions:In pregnant and perinatal women in China, the detection rate of depression in early pregnancy was highest compared with those in medium-term and late pregnancy. The detection rate of depression increased again in postpartum period. The depression status detected in the early pregnancy remained in the medium-term and late pregnancy and postpartum period. Exercise, BMI, educational level, living environment satisfaction and marital satisfaction can affect the incidence of depression in pregnant and perinatal women.