Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study

BackgroundThe relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period.ObjectivesWe investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms.DesignA prospective cohort study design was used.SettingMaternity unit of a medical center.ParticipantsThis study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.MethodsPain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression.ResultsAfter adjusting for covariates, women who had perineal pain at 4–6 weeks postpartum showed an increased risk for depression at 4–6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4–6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β = 0.63, p = 0.02). Any pain intensity score at 3–5 days postpartum predicted depression at 3 months (β = 0.01, p = 0.04). Women with high depression scores at 3–5 days had a two- or three-fold higher risk for depression at 4–6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively).ConclusionsOur study provides robust evidence that perineal pain 4–6 weeks postpartum is associated with depressive symptoms 4–6 weeks and 6 months postpartum; pain at 3–5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3–5 days postpartum, predict depressive symptoms during the 6-month postpartum period.     

分娩方式对产后并发症的影响

目的 比较不同分娩方式对产妇产后并发症的影响.方法所选产妇按照分娩方式分成自然分娩组、无痛分娩组和剖宫产组,观察产妇产后出血量、产后24 h子宫高度下降程度、产后Beck抑郁评分和开始泌乳时间.结果三组产妇产后2 h出血量比较:剖宫产组明显高于无痛分娩组和自然分娩组,差异有统计学意义(P<0.05),无痛分娩组和自然分娩组比较差异无统计学意义(P>0.05).产后Beck抑郁评分比较:剖宫产组评分最高,无痛分娩组评分最低,组间比较差异有统计学意义(P<0.05).产后24 h宫高下降程度比较:剖宫产组明显小于无痛分娩组和自然分娩组,差异有统计学意义(P<0.05),无痛分娩组和自然分娩组间比较差异无统计学意义(P>0.05).三组产妇产后开始泌乳时间比较差异无统计学意义(P>0.05).结论 剖宫产增加产妇产后并发症风险,无痛分娩未见对产妇有不良影响,是一种较好的分娩方式.     

Predicting Changes in Depressive Symptoms from Pregnancy to Postpartum: The Role of Brooding Rumination and Negative Inferential Styles

The current study examined the role of cognitive factors in the development and maintenance of depressive symptoms from pregnancy into the postpartum period. One hundred and one women were assessed for levels of rumination (brooding and reflection), negative inferential styles, and depressive symptoms in their third trimester of pregnancy and depressive symptom levels again at 4 and 8 weeks postpartum. We found that, although none of the three cognitive variables predicted women’s initial depressive reactions following childbirth (from pregnancy to 1 month postpartum), brooding rumination and negative inferential styles predicted longer-term depressive symptom changes (from pregnancy to 2 months postpartum). However, the predictive validity of women’s negative inferential styles was limited to women already exhibiting relatively high depressive symptom levels during pregnancy, suggesting that it was more strongly related to the maintenance of depressive symptoms into the postpartum period rather than increases in depressive symptoms following childbirth. Modifying cognitive risk factors, therefore, may be an important focus of intervention for depression during pregnancy.     

产后抑郁症及其社会心理因素的相关性研究

目的调查产后抑郁症的发病情况;探讨与产后抑郁症相关的社会心理因素。方法采用分层整群抽样方法,抽取长沙市2所三级甲等医院和2所二级甲等医院自2004年9月至2005年1月在这4所医院进行产后6周复查的320例初产妇,并对其进行问卷调查。调查问卷包括Ed inburgh产后抑郁量表(EPDS)、自编产妇一般资料及社会心理因素调查问卷。采用Ep idata3.02软件建立数据库,所有资料均采用SPSS11.5统计软件处理。统计方法包括χ2检验、单因素和多因素非条件logistic分析。结果(1)300例产妇中,EPDS总分≥13分抑郁阳性并确诊为抑郁症者52例,产后抑郁症的发病率为17.30%。(2)社会心理因素的多因素非条件logistic回归分析结果显示:干部、知识分子职业(P=0.011)、家庭经济收入(P=0.003)、居住条件(P=0.001)、分娩疼痛承受力(P=0.019)、新生儿性别(P=0.003)、丈夫家属的支持(P=0.000)与产后抑郁症相关,有统计学意义。其OR值分别为:9.886、0.408、2.455、0.131、3.334、7.246。结论(1)产后6周内一部分妇女出现不同程度的抑郁性障碍,应引起高度重视。(2)产后抑郁症相关的社会心理危险因素有干部知识分子职业、丈夫家属的不支持、生女婴、居住条件差;保护性因素是家庭经济收入高与有分娩疼痛承受力。(3)针对产后抑郁症的影响因素,采取相应的干预措施,有助于预防其发生。     

Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

Acute and chronic pain delay recovery and impair outcomes after major pediatric surgery. Understanding unique risk factors for acute and chronic pain is critical to developing effective treatments for youth at risk. We aimed to identify adolescent and family psychosocial predictors of acute and chronic postsurgical pain after major surgery in adolescents. Participants included 119 youth age 10 to 18 years (M_age = 14.9; 78.2% white) undergoing major musculoskeletal surgery and their parents. Participants completed presurgery baseline questionnaires, with youth reporting on baseline pain, anxiety, depression, insomnia and sleep quality, and parents reporting on parental catastrophizing and family functioning. At baseline, 2-week, and 4-month postsurgery, youth completed 7 days of daily pain diaries and reported on health-related quality of life. Sequential logistic regression models examined presurgery predictors of acute and chronic postsurgical pain, defined as significant pain with impairment in health-related quality of life. Acute pain was experienced by 27.2% of youth at 2 weeks, while 19.8% of youth met criteria for chronic pain at 4 months. Baseline pain predicted acute pain (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.32–2.90), while depressive symptoms (OR = 1.22; 95%CI = 1.01–1.47), and sleep quality (OR = 0.26; 95%CI = 0.08–0.83) predicted chronic pain. Tailored interventions need to be developed and incorporated into perioperative care to address risk factors for acute and chronic pain.PerspectiveLongitudinal results demonstrate adolescents’ presurgery pain severity predicts acute postsurgical pain, while depressive symptoms and poor sleep quality predict chronic postsurgical pain. Tailored interventions should address separate risk factors for acute and chronic pain after adolescent surgery.     

全程护理干预对独生女产妇心理状态及分娩质量的影响

目的：探讨产前、产时、产后全程护理干预对独生女产妇心理状态及分娩质量的影响。方法：将80例独生女产妇按照入院单双日期分为试验组和对照组各40例,对照组采取传统的产科服务模式,试验组采取产前信息支持与认知护理干预、产时全程陪伴及疼痛护理干预、产后康复指导护理干预等,比较两组产妇人院时与出院时的焦虑及抑郁程度、分娩方式、总产程时间、产后2h出血量及新生儿Apgar评分等。结果：两组产妇焦虑及抑郁程度、分娩方式、总产程时间、产后出血量及新生儿Apgar评分等情况比较差异有统计学意义（P〈0．05）。结论：对独生女产妇进行产前、产时、产后全程护理干预,可明显缓解产妇的焦虑及抑郁症状,缩短产程,减少产后出血,提高产科分娩质量,降低剖宫产率。     

Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors

This study evaluated a theoretically and empirically based model of the progression of acute neck and back pain to chronic pain and disability, developed from the literature in chronic pain, cognition, and stress and trauma. Clinical information and standardized psychosocial measures of cumulative traumatic events exposure (TLEQ), depressed mood (CES-D), pain (DDS), physical disability (PDI), and pain beliefs (PBPI) were collected at baseline from 84 acute back pain patients followed at an Acute Back Clinic over 3 months. Path analysis was used for the longitudinal prediction of perceived pain and disability. The predictive model accounted for 26% of the variance in persistent pain intensity and 58% of the variance in perceived physical disability at 3 months. Greater exposure to past traumatic life events and depressed mood were most predictive of chronic pain; depressed mood and negative pain beliefs were most predictive of chronic disability. More cumulative traumatic life events, higher levels of depression in the early stages of a new pain episode, and early beliefs that pain may be permanent significantly contribute to increased severity of subsequent pain and disability. Replication in a larger sample is desirable to confirm these paths. Early detection of elevated depressive symptoms and high trauma exposure may identify individuals at greater risk for developing chronic pain syndromes who may benefit from early multidisciplinary intervention.     

