产妇产后初期抑郁状况、影响因素及干预措施

目的分析产妇产后初期(产后第7天)抑郁状况,探讨相关影响因素及干预措施。方法选取2016年7月-2017年12月在泸县妇幼保健院分娩的85例产妇为研究对象,于产后第7天采用爱丁堡产后抑郁量表(EPDS)评定产妇抑郁状况,对EPDS筛查阳性者进行产后抑郁影响因素问卷调查,并予以相应的心理干预,比较其干预前后EPDS评分。结果 EPDS评分9分者共46例(54.12%),其中存在产后抑郁倾向者25例(29.41%)、产后抑郁者21例(24.71%)。EPDS阳性者产后初期出现抑郁症状的因素主要有:孕期知识掌握不足(47.83%)、家庭/社会支持不足(47.83%)、无法适应产后角色或(和)自身改变(43.48%)。阳性者干预前后EPDS评分比较差异有统计学意义[(16.26±5.34)分vs.(12.24±4.15)分,t=12.528,P=0.021]。结论产妇产后初期抑郁发生率较高,其影响因素较多,尽早采取心理干预措施可能有助于改善产妇的抑郁情绪。     

产后抑郁对母乳喂养的影响

目的 :调查产后抑郁患者心理社会因素及其对母乳喂养的影响。　方法 :对 2 76例产妇在产后第 3、4 2天收集有关的心理、社会、产科因素、母乳喂养情况 ,并用抑郁自评量表 (SDS)进行评定 ,得分 >4 1为抑郁组 (其中≥ 5 0分为抑郁状态 ) ,≤ 4 0为正常组 ,两组对比分析。　结果 :产后第 3天 ,产后抑郁的发生率为 2 2 .5 % ,产后 4 2天其发生率为 1.1% (P <0 .0 1)。产后抑郁有许多心理社会因素及产科因素。产后第 4 2天抑郁组纯母乳喂养占 5 9.8% ,正常组 75 .3% ,差异有显著性 (P <0 .0 5 )。　结论 :产后抑郁的发生具有一定的心理社会和产科因素 ,但对母乳喂养有负性影响应引起重视     

高龄孕产妇焦虑、抑郁症状分析

目的：探讨高龄孕产妇焦虑、抑郁症状的发生率及相应的危险因素。方法：随机选取两家妇产科医院的孕妇522名,采用综合医院焦虑和抑郁量表（HAD）、爱丁堡产后抑郁量表（EPDS）和自编危险因素问卷,分别评估人组时、孕38周、产后7d、产后42d和产后3个月的焦虑、抑郁症状。结果：522名中有19例高龄孕产妇。高龄孕产妇5个时点的焦虑症状发生率依次为：15.8％、11．1％、21．1％、6．7％和10．0％;孕期HAD评定的抑郁症状发生率为21．1％、11.1％,产后EPDS评定抑郁症状发生率为10.5％、28．6％和20．0％。高龄孕产妇焦虑、抑郁症状的发生率均高于非高龄孕产妇。初潮年龄和担忧孩子喂养与高龄孕产妇人组时的抑郁情绪相关,分娩时紧张状态和产后抢救与产后7d的焦虑情绪相关。结论：高龄孕产妇存在较多的焦虑和抑郁情绪,应针对其危险因素进行预防。     

产后抑郁的影响因素调查及个体心理干预效果

目的探讨产后抑郁的影响因素及个体心理干预效果,为产后抑郁的防治提供参考。方法选择2016年2月-2018年2月在泸县妇幼保健院妇产科分娩、爱丁堡产后抑郁量表(EPDS)评分≥9分且符合《中国精神障碍分类与诊断标准(第3版)》(CCMD-3)产后抑郁症诊断标准的产妇62例,采用自制影响因素调查问卷进行调查,分析产妇发生抑郁症状的主要影响因素。采用随机数字表法将62例产妇分为对照组和观察组各31例,对照组给予常规心理疏导,观察组给予个体化心理干预,均干预7天。干预前和干预后,采用EPDS和汉密尔顿抑郁量表17项版(HAMD-17)评定产妇抑郁症状。结果 62例产妇产后抑郁的影响因素中,受分娩疼痛、激素变化影响出现情感脆弱(30.65%)的比例最高,其次为难以做好母亲角色转变(24.19%)和难以适应分娩后自身变化(17.74%)。干预后,观察组EPDS和HAMD-17评分均低于对照组,差异均有统计学意义[(13.26±4.36)分vs.(17.63±3.56)分,(14.02±6.13)分vs.(25.32±5.54)分,t=14.272、12.526,P均0.05]。结论产后抑郁的心理因素较多,个体化心理干预对产后抑郁的改善效果优于常规心理疏导。     

