产后抑郁症相关因素的临床研究

为了探索孕妇产后发生抑郁症相关因素,随机抽取1997年1～11月产前门诊中决定在本院分娩的孕妇1052例进行情绪测定（HAD）,以产后抑郁量表（EPDS）跟踪调查至产后7天866例。调查结果表明：EPDS阳性率为15．01％,HAD问卷中A值总分、D值总分≥11分的分别为5．13％7Z4．37％。分析了影响EPDS和A、D值的相关因素,提出相应的社区护理措施,把孕妇心理护理工作延伸到社区,进入家庭,以适应新的医学模式的转变,以利母婴身心健康。     

城市、农村产后抑郁症相关因素对照研究

目的：探讨城市、农村产后抑郁症发生率及其相关因素的差别。方法： 随机抽取城市、农村产前检查的孕妇942例，进行医院焦虑及抑郁自评量表（HAD）调查，筛出A值、D值≥8分的孕妇132例，进行产后艾氏抑郁量表（EPDS）跟踪调查至产后7d；并把孕期情绪正常，产后情绪异常主动回访的46例一起加入分析研究。结果：城市EPDS阳性率为15．0％（82／546）、农村为14．7％（58／396），P＞0．05；当A值、D值≥8分时，EPDS阳性率城市（83．3％）高于农村（56．6％），P＜0．01；当A值、D值＜8分，城市（4．64％）和农村（7．14％）的EPDS阳性率相近P＞0．05。结论：孕妇情绪正常时城市、农村EPDS阳性率无明显差别，情绪异常时差别有极显著性。     

孕妇情绪影响因素探讨

随机抽取１９９７年１～１１月决定在本院分娩的部分孕妇,采用医院焦虑及抑郁自评量表（ＨＡＤ）进行孕期情绪测定,其中以艾氏产后抑郁量表（ＥＰＤＳ）跟踪调查至产后７天内８６６例。结果：ＨＡＤ问卷中Ａ值总分、Ｄ值总分≥１１分的分别为５．１３％及４．３７％,随着Ａ值、Ｄ值分值的增高,ＥＰＤＳ阳性率也随之升高。并对孕期焦虑、抑郁的相关因素进行单因素和多元逐步回归分析,发现孕妇焦虑情绪与本人健康状况、孕妇企盼生     

临产前干预措施对产后抑郁症的发病及疗效的影响

目的观察临产前干预措施对产后抑郁症发生率及疗效的影响。方法选择在我院产检和分娩的孕妇2868例，平均随机分成对照组和干预组（各1434例）。对两组孕妇于孕期行医院焦虑-抑郁情绪自评量表（HAD）测试（≥11分诊断为焦虑抑郁情绪），产后行艾迪产后抑郁量表（EPDS）测试（≥13分诊断为产后抑郁症）。对干预组孕妇临产前行6项干预措施，对照组无干预措施。观察两组的产后抑郁症的发生率及疗效。结果①HAD≥11分：对照组135例（9．41％），其中产后抑郁症发病70例（51．85％）；干预组139例（9．69％），其中产后抑郁症发症31例，31例（22．30％），两组比较，差异有极显著性（P〈0．01）。②EPD5≥13分，对照组211例，占14．71％，干预组85例，占5．93％，两组比较，差异有极显著性（P〈0．01）。③治愈率比较，对照组半年治愈率及一年治愈率分别为51例（24．17％）和139例（65．88％）；干预组半年治愈率及一年治愈率分别为42例（49．41％）和78例（91．76％）。两组比较，差异有极显著性P〈0．01。结论产后抑郁症发生率14．71％，对母婴的影响较大；孕妇临产前焦虑、抑郁情绪是产后抑郁症的高危因素，临产前采用干预措施能够显著降低产后抑郁症的发生率，提高治愈率，值得推广。     

农村孕妇产后抑郁症的相关因素分析

目的：探索本省农村孕妇发生产后抑郁症的相关因素，便于指导基层妇幼保健院（所）护理人员及农村妇幼保健人员对孕产妇提供恰当的心理保健和护理。方法：随机抽取1998年1月－1999年12月在山区县妇幼保健院就诊的孕妇396例，进行孕期情绪测定（HAD），以产后抑郁量表（EPDS）进行产后跟踪调查至产后7天内370例，3个月12例，6个月4例，1年10例。结果：孕期焦虑情绪发生率为6．06％，抑郁情发生率8．08％，产后抑郁症的发生率14．65％，与1997年我省城市调查结果5．13％，4．37％和15．01％相近.结论：要降低农村孕妇产后抑郁症发生率，首先应规范农村孕妇孕期保健并加强孕期心理护理；随之加强产时服务并提倡自然分娩，最后抓住农村社区重点护理人群及其要素实施有针对性的身心护理和面对面的健康教育。     