A longitudinal study of maternal postpartum depression symptoms

The purpose of this study was to examine changes in maternal depression symptoms over time from the postpartum period to 2 years after delivery among a sample of women identified with elevated depression symptoms at 2 to 4 weeks postpartum, a longitudinal within-subjects design was used to examine changes in maternal depression symptoms. Two years after delivery, 62 women who had elevated depression scores at 2 to 4 weeks postpartum completed mailed questionnaires including a Demographic Information Sheet, the Beck Depression Inventory II, and the Parenting Stress Index. Among this sample of women, 30.6% scored in the depressed range 2 years after delivery. Although depression scores decreased over time, the significant change in mean scores occurred from 4 to 8 weeks to 10 to 14 weeks postpartum, and mean scores did not change significantly from 10 to 14 weeks, to 14 to 18 weeks, to 2 years after delivery. Depression history, lower overall social support, and higher parental distress were associated with higher depression scores among mothers at 2 years after delivery. Initial decrease in depression scores suggests that postpartum depression symptoms posed a time-limited problem for many women with peak occurrence from 4 to 8 weeks after delivery. However, for many women depression symptoms persisted at 2 years after delivery. Previous depression, limited current support, and parental distress increased depression symptom severity. Additional longitudinal research is needed to determine factors that increase and ameliorate risk for chronic maternal depression. Clinical assessment of maternal depression beyond the early postpartum weeks is warranted for at-risk women.     

Relationships Among Prenatal Maternal Attachment, Presence of Postnatal Depressive Symptoms, and Maternal Role Attainment

purpose . To examine the relationships among a woman's attachment to her fetus, the presence of postpartum depressive symptoms, and subsequent perceptions of maternal role attainment three months after birth
design . A longitudinal, panel design
setting . Hospital-sponsored childbirth education classes
participants . Primiparous women (N = 136) at 24–40 weeks of pregnancy and 9–14 weeks after the birth
main outcome measures . Perceived Competence Scale, Myself as Mother Scale, and My Baby Scale
results . Prenatal maternal attachment was positively related to maternal role attainment but not to postpartum depressive symptoms. Postpartum depression was negatively related to maternal role attainment.
conclusions . These findings enhance maternal identity theory and provide a means to evaluate the transition to motherhood.     

阶段性健康教育对初产妇的负性情绪、疼痛程度和分娩方式的影响

[目的]探讨阶段性健康教育对初产妇的负性情绪、疼痛程度和分娩方式的影响.[方法]选择2015年1~12月本院收治的128例初产妇,根据分层抽样法将产妇分为观察组(n=64)及对照组(n=64),对照组围产期应用常规性护理,观察组围产期应用阶段性健康教育护理;应用焦虑自评量表(SAS)及抑郁自评量表(SDS)对两组产妇干预前后负性情绪进行评价,记录两组产妇分娩疼痛、产程及分娩结局情况.[结果]观察组干预后SAS、SDS评分均低于对照组(P<0.05);观察组分娩时疼痛评分低于对照组(P<0.05),第一产程、第二产程时间均短于对照组(P<0.05);观察组产后出血率、剖宫产率、产褥期抑郁症发生率均低于对照组(P<0.05),而42 d母乳喂养率、产妇满意率高于对照组(P<0.05).[结论]阶段性健康教育能有效改善初产妇焦虑、抑郁情绪,有利于缩短产妇产程,减轻产妇分娩疼痛感,降低产妇剖宫产率及产后抑郁症发生率,提高产妇母乳喂养率及满意率.     

