产后抑郁症的心理因素分析及预防对策研究

目的分析产后抑郁症发病的心理因素,并探讨相应的对策。方法对820例孕妇于妊娠36~38周施测艾森克个性量表(EPQ)及焦虑、抑郁情绪测定量表(HAD),在产后4~6周施测爱丁堡产后抑郁量表(EPDS)。结果产后抑郁症患者在EPQ的N量表和P量表上的评分均显著高于无产后抑郁症产妇,在L量表上的评分则显著低于后者,两者在E量表上的评分无显著差异。孕期有焦虑、抑郁情绪的产妇产后抑郁症的发病率显著高于孕期无焦虑、抑郁情绪的产妇(2χ=21.43,26.39,P<0.005)。结论产妇产后抑郁症的发生既有其心理根源,也与其孕期的焦虑抑郁情绪有密切的关系。加强孕期保健、采取及时筛查与干预措施是预防产后抑郁症的关键。     

Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: diagnostic and treatment implications

STUDY OBJECTIVES: To develop clinical guideposts to identify patients with salient nightmare conditions. DESIGN: Prevalence data from a retrospective chart review on a consecutive series of sleep patients to assess how or whether those with nightmares (1) rank nightmare complaints compared to other sleep complaints, (2) link nightmares to disrupted sleep, (3) report worse sleep symptoms and health outcomes compared to other sleep patients, and (4) endorse criteria for a salient nightmare condition on the Disturbing Dream and Nightmare Severity Index. SETTING: Two community sleep facilities: private sleep medical center and a hospital-based sleep lab. PATIENTS: Seven hundred eighteen patients presenting at intake: sleep center (n = 620); sleep lab (n = 98). MEASUREMENTS AND RESULTS: Standard sleep parameters and various health outcomes were assessed with self-report measures. Of 718 sleep patients, 186 ranked a nightmare complaint among their sleep problems, of whom 117 linked their bad dreams to disrupted sleep, suggesting a potential salient nightmare condition. Compared to all other sleep patients, these 117 cases demonstrated consistent significant patterns of worse or more prevalent problems with self-reported sleep indexes, insomnia, sleep quality, sleep-fragmentation factors, sleep-related daytime impairment, psychiatric history, medical comorbidity, and parasomnias. The Disturbing Dream and Nightmare Severity Index identified those with salient nightmare complaints and correlated with worse sleep and health outcomes. CONCLUSIONS: At 2 sleep medical facilities, 16% of patients presented with an apparent salient nightmare condition, and these patients were identified with simple clinical guideposts, which could be incorporated at intake in various sleep medicine settings.     

Nightmare prevalence, nightmare distress, and self-reported psychological disturbance

STUDY OBJECTIVES: The relationship between nightmare prevalence, nightmare distress, and self-reported psychological disturbance was assessed prospectively. DESIGN: Differences in self-reported psychological disturbance as a function of nightmare prevalence was investigated by MANCOVA's with non-nightmare dreams as the covariate as well as Pearson correlations. The relative contribution of nightmare prevalence and distress to the prediction of psychological disturbance was investigated through multiple regression analyses. SETTING: N/A. PARTICIPANTS: 116 participants (mean age = 20 years) completed self-report indices of depression, anxiety, dissociation, psychosis-proneness, and a psychiatric symptom checklist and kept a nightmare log for 21 consecutive nights. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Frequent nightmares were associated with higher levels of psychological disturbance. Individuals who reported 3 or more nightmares across the 3 weeks reported more dissociation, psychosis-proneness and psychiatric symptoms than participants reporting 2 nightmares or less. However, nightmare prevalence and distress were not significantly correlated and differentially predicted to different types of waking psychological disturbance. Multiple regressions further indicated that nightmare distress accounted for much of the unique explanatory variance in predicting clinical states associated with high negative affect (anxiety and depression). Last, there was no evidence for a specific relationship between nightmares and psychosis-proneness. CONCLUSIONS: The findings suggest that it is not the incidence of nightmares which is associated with poorer waking psychological functioning, especially anxiety and depression states, but the reported distress associated with the nightmare experience which is the critical variable in predicting higher psychological disturbance.     