产后抑郁症的影响因素及干预措施研究

目的探讨产后抑郁症的影响因素,观察干预措施对产后抑郁症发病率的影响。方法选择在浙江永嘉人民医院行产前检查并在本院分娩的孕妇1100例,按单双号随机分为对照组（550例）和干预组（550例）。对两组孕妇于孕期行医院焦虑一抑郁情绪自评量表（HAD）测试,于产后3天至8周行艾迪产后抑郁量表（EPOS）测试。对干预组孕妇实施干预,对照组孕妇采取普通产科护理措施,观察两组产妇的产后抑郁症发生率变化情况。结果在98名焦虑一抑郁情绪者中,产后抑郁症的发生率为41．8％,高于正常人群的6．2％,二者差异存在统计学意义（P〈0．01）。对照组产妇产后抑郁症发生率为13．1％。干预组产妇产后抑郁症的发生率为5．6％,干预组的发生率低于对照组（P〈0．01）。在产前有焦虑一抑郁情绪的人群中,干预组的产后抑郁症发生率为25．0％,对照组的产后抑郁症发生率为58．0％,二者差异也具有统计学意义（P〈0．01）。结论产前焦虑一抑郁情绪是产后抑郁症的高危因素。采取综合干预措施能够显著降低产后抑郁症的发生率。     

女性围产期抑郁动态观察及相关因素研究

目的:观察女性围产期抑郁情绪动态变化及探讨女性孕期压力水平、应对方式与围产期抑郁的相关性.方法:采用便利抽样法选取在合肥市某三甲医院门诊孕期检查的162例孕妇为调查对象,运用妊娠压力量表(PPS)、简易应对方式问卷(SCSQ)评估孕期压力水平和孕妇应对压力的方式,运用爱丁堡产后抑郁量表(EPDS)评估孕期、产后的抑郁情绪.结果:孕产妇孕期抑郁、产后抑郁的发生率分别为47.53％ (77/162)、48.77％ (79/162);纵向追踪发现,孕期77例抑郁女性中,在产后有24例女性(31.17％)转为非抑郁;孕期85例非抑郁女性中,在产后有26例女性(30.59％)转为抑郁.其次,妊娠晚期孕妇妊娠总体压力为轻度水平[中位数(M)=1.57].孕妇应对方式总分(1.57 ±0.03)分,积极应对方式评分为(1.93±0.04)分,消极应对方式评分为(1.03±0.03)分.与常模比较,其中,积极应对方式评分比常模评分高,差异有统计学意义(t=1.96,P＜0.01).孕妇孕期抑郁情绪与妊娠压力总分、各压力因子得分呈正相关,与应对方式总分、积极应对分值呈负相关.产妇产后抑郁情绪与妊娠压力总分、各压力因子得分呈正相关,与积极应对分值呈负相关.多元逐步回归分析显示,孕期抑郁情绪是产后抑郁的危险因素,家庭关系是产后抑郁情绪的保护因素.结论:在产前对孕妇做好心理健康水平的筛查和干预,对于产后抑郁的预防有着重要意义.     

抑郁情绪对初发性脑卒中患者运动功能和ADL的影响

目的观察抑郁情绪对初发性脑卒中患者运动功能和日常生活能力评分的影响。方法69例初发性脑卒中患者出院前分别接受了汉密尔顿抑郁量表（Hamilton Depression Rating Scale for Depression，HAMD）、Fugl-Meyer运动功能（FMA）和日常生活能力评估（ADL）评估。结果69例初发性脑卒中患者出院前平均HAMD总分为（11．09±3．47）分，卒中后抑郁患者37例，患病率53．62％。卒中后有抑郁患者出院时的上肢运动功能、下肢运动功能、FMA总分和ADL总分均明显低于无抑郁患者（P〈0．01～0．05）。结论抑郁情绪对卒中患者出院时运动功能和ADL评分有显著影响，尽早进行干预非常必要。     