Marital functioning, chronic pain, and psychological distress

This study examined whether marital functioning variables related uniquely to psychological distress and diagnoses of depressive disorder independent of pain severity and physical disability. Participants were 110 chronic musculoskeletal pain patients. Hierarchical regression results showed that marital variables (i.e. marital satisfaction, negative spouse responses to pain) contributed significantly to depressive and anxiety symptoms over and above the effects of pain severity and physical disability. In contrast, marital variables were not significantly related to diagnoses of depressive disorder (i.e. major depression, dysthymia, or both) after controlling for pain variables. In multivariate analyses, physical disability and marital satisfaction were uniquely related to depressive symptoms whereas physical disability, pain severity, and negative spouse responses to pain were uniquely related to anxiety symptoms. Only physical disability was uniquely related to major depression. The results suggest that models of psychological distress in chronic pain patients might be enhanced by attributing greater importance to interpersonal functioning and increasing attention to anxiety.     

Documented and self-reported child abuse and adult pain in a community sample

OBJECTIVES: To examine the association of chronic pain in young adults with childhood exposure to maltreatment and to determine whether depressive symptoms mediate such an association. DESIGN: A total of 649 members of a randomly selected cohort of young adults from a multiwave, multi-informant epidemiological study were interviewed with regard to chronic pain and symptoms of major depressive disorder. Maltreatment was measured both by retrospective self-report and by official records of substantiated child maltreatment. OUTCOME MEASURES: Current complaints of frequent pain and functionally impairing chronic pain were assessed in young adult interviews at mean age 22. RESULTS: Net of demographic factors, adult chronic pain was associated with self-reported sexual abuse. This association persisted after the contribution of concurrent depression was statistically controlled. Elevations of pain attributable to documented maltreatment were comparatively modest and below the threshold of statistical significance. Pain complaints in participants who self-reported physical abuse were not significantly elevated. CONCLUSIONS: Overall, results show an association between self-reported sexual abuse history and adult pain complaints in this general population sample, which was not attributable to symptoms of depression at the time of such reports.     

Acculturation level and postpartum depression in Hispanic mothers

PURPOSE: Perinatal health outcomes for Hispanic women are associated with acculturation. The purpose of this study was to explore the relationship between acculturation levels and postpartum depressive symptomatology and diagnosed postpartum depression among Hispanic subgroups. STUDY DESIGN AND METHODS: The Postpartum Depression Screening Scale and the Short Acculturation Scale were used in the two phases of data collection. Phase 1 and 2 samples consisted of 377 and 150 Hispanic mothers, respectively. Puerto Rican mothers showed higher levels of acculturation than Mexican and other Hispanic women. A DSM-IV diagnostic interview (SCID) was used to establish a diagnosis of depression. Hierarchical regression analyses were used to study the unique relationships between ethnicity, depressive symptomatology, diagnosed depression, and acculturation. RESULTS: There was no consistent relationship between acculturation and postpartum depression. Significant predictors of elevated postpartum depressive symptoms in Hispanic mothers were Puerto Rican ethnicity and cesarean delivery. Single marital status was a significant risk factor for postpartum depression. A limitation of the study was use of language as the sole criterion measure for acculturation. Acculturation is a complex construct with problematic measurement that needs greater refinement to facilitate research in which it is used as a variable. CLINICAL IMPLICATIONS: Hispanic mothers are a heterogeneous group and should not be treated as a homogeneous group. Subgroups of Hispanic mothers may not have the same level of acculturation or the same level of postpartum depressive symptomatology.     

Psychosocial outcomes of vaginal and cesarean births in Taiwanese primiparas

The purpose of this study was to examine differences in psychosocial outcomes between primiparas experiencing vaginal deliveries and primiparas experiencing cesarean deliveries. One hundred and ninety-four vaginal delivery primiparas and 81 cesarean delivery primiparas from the Kaohsiung city area in Taiwan were recruited at 6 weeks postpartum to participate in this study. Using two-sample t tests, we found no significant differences in perceived stress, self-esteem, or depression between vaginal and cesarean delivery primiparas. However, the cesarean delivery primiparas showed a significantly higher level of perceived social support than vaginal delivery primiparas. Types of cesarean (planned vs. unplanned) and types of anesthesia (general vs. epidural) were not significant factors influencing psychosocial outcomes for cesarean delivery primiparas. The lack of substantial differences between the groups may be a result of the normalizing effect of the high cesarean birthrate and greater social support given to this method of childbirth. Cultural concerns of offspring gender and choosing an auspicious time for delivery may also have ameliorative effects on the occurrence of psychosocial difficulties with a cesarean delivery in Taiwan.     