Suicidality and sleep disturbances

STUDY OBJECTIVES: A growing body of research indicates that sleep disturbances may be specifically linked to suicidal behaviors. It remains unclear, however, whether this link is largely explained by depressive symptoms. The present study investigated the relationship between suicidality, depression, and sleep complaints in a clinical outpatient setting. DESIGN AND SETTING: Upon admission, 176 outpatients completed measures on sleep disturbances, suicidal symptoms, and depression. Several sleep disturbances were evaluated with regard to suicidal ideation, including insomnia, nightmares, and sleep-related breathing symptoms. MEASUREMENTS AND RESULTS: Regression analyses revealed that insomnia and nightmare symptoms were associated with both depressive symptoms and suicidality. Sleep-related breathing symptoms were associated with depressive symptoms, but did not show an association with suicidal ideation. After controlling for depressive symptoms, only nightmares demonstrated an association with suicidal ideation. This relationship emerged as a nonsignificant trend (P = .06). Nightmares were particularly associated with suicidality among women compared with men. Posthoc analyses revealed that, after controlling for sex and depressive symptoms, nightmare symptoms were significantly associated with suicidality (P = .04). CONCLUSIONS: Although insomnia and nightmares were significantly associated with depressive and suicidal symptoms, after controlling for additional variables, such as depression and sex, only nightmares remained associated with suicidality. This association was slightly stronger among women compared with men.     

Concerns of women regarding pregnancy and childbirth during the COVID-19 pandemic

ObjectiveBetter understand knowledge, attitudes and practices of pregnant women and mothers of infants around coronavirus disease 2019 (COVID-19).MethodsA 58-item electronic survey was distributed to pregnant and postpartum women (infants <12 months) who were >15 years, English-speaking and enrolled in prenatal programs. Data is summarized using central tendency, frequencies and nonparametric statistics.ResultsOf 114 (51 % response rate) participants, 82.5 % reported negative changes in mental status measures (e.g. stress, anxious thoughts, changes in sleep patterns). All reported risk-reduction behavior changes (e.g. handwashing/use of sanitizer, social distancing). Significant changes were reported in employment and financial status due to the pandemic. Increases in alcohol consumption among postpartum women were also reported. Few reported changes in prenatal, infant or postpartum healthcare access.ConclusionThis study provides initial insight into the knowledge, attitudes and practices of pregnant and postpartum women during the COVID-19 pandemic. This study is limited as participants represent a single Midwest community and social desirability response bias may have impacted responses. However, results may inform future interventions to support pregnant women and mothers of infants during pandemics.Practice implicationsProviders should consider the impact of such events on mental status, access to resources and changes in behaviors.     

Sleep in normal late pregnancy.

Twelve women in their third trimester of pregnancy and 10 age-matched nonpregnant controls underwent complete polysomnography for one night in the laboratory. Seven of the original women returned for a second study 3-5 months postpartum. During late pregnancy, women showed increased wake after sleep onset (WASO) and a lower sleep efficiency in comparison with the control group. The percentage of rapid eye movement (REM) sleep was significantly decreased and the percentage of stage 1 significantly increased compared to the nonpregnant group. At 3-5 months postpartum, a significant reduction in WASO and increased sleep efficiency were noted. However, only a slight increase was noted in REM sleep during the postpartum period compared to the prepartum period. The most frequent sleep complaints in the pregnant group were restless sleep, low back pain, leg cramps and frightening dreams. In summary, in accordance with their complaints, women in their third trimester demonstrated polysomnographic patterns of sleep maintenance insomnia.     