宿州市292名孕妇抑郁焦虑症状检出率及其影响因素分析

目的探讨孕妇焦虑抑郁症的发生现状及其相关危险因素,并提出预防对策。方法随机抽取2010年1-12月在宿州市妇幼卫生保健所门诊进行产前检查的孕妇进行问卷调查,采用焦虑自评量表（self-rating anxiety scales,SAS）、抑郁自评量表（self-rating depression scales,SDS）衡量孕妇焦虑及抑郁状况。应用SPSS13．0统计软件进行统计分析。结果被调查的292名孕妇中具有焦虑症状的64例,占21．9％。其中轻度45例（70．3％）,中度17例（26．6％）,重度2例（3．1％）;孕妇具有抑郁症状的61例,占20．9％,其中轻度46例（75．4％）,中度15例（24．6％）。孕妇同时具有焦虑和抑郁症状的40例,占13．7％。通过多因素logistic回归分析结果显示,在控制孕妇年龄、文化程度、家庭收入和户籍等混杂因素后,孕妇焦虑相关的主要危险因素为人工流产史（OR=5．372）、未进行产前检查（OR=6．674）;孕妇抑郁相关的危险因素为孕期服用药物（OR=2．90s）。结论孕妇存在明显的焦虑和抑郁负性情绪,以轻、中度为主。应对孕妇进行心理保健、咨询、指导,加强孕产期健康教育,疏导孕妇心理压力。对孕产妇的心理支持应提前到孕期乃至孕前,提高孕妇身心健康。     

情绪因素对慢性前列腺增生症患者下尿路症状评分的影响

目的：观察情绪因素对慢性前列腺增生症（BPH）患者下尿路症状评分的影响。方法：选择86例BPH患者,入选对象在开始治疗前接受汉密尔顿抑郁量表和国际前列腺症状评分量表（IPSS）评估。结果：86例BPH中存在抑郁情绪者30例（抑郁情绪组）,患病率34．88％,无抑郁情绪者56例（对照组）,抑郁情绪患者IPSS各症状评分和IPSS总分均明显高于对照组（P均〈0．05—0．01）。结论：抑郁情绪可加重BPH患者的下尿路症状。     

产后抑郁症的相关问题分析

目的探讨产后抑郁症（postnatal depression）的相关因素及其发病机制。方法本研究采用《爱丁堡产后抑郁量表》（Edinburgh Postnatal Depression Scale，EPDS），以2005年1月至2005年12月在本院妇产科住院分娩的1347例产后诊断为抑郁症的患者146例为研究对象（观察组），与同期分娩的正常产妇146例进行对照（对照组），观察其发病率、诱因、病史及对新生儿的影响。结果本研究显示，产后抑郁症发病率为10．96％（146／1332），43．84％有明确诱因（64／146）；有经前综合征病史的患者，观察组发病率高于对照组（P〈0．01）；产时出血量比较，观察组多于对照组（P〈0．01）；所生新生儿发生激惹比较，观察组多于对照组（P〈0．01）。结论产后抑郁症患者存在明显的性激素骤变，推测抑郁症可能由性激素异常变化引起。     

Rates and Correlates of Depression Symptoms in a Sample of Pregnant Veterans Receiving Veterans Health Administration Care

BackgroundDepression is the most commonly diagnosed medical condition among women veterans ages 18 to 44; however, depression symptoms occurring during pregnancy have not been well-studied in this population.MethodsPregnant veterans were recruited from 15 Veterans Health Administration sites across the United States; our sample included 501 participants. Sociodemographic characteristics, military service, health status, and pregnancy related factors, as well as the Edinburgh Postnatal Depression Scale (EPDS), were collected as part of a telephone survey. Additional data were obtained from electronic health record data. We used multivariable logistic regression models to examine factors associated with an EPDS score suggestive of clinically significant depressive symptoms (≥10).FindingsPrenatal EPDS scores of 10 or greater were calculated for 28% of our sample. Our final model indicated that factors associated with decreased odds of an EPDS score of 10 or greater included spousal or partner support during pregnancy (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.16–0.77) and employment (aOR, 0.40; 95% CI, 0.24–0.67). A past diagnosis of anxiety (aOR, 2.54; 95% CI, 1.43–4.50), past antidepressant use (aOR, 3.27; 95% CI, 1.71–6.24), and active duty service (aOR, 1.91; 95% CI, 1.08–3.37) were associated with increased odds of having an EPDS score of 10 or greater.ConclusionsThis is the first quantitative estimate of depression symptoms in pregnant veterans across multiple Veterans Affairs facilities. The prevalence of depression symptomology was greater than the high end of prevalence estimates in the general pregnant population. Given that the risk of depression increases during the postpartum period, women who can be identified with depressive symptomatology during pregnancy can be offered critical resources and support before giving birth.     