爱丁堡产后抑郁量表的临床应用

目的:初步探讨Edinburgh产后抑郁量表（EPDS）用于中国妇女的临床用．量表性能及适宜的分界值。方法：298名产妇在产后第三天用EPDS、BDI、GHQ进行评定,抽取部分产妇用DSM－Ⅲ－R临床试验式检查－住院版（SCID－NP）进行调查,以建立DSM－Ⅲ－R抑郁障碍的诊断。结果：EPDS和BDI、GHQ具有良好的平行效度。以BDI量表分和DSM－Ⅲ－R诊断结果为标准,其临床筛查分界值应为9／10。结论：EPDS具有良好的临床使用性能,是筛查产后抑郁简便而敏感的量表,推荐其分界值为9／10。     

心理护理干预对孕产妇的妊娠结局及产后抑郁状况的影响

目的研究孕产妇实施心理护理干预对其妊娠结局及产后抑郁状况的影响。方法以2012年3月~2013年12月期间在我院妇产科分娩的70例孕产妇为对照组。选取2014年1月~2016年2月期间于我院妇产科分娩的100例孕产妇为观察组研究对象。对照组实施常规护理干预,观察组在对照组基础护理干预的基础上实施心理护理干预。对比分析两组的妊娠结局、产后5天与3周后的爱丁堡产后抑郁量表(EPDS)评分情况。结果观察组患者的自然分娩率显著高于对照组,而产后出血率与剖宫产率显著低于对照组;产后5天以及产后3周,观察组患者的EPDS评分显著低于对照组,且产后抑郁的发生率显著低于对照组,差异均具有统计学意义(P0.05)。结论为孕产妇实施心理护理干预能有效改善孕产妇的妊娠结局,降低产后抑郁的发生率,是临床效果显著的护理方式。     

苏州市某社区产后抑郁流行病学调查及相关危险因素

目的调查苏州市某社区产后抑郁的检出率及相关危险因素,为产后抑郁的防治提供参考。方法选取苏州市某社区88例产妇,采用爱丁堡产后抑郁量表(EPDS)评定其产后抑郁情况,采用艾森克人格问卷(EPQ)和社会支持评定量表(SSRS)评定产妇的个性特征及社会支持情况。以EPDS评分9分为界将产妇分为产后抑郁组和正常组,分析影响产后抑郁的相关因素。结果苏州市某社区产后抑郁检出率为21.6%;产后抑郁组EPQ神经质(N)维度评分高于正常组,差异有统计学意义[(88.45±8.07)分vs.(37.16±8.22)分,t=2.625,P0.05]。产后抑郁组与正常组SSRS总评分与各维度评分比较差异均无统计学意义(t=-1.411~-0.590,P均0.05)。产后抑郁组SSRS客观支持及主观支持评分与EPDS评分均呈负相关(r=-0.471、-0.459,P均0.05)。结论苏州市某社区产后抑郁的检出率较高,产妇的神经质人格特质与产后抑郁有关。     

流产后抑郁障碍调查

目的：主要调查香港地区中国妇女流产后精神疾病的患病率。方法：对282名妇女在流产后6周用30项一般健康问卷（GHQ）、Edinburgh产后抑郁量表（EPDS）和Beck抑郁量表（BDI）进行评定,以DSM－Ⅲ-R定式检查（SCID）建立诊断,检验GHQ、EPDS与DSM－Ⅲ-R诊断间效标效度,以及和BDI间的平行效度。结果：29名妇女（10．3％）符合DSM-Ⅳ-R重症抑郁诊断,GHQ、EPDS具有良好的效标效度和平行效度。结论：中国香港妇女流产后精神障碍患病率降低,EPDS、GHQ适合用于综合性医院中流产后抑郁障碍的筛查。     