Patient preference for counselling predicts postpartum depression: a prospective 1-year follow up study in high-risk women

BACKGROUND: Patient preferences have been associated with a positive effect of depression treatment. Little is known about patient preferences in at-risk samples. The aim of this study was to examine the role of patient preference for counselling in the occurrence of postpartum depression in high-risk women. METHOD: We conducted a prospective 1-year follow up study in two hospitals and four midwifery practices in The Netherlands. Participants were 90 pregnant women at high risk for postpartum depression: 45 high-risk women who preferred no counselling, 45 high-risk women who preferred counselling. Both groups received care as usual. The main outcome measure was clinical depression (Research Diagnostic Criteria) at 3, 6, and 12 months postpartum. RESULTS: Point-prevalence rates of clinical depression were significantly higher in high-risk women who preferred counselling compared with high-risk women who did not prefer counselling (24% versus 9%, P=0.048; 19% versus 5%, P=0.048, at 3 and 6 months postpartum, respectively). No significant difference was found at 12 months postpartum. Across the first-year postpartum, high-risk women who preferred counselling were at seven-fold increased risk for clinical depression (OR=7.7, 95% CI 1.7-33.8, P=0.007). CONCLUSIONS: Patient preference for counselling is an important predictor of postpartum depression in pregnant women at high risk for postpartum depression. Patient preferences may reflect validly a perceived need for intervention in high-risk women. This finding emphasises the need to take patient preference for counselling into account as an important variable to identify a high-risk population.     

Infant sleep and feeding patterns are associated with maternal sleep,stress, and depressed mood in women with a history of major depressive disorder (MDD)

Our goal was to examine associations of infant sleep and feeding patterns with maternal sleep and mood among women at risk for postpartum depression. Participants were 30 women (age?±?SD?=?28.3?±?5.1 years) with a history of MDD (but not in a mood episode at enrollment) who completed daily sleep diaries, wore wrist actigraphs to estimate sleep, and had their mood assessed with the Hamilton Depression Rating Scale (HAM-D-17) during four separate weeks of the perinatal period (33 weeks pregnancy and weeks 2, 6, and 16 postpartum). They logged their infants’ sleep and feeding behaviors daily and reported postnatal stress on the Childcare Stress Inventory (CSI) at week 16. Mothers’ actigraphically estimated sleep showed associations with infant sleep and feeding patterns only at postpartum week 2. Shorter duration of the longest infant-sleep bout was associated with shorter maternal sleep duration (p?=?.02) and lower sleep efficiency (p?=?.04), and maternal sleep efficiency was negatively associated with the number of infant-sleep bouts (p?=?.008) and duration of infant feeding (p?=?.008). Neither infant sleep nor feeding was associated with maternal sleep at 6 or 16 weeks, but more disturbed infant sleep and more frequent feeding at 6 weeks were associated with higher HAM-D scores at 6 and 16 weeks and higher CSI scores. Sleep in the mother-infant dyad is most tightly linked in the early postpartum weeks, but mothers continue to experience disturbed sleep and infant sleep and feeding behaviors continue to be associated with mothers’ depressive symptoms and stress ratings as long as 16 weeks postpartum. These data imply that interventions designed to improve maternal sleep and postpartum mood should include both mothers and infants because improving infant sleep alone is not likely to improve maternal sleep, and poor infant sleep is linked to postpartum depression and stress.     

Predictors of postpartum depressive symptoms in Icelandic women

Summary Objective: The aim of the survey was to investigate the prevalence of postpartum depressive symptoms among Icelandic women and the predictive capacity of parental stress and infant difficulty. Method: A sample of women (n = 734), 2–3 months after giving birth was studied by mailed questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS); Parent Stress Index/Short Form (PSI/SF) and the Infant Difficulty Index (IDI). Demographic questions were also included. Results: The mean for depressive symptoms was 6.5, with 14% of the women experiencing frequent symptoms. Maternal stress and worries about health of the infant predicted depressive symptoms best. These variables explained 34% of the variance and social variables did not add to prediction. Conclusion: Maternal stress and worries about infant health are suggested as powerful predictors of postpartum depressive symptoms and are useful indicators for planning health care of mothers with young infants.     