三种不同分娩方式对产妇产后抑郁发生情况的研究

目的比较自然分娩、自愿剖宫产、指征剖宫产产妇产后抑郁症的发生情况,探讨产后抑郁症与分娩方式的相关性及其心理护理的侧重面。方法以爱丁堡产后抑郁量表为筛查量表,对广州市177例产妇进行问卷调查,将其分为自然分娩组、自愿剖宫产组、有手术指征剖宫产组,进行产后抑郁症发病率比较。结果自然分娩组、自愿手术组及手术指征组产妇产后抑郁症发病率差异有显著性意义（x2=6．1281,P〈O．05）。手术指征组发病率最高（46．67％）,自然分娩组次之（36．67％）,自愿手术组发病率最低（21．43％）。结论有手术指征的剖宫产是产后抑郁症的高危因素。医护人员应对有手术指征的产妇采取预防性干预措施,减少产后抑郁症的发生。     

Clinical aspects of depression in chronic pain patients.

It has been widely recognized that an appreciable proportion of chronic pain patients have depressive disorders. Although numerous studies and several literature reviews have examined the relationship between chronic pain and depression, disorders of mood come in many forms, and little attention has been paid to the different types of depressive disorders found among patients with chronic pain. In this article, the different ways in which a chronic pain patient may manifest depression are discussed. Diagnostic criteria for major depression, dysthymia, and atypical depression are described, and the relevance of these disorders and of masked depression to chronic pain is discussed. The medical illnesses and medications that can cause symptoms of depressive disorders are also briefly described. Depressive disorders and their concomitants are an integral part of the experience of chronic pain and are important in developing an optimal treatment plan. For these reasons, they should be carefully evaluated in all patients with chronic pain.     

产后抑郁症及其家庭环境相关性探讨

目的 了解当地产后抑郁症的发病情况以及与产后抑郁症发生相关的家庭环境因素，寻找预防产后抑郁症的有效措施。方法 对我院237例产妇以爱丁堡产后抑郁量表（EPDS）进行筛选，以确定产后抑郁症患者，然后以家庭环境量表（FES-CV）和自编家庭条件问卷进行调查。结果 当地产后抑郁症的发病率为12，66％；各年龄组产妇产后抑郁症的发病率没有显著差异；家庭环境道德宗教观和控制性评分无统计学意义（P〉0.05），其余各项均有统计学意义（P〈0.05）；家庭环境因素中经济收入、居住条件、夫妻关系和丈夫照顾程度与PPD发生相关，具有统计学意义。结论 产后5周产妇即可出现不同程度的抑郁症表现；经济收入低、居住条件差、夫妻关系不和睦以及丈夫照顾不周是产后抑郁症发生的危险因素；应针对不同的危险因素采取不同的预防措施。     

腹式深呼吸法用于产后子宫按摩时的减痛效果观察

目的 观察产妇在按摩子宫时运用腹式深呼吸缓解疼痛的效果。 方法 将顺产及剖宫产妇分别设对照组及观察组,对照组按常规子宫按摩程序进行子宫按摩;观察组在按摩前指导其进行腹式深呼吸,呼气时下压宫底再进行有节律的子宫按摩,记录产妇子宫按摩时的疼痛程度。 结果 顺产产妇运用腹式深呼吸法为子宫按摩时的减痛效果不明显,剖宫产产妇子宫按摩时减痛效果明显。 结论 腹式深呼吸法可有效缓解剖宫产妇产后子宫按摩时的疼痛。