Routine screening for postpartum depression

BACKGROUND: Postpartum depression (PPD) is a common and often overlooked condition. Validated screening tools for PPD exist but are not commonly used. We present the 1-year outcome of a project to implement universal PPD screening at the 6-week postpartum visit. METHODS: Universal screening with the Edinburgh Postnatal Depression Scale (EPDS) was implemented in all community postnatal care sites. One-year outcome assessments (diagnosis and treatment of PPD) were completed for a sample of the women screened using medical record review of all care they received during the first year postpartum. RESULTS: Sixty-eight (20%) of the 342 women whose medical records were reviewed had been given a documented diagnosis of postpartum depression, resulting in an estimated population rate of 10.7%. Depression was diagnosed in 35% of the women with elevated EPDS scores (> or =10) compared with 5% of the women with low EPDS scores (<10) in the first year postpartum. Treatment was provided for all women diagnosed with depression, including drug therapy for 49% and counseling for 78%. Four women were hospitalized for depression. Some degree of suicidal ideation was noted on the EPDS by 48 women but acknowledged in the chart of only 10 women, including 1 with an immediate hospitalization. The rate of diagnosis of postpartum depression in this community increased from 3.7% before the routine use of EPDS screening to 10.7% following screening. CONCLUSIONS: A high EPDS score was predictive of a diagnosis of postpartum depression, and the implementation of routine EPDS screening at 6 weeks postpartum was associated with an increase in the rate of diagnosed postpartum depression in this community.     

318例产妇产褥期抑郁症患病率相关因素及防治策略探讨

目的了解产妇产褥期抑郁症的患病率,探讨相关因素及防治策略,以降低产妇产褥期抑郁症的发病率和危害性。方法采用爱丁堡产后抑郁量表(EPDS)和自拟的一般资料调查表对318例产妇进行调查。结果对318例产妇的有效资料进行分析,其中产褥期情绪不良患病率为21.38%,产褥期抑郁症患病率为11.95%。青春期、高龄初产妇、婚姻满意度差、孕期情绪不稳定、不良妊娠分娩史、对新生儿性别期望高、社会支持低、认为养孩子是负担、对抚养孩子缺乏信心、曾有过产褥期抑郁症或抑郁症病史等是产褥期抑郁症的主要影响因素。结论产褥期抑郁症的患病率较高,是多种因素综合作用的结果。针对病因进行预防及采取相应的对策,可减少产后抑郁症的发生,提高妇女生活质质。     

Screening for Antepartum Depression Through Community Health Outreach in Swaziland

Maternal depression, including antepartum and postpartum depression, is a neglected public health issue with potentially far-reaching effects on maternal and child health. We aimed to measure the burden of antepartum depression and identify risk factors among women in a peri-urban community in Swaziland. We conducted a cross-sectional study within the context of a community outreach peer support project involving “Mentor Mothers”. We used of the Edinburgh Postnatal Depression Scale (EPDS) to screen women for depression during the third trimester of pregnancy, using a cut-off score of ≥13 to indicate depression. We also collected demographic and socioeconomic factors, and assessed the association of these factors with EPDS score using logistic regression models. A total of 1038 pregnant women were screened over a period of 9 months. Almost a quarter (22.7 %) had EPDS scores ≥13 and 41.2 % were HIV positive. A fifth, 17.5 % were teenagers and 73.7 % were unemployed. Depression was not associated with HIV status, age or employment status. However, women with multiple socioeconomic stressors were found to be more likely to score highly on the EPDS. Depression was common among pregnant women in the peri-urban areas of Swaziland. Screening for depression using the EPDS is feasible and can be included in the community health worker standard tool box as a way to improve early detection of depression and to highlight the importance of maternal mental health as a core public health concern.     