Sleep and Depression in Postpartum Women: A Population-Based Study

Study Objectives:

(1) To describe the prevalence of and risk factors for postpartum maternal sleep problems and depressive symptoms simultaneously, (2) identify factors independently associated with either condition, and (3) explore associations between specific postpartum sleep components and depression.

Design:

Cross-sectional.

Setting:

Population-based.

Participants:

All women (n = 4191) who had delivered at Stavanger University Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks postpartum. The response rate was 68% (n = 2830).

Interventions:

None.

Measurements and results:

Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of sleep problems, defined as PSQI > 5, was 57.7%, and the prevalence of depression, defined as EPDS ≥ 10, was 16.5%. The mean self-reported nightly sleep duration was 6.5 hours and sleep efficiency 73%. Depression, previous sleep problems, being primiparous, not exclusively breastfeeding, or having a younger or male infant were factors associated with poor postpartum sleep quality. Poor sleep was also associated with depression when adjusted for other significant risk factors for depression, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression.

Conclusions:

Poor sleep was associated with depression independently of other risk factors. Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.

Citation:

Dørheim SK; Bondevik GT; Eberhard-Gran M; Bjorvatn B. Sleep and depression in postpartum women: a population-based study. SLEEP 2009;32(7):847-855.     

The prevalence of restless legs syndrome among pregnant women in Japan and the relationship between restless legs syndrome and sleep problems

STUDY OBJECTIVES: To clarify the prevalence of restless legs syndrome (RLS) in pregnant women living in Japan and to analyze the relationship between sleep problems and RLS, in order to discuss ways for pregnant women to obtain comfortable sleep and to improve the health of both the mother and child. DESIGN: A cross-sectional questionnaire survey. SETTING: 500 clinical institutions with maternity services were randomly sampled from a list of organizations identified in a survey by the Japan Association of Obstetricians and Gynecologists. Of these 500 institutions, 260 participated in the survey. PARTICIPANTS: 16,528 pregnant women living in Japan. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: In this survey of pregnant women, the prevalence of RLS was found to be 19.9%. An analysis was conducted on the relationship between RLS and other factors such as subjective evaluation of sleep, difficulty initiating sleep, difficulty maintaining sleep, early morning awaking, and excessive daytime sleepiness. The result of this analysis suggested that women with these sleep-related problems were more likely to have RLS than those without. In addition, RLS was more prevalent in the later stages of pregnancy. CONCLUSION: In the pregnant women in our survey, the prevalence of RLS was found to be 19.9%, which is higher than the prevalence of RLS that has been found in the general public in a previous study. This suggests that RLS-related sleep problems may be an important public health issue among pregnant women in Japan. This finding may have implications for attempts to improve sleep hygiene in this group.     

The relationship between sleep and mood in first-time and experienced mothers

Sleep disruption has been suggested to contribute to postpartum mood, but few studies have explored differences in this relationship between nulliparous and multiparous mothers. This study compared the interaction of sleep and mood as a function of parity. Thirty-five nulliparous and 34 multiparous mothers completed questionnaires on mood and sleep, and wore actigraphs for 7 days during the third trimester of pregnancy and within 2 weeks postpartum. Mood and objective sleep were better in multiparas than in nulliparas after delivery. However, other than a stronger association between subjective sleep and stress in nulliparous mothers, the relationship between sleep and mood did not differ significantly between the two groups. This suggests that parity might play only a limited role in the interaction between sleep and mood during the immediate postpartum period.     