分娩前后孕产妇心理状态调查

目的:了解初产妇在分娩前后的焦虑、抑郁情况。方法:采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和爱丁堡产后抑郁量表(EPDS)进行评定分析,测定血雌二醇和孕酮值。结果:分娩前后均有一定的焦虑和抑郁发生率。结论:应重视孕产妇的心理状态。     

社会心理支持系统对产后抑郁的影响

目的：探讨孕妇学校学习、导乐分娩、分娩镇痛及产后访视联合应用的社会心理支持系统对产后抑郁的影响。方法选择从2013年1月-2014年1月建卡,孕期坚持在我院正规产检、分娩并进行产后访视,无产科合并症及并发症的初产妇共200例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、爱丁堡孕产期抑郁量表(EPDS)及社会支持量表(SSRS)分别对是否接受社会心理支持系统进行孕期及分娩期生理及心理指导的两组孕妇进行调查。结果接受社会支持系统的初产妇(观察组)在第一产程及产后42天的SAS、SDS评分低于未接受社会支持系统的初产妇(对照组)(P<0.05),产后42天观察组EPDS评分低于对照组、SSRS及婚姻满意度评分高于对照组(P<0.05)。结论孕妇学校学习、导乐分娩、分娩镇痛及产后访视的社会心理支持系统可缓解孕期、分娩及产后焦虑,降低产后抑郁的检出率。     

Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: a prospective study

Aim:  Many studies have documented serious effects of postpartum depression. This prospective study sought to determine predictive factors for postpartum depression.
Methods:  Pregnant women ( n  = 239) were enrolled before 24 weeks in their pregnancy. At 6 weeks postpartum, 30 women who had postpartum depression and 30 non-depressed mothers were selected. The Edinburgh Postnatal Depression Scale (EPDS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSES) Marital Satisfaction Scale (MSS), and the Childcare Stress Inventory (CSI) were administered to all 60 mothers at 24 weeks pregnancy, 1 week postpartum, and 6 weeks postpartum.
Results:  The differences in most of the diverse sociodemographic and obstetric factors assessed were not statistically significant. There were significant differences in MSS scores at 24 weeks pregnancy ( P  = 0.003), and EPDS ( P  < 0.001; P  = 0.002), BDI ( P  = 0.001; P  = 0.031), and BAI ( P  < 0.001; P  < 0.001) at both 24 weeks pregnant and 1 week postpartum, while there was no significant difference in the RSES scores at 24 weeks pregnant ( P  = 0.065). A logistic regression analysis was performed on the following factors: 'depressive symptoms immediately after delivery' (EPDS and BDI at 1 week postpartum), 'anxiety' (BAI prepartum), 'stress factors from relationships' (MSS prepartum and CSI at 1 week postpartum) or 'self-esteem' (RSES prepartum). When these four factors were added individually to a model of the prepartum depressive symptoms (EPDS and BDI prepartum), no additional effect was found.
Conclusions:  The optimum psychological predictor is prepartum depression, and other psychological measures appear to bring no significant additional predictive power.     

Rates of deliberate self-harm in Asians: findings and models

The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13%. Prevalence estimates are affected by the nature of the assessment method (larger estimates in studies using self-report measures) and by the length of the postpartum period under evaluation (longer periods predict high prevalences). A meta-analysis was undertaken to determine the sizes of the effects of a number of putative risk factors, measured during pregnancy, for postpartum depression. The strongest predictors of postpartum depression were past history of psychopathology and psychological disturbance during pregnancy, poor marital relationship and low social support, and stressful life events. Finally, indicators of low social status showed a small but significant predictive relation to postpartum depression. In sum, these findings generally mirror the conclusions from earlier qualitative reviews of postpartum depression risk factors.     