Differential Predictors of Postpartum Depression and Anxiety: The Edinburgh Postnatal Depression Scale Hebrew Version Two Factor Structure Construct Validity

Objectives Postpartum anxiety (PPA) is as prevalent and disruptive as postpartum depression (PPD), although less commonly addressed. The Edinburgh Postnatal Depression Scale (EPDS), originally created to screen for PPD, was found to include anxiety and depression subscales. This study examined the construct validity of the EPDS PPD and PPA subscales by examining differential predictors of both in a structural regression model. Methods Women (n?=?969) were recruited from a maternity ward in Jerusalem, Israel and completed a demographic survey; 715 (74%) women were screened for PPD and PPA at 6 weeks postpartum using the EPDS. Results History of depression was a significant predictor of PPD symptoms and PPA symptoms. Income and number of past pregnancies were significant predictors of PPA symptoms. Conclusions for practice PPD and PPA have different predictors, suggesting that the EPDS depression and anxiety subscales should be scored separately. Further assessment and treatment should be tailored to specific symptoms of depression and/or anxiety reported.     

Aboriginal and Torres Strait Islander women's experience when interacting with the Edinburgh Postnatal Depression Scale: a brief note

Background: The Edinburgh Postnatal Depression Scale (EPDS) is one of the most widely used screening instruments for maternal perinatal anxiety and depression. It has maintained its robust performance when translated into multiple languages, when used prenatally and when used with perinatal fathers; thus the tool is also known as the Edinburgh Depression Scale (EDS). However, there have been no published psychometric data on versions of the EPDS adapted for screening Australian Aboriginal and Torres Strait Islander women. We describe the development of ‘translations’ of the EPDS and report their basic psychometric properties. Method: During the Queensland arm of the beyondblue National Postnatal Depression Program (2001–2005), partnerships with Aboriginal and Torres Strait Islander women were forged. At TAIHS’ stand alone “Mums and Babies” unit 181 women of Aboriginal or Torres Strait Islander descent were recruited into the study through their antenatal and postnatal visits and 25 were recruited at Mt Isa. Participants completed either the translation or the standard version of the EPDS both antenatally and postnatally. Results: The ‘translations’ of the EPDS demonstrated a high level of reliability. The was a strong correlation between the ‘translations’ and the EPDS. The ‘translations’ and the standard EPDS both identified high rates of women at risk of depression although the ‘translations’ identified higher rates. Conclusion: We argue that the ‘translation’ may have been a more accurate predictor of perinatal women at risk for depression, but acknowledge that a lack of validity evidence weakens this conclusion.     

The Edinburgh Postnatal Depression Scale: Screening Tool for Postpartum Anxiety as Well? Findings from a Confirmatory Factor Analysis of the Hebrew Version

Objectives The Edinburgh Postnatal Depression Scale (EPDS) was originally created as a uni-dimensional scale to screen for postpartum depression (PPD); however, evidence from various studies suggests that it is a multi-dimensional scale measuring mainly anxiety in addition to depression. The factor structure of the EPDS seems to differ across various language translations, raising questions regarding its stability. This study examined the factor structure of the Hebrew version of the EPDS to assess whether it is uni- or multi-dimensional. Methods Seven hundred and fifteen (n = 715) women were screened at 6 weeks postpartum using the Hebrew version of the EPDS. Confirmatory factor analysis (CFA) was used to test four models derived from the literature. Results Of the four CFA models tested, a 9-item two factor model fit the data best, with one factor representing an underlying depression construct and the other representing an underlying anxiety construct. Conclusions for Practice The Hebrew version of the EPDS appears to consist of depression and anxiety sub-scales. Given the widespread PPD screening initiatives, anxiety symptoms should be addressed in addition to depressive symptoms, and a short scale, such as the EPDS, assessing both may be efficient.     

产后抑郁者的心理特征及社会支持情况分析

目的研究产后抑郁者的人格特征、社会支持情况及其与产后抑郁的关系。方法对237例产妇评定爱丁堡产后抑郁量表(EPDS)、艾森克人格问卷(EPQ)、社会支持评定量表(SSRS)以及自编一般情况调查表。结果产后抑郁组与正常组在人格特征各维度和社会支持评分上存在着显著差异;两组在产前焦虑、经济条件、夫妻关系、睡眠不足、负性生活事件等方面有显著性差异(P<0.01)。结论内倾型、神经质女性易发生产后抑郁;产后抑郁的女性社会支持情况较正常女性差,其中以缺乏客观支持为主;产前焦虑等因子通过人格特征和社会支持情况来影响EPDS总分。