不宁腿综合征孕妇的睡眠质量

目的：研究孕妇不宁腿综合征（RLS）的发生情况及其相关因素，及不宁腿综合征对孕妇睡眠质量的影响。方法：用国际不宁腿量表观察113例孕妇的不宁腿综合征发生情况，用匹兹堡睡眠质量指数量表（PSQI）以及一般情况量表评定孕妇的睡眠情况，探讨不宁腿综合征与孕妇的年龄、孕期、睡眠质量等因素之间的关系。结果：孕妇不宁腿综合征的门诊检出率为12．4％（14／113），患有不宁腿综合征孕妇的PSQI得分≥8的有4例（占28．6％），不患不宁腿综合征的孕妇PSQI得分≥8者有10例（10．1％，x^2=-3．86，P〈0．05），其它观察指标与不宁腿的发生无关（P〉0．05）。结论：孕妇伴RLS患者睡眠质量较差，孕妇不宁腿综合征的发生情况与年龄、孕期等因素无关。     

Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study

PURPOSE: To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women. MATERIALS AND METHODS: We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approximately 1 month postpartum. The 15 women in the CBT condition received 9 bi-weekly 1-hour individual CBT sessions, targeting and modifying negative patterns of thinking and behaviors occurring in the context of the dyadic relationship. RESULTS: The analysis of covariance (ANCOVA) showed that there were significant differences in all postpartum measures between the 2 groups, indicating that our antenatal intervention with CBT was effective in reducing depressive symptoms and improving marital satisfaction, which lasted until the postpartum period. CONCLUSION: Our pilot study has provided preliminary empirical evidence that antenatal CBT intervention can be an effective preventive treatment for PPD. Further study in this direction was suggested.     

Development of disturbing dreams during adolescence and their relation to anxiety symptoms

STUDY OBJECTIVES: This work assesses the prevalence and development of disturbing dreams among adolescents and the association of these dreams with anxiety. DESIGN: Sex differences in prevalence were analyzed with chi-square analyses. Changes over time were assessed with Wilcoxon tests and cross-tabulation tables. Associations with anxiety and DSM-III-R symptoms were assessed with ANOVA designs. SETTING: N/A PARTICIPANTS: A total of 610 boys and girls rated their recall of disturbing and normal dreams at both 13 and 16 years of age. Subgroups of subjects were evaluated for anxiety symptoms at age 13 and for DSM-III-R symptoms of separation anxiety (SA), overanxious disorder (OD) and generalized anxiety disorder (GAD) at age 16. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: The recall of disturbing dreams was more prevalent for girls than for boys at both ages, and increased over time for girls while it decreased for boys. The recall of normal dreams was also more prevalent for girls at both ages, but this difference could not fully account for the difference in recall of disturbing dreams. Normal dream recall increased from age 13 to 16 for both sexes. The frequent occurrence of disturbing dreams was associated with anxiety at age 13 and with GAD, SA and OD symptoms at age 16 for both sexes. Evidence of more numerous OD symptoms for girls with frequent disturbing dreams suggests that this form of anxiety may partially account for the observed sex difference in disturbing dream prevalence. CONCLUSIONS: The findings highlight a prevalence of disturbing dreams that is especially marked for adolescent girls. Unlike previous cross-sectional studies, which have found the same sex difference, this longitudinal design also calls attention to within-subjects changes in disturbing dream recall. The results also confirm that the frequent recall of disturbing dreams is associated with pathological symptoms of trait anxiety-apparently even as young as 13 years of age. Further study of disturbing dreams may contribute to understanding of associated pathophysiological factors which, too, vary by sex (e.g., PTSD, insomnia, depression).     

孕妇睡眠质量状况与家庭功能的相关性

目的:了解孕妇睡眠质量与家庭功能的关系,为改善孕妇睡眠质量提供参考。方法:采用匹兹堡睡眠指数量表(PSQI)、家庭功能量表(家庭支持APGAR问卷)对239名孕妇进行测评。结果:本组孕妇PSQI总分及各因子分(USM除外)均高于正常女性群体(U=5.32~19.40,P0.001),且28.8%(64/239)患者PSQI总分大于7分,远高于正常女性群体(χ~2=33.89,P0.001);本组孕妇的家庭功能状况较以往的研究差(χ~2=6.69,P=0.035);孕妇的PSQI总分及各因子分(USM除外)均与其家庭功能分呈负向相关(P0.05或0.01)。结论:孕妇的睡眠质量和家庭功能状况均较差,改善其家庭功能状况有助于睡眠质量的提升。     

1008例孕晚期妊娠妇女焦虑、抑郁情绪调查

目的了解孕晚期妊娠妇女焦虑、抑郁情绪的发生情况。方法采用状态-特质焦虑量表(STAI)、自评抑郁量表(SDS)以及自制的孕妇基本情况调查表,对1008名孕妇在孕32～34周时进行测试,并对结果进行分析。结果 1008名孕妇状态焦虑情绪发生率为20.3%,特质焦虑情绪发生率为5.9%,状态焦虑情绪评分明显高于国内正常人群(t=5.12,P<0.01);抑郁情绪发生率为23.7%,其中轻度抑郁发生率为18.5%,中度抑郁发生率为4.8%,重度抑郁发生率为0.5%。孕期状态焦虑、特质焦虑和抑郁情绪的发生率均以户籍孕妇最低,流动孕妇最高(χ2=15.65,7.07,28.19;P<0.01或<0.05)。结论孕期焦虑、抑郁情绪普遍存在。     

Knowledge of childhood sleep: a possible variable in under or misdiagnosis of childhood sleep problems

Evidence demonstrates that health professionals have limited knowledge about childhood sleep, frequently do not screen for these problems and often rely on parents to raise sleep issues at clinic visits. However, little is known about parents' sleep knowledge. The goal of this study was to assess parents' knowledge of sleep and specifically: (i) sleep aspects related to the age of children; (ii) developmentally normal sleep; and (iii) sleep problems that may lead to parents' ability to raise sleep issues at clinic visits. This study evaluated the knowledge of 170 parents of children aged 2-17 years about infant, child and adolescent sleep patterns and problems. The majority of parents could not answer correctly questions about developmental sleep patterns or sleep problems, but were more likely to answer correctly questions about normal infant sleep patterns and about sleep problems during waking hours. Parents also were more likely to answer 'don't know' to questions about: (i) older children and adolescents; (ii) sleep apnea; and (iii) dreams and nightmares. The implications of these findings for the identification, intervention and prevention of childhood sleep problems are discussed.     

Prevalence and genotype distribution of cervical human papillomavirus infection: Comparison between pregnant women and non-pregnant controls

Controversies exist on the effect of pregnancy on human papillomavirus (HPV) infection. A cross-sectional section study was conducted to compare the prevalence and genotype distribution of cervical HPV infection between pregnant and non-pregnant women in Hong Kong. Cervical samples were collected from 308 pregnant women and from the same number of age-matched controls recruited from a cervical cancer screening center located at the same hospital. HPV was detected by the polymerase chain reaction, followed by genotype identification by restriction fragment length polymorphism and direct sequencing analyses. The prevalence of HPV for pregnant women was 10.1%, without significant variation with age, gestation, gravidity and parity. The prevalence of HPV for non-pregnant group was 11.4% and did not show significant difference when compared to the pregnant group either by overall or age-stratified subgroup analyses. When the analysis was stratified according to the risk-type of HPV infection, still no significant difference between pregnant and non-pregnant groups was observed (all types: 10.1 vs. 11.4%, P = 0.602; high-risk types: 5.8 vs. 7.8%, P = 0.338; low-risk types: 1.0 vs. 2.9%, P = 0.080; unknown-risk types: 3.2% vs. 1.3%, P = 0.105). The results of this study show no evidence for an influence of pregnancy on HPV prevalence, and a majority of HPV-infected pregnant women had normal cervical cytology. HPV positive results in pregnant women per se should be managed conservatively.