The role of some psychological, psychosocial and obstetrical factors in the intensity of postpartum blues

AIM: Within days following birth, most women show signs of mood changes, commonly named baby blues. Baby blues can result in postpartum depression. Hence it appears important to explore in more details the clinical background related to the intensity of postpartum blues. The aim of this study is to investigate the contribution of psychological, psychosocial and obstetrical factors to the intensity of postpartum blues. METHOD: One hundred and forty-eight women participated in the study and completed questionnaires three days after delivery. A questionnaire was built to collect information on psychosocial and obstetrical factors. The Maternity Blues (Kennerley and Gath, 1989) was used to assess postpartum blues. Psychological factors were measured with the Maternal Self-Report Inventory (Shea et Tronick, 1988), the Perceived Stress Scale (Cohen, Kamarch et Mermelstein, 1983) and the Sarason's Social Support Questionnaire (1983). RESULTS: Four multiple regression analyses were conducted to predict the intensity of postpartum blues by entering psychosocial factors, history of depression, obstetrical factors and psychological and relational factors. Significant predictors (maternal self-esteem, marital status, previous psychotherapeutic treatment, previous antidepressant treatment) were entered in a multiple regression analysis predicting the intensity of postpartum blues. This model accounted for 31% of the variance in the intensity of postpartum blues (F(4, 143)=17.9; P<0.001). Maternal self-esteem (beta=-0.37; P<0.001), marital situation (beta=-0.16; P=0.02) were significant predictors. Previous antidepressant treatment (beta=0.13; P=0.05) was almost a significant predictor. CONCLUSION: The preventive implication of this study is important. Some psychological and psychosocial variables predicted the intensity of postpartum blues and may be used in order to detect women who exhibit risk factors.     

孕期心理干预对产后情绪的影响

目的探讨孕期对孕妇及家属给予心理干预对产后抑郁、焦虑情绪的影响。方法对270名孕妇和268名孕妇家属分别进行心理干预,对照组269名孕妇接受一般教育,干预组及对照组在孕期填写一般情况调查表及SDS、SAS量表,产后1周、1个月、6个月填写SDS、SAS量表。结果干预组产后抑郁焦虑发生率较对照组明显降低(P<0.05)。结论孕期加强对孕妇及家属的心理教育有利于稳定情绪,降低产后抑郁、焦虑的发生。     

The lived experience of postpartum depression in a psychiatric population

PROBLEM: Studies have examined the quantitative causal factors of postpartum depression. However, the lived experience of postpartum depression has not been investigated. METHOD: Using a psychophenomenological design, the investigators examined reports from seven clients with a psychiatric diagnosis of postpartum depression and the role life experiences played in their labor, delivery, and postpartum periods. FINDINGS: Phenomenological analysis indicated that the psychological and physiological effects of abuse interact to create a cognitive frame of reference similar to the experience of abuse. CONCLUSION: The normal developmental event of childbearing contributes to the recall of abuse and sets the stage for postpartum depression.     

Risk factors for antenatal depression: A review

Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.     

Early postpartum mood as a risk factor for postnatal depression in Nigerian women

OBJECTIVE: This report explored early postpartum mood changes and their correlation with postnatal depression in African women. METHOD: Scores on the Maternity Blues Scale and the Edinburgh Postnatal Depression Scale for 478 women on the fifth day postpartum were compared with the women's Research Diagnostic Criteria diagnosis at 4 and 8 weeks postpartum. RESULTS: The Maternity Blues Scale and the Edinburgh Postnatal Depression Scale scores at day 5 postpartum were found to reliably predict the diagnosis of depression at 4 and 8 weeks postpartum. CONCLUSIONS: African women at risk of postnatal depression can be identified in the early postnatal period by incorporating simple screening methods.     

Antenatal risk factors for postpartum depression: a synthesis of recent literature

Postpartum nonpsychotic depression is the most common complication of childbearing, affecting approximately 10-15% of women and, as such, represents a considerable health problem affecting women and their families. This systematic review provides a synthesis of the recent literature pertaining to antenatal risk factors associated with developing this condition. Databases relating to the medical, psychological, and social science literature were searched using specific inclusion criteria and search terms, in order to identify studies examining antenatal risk factors for postpartum depression. Studies were identified and critically appraised in order to synthesize the current findings. The search resulted in the identification of two major meta-analyses conducted on over 14,000 subjects, as well as newer subsequent large-scale clinical studies. The results of these studies were then summarized in terms of effect sizes as defined by Cohen. The findings from the meta-analyses of over 14,000 subjects, and subsequent studies of nearly 10,000 additional subjects found that the following factors were the strongest predictors of postpartum depression: depression during pregnancy, anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, low levels of social support, and a previous history of depression. Critical appraisal of the literature revealed a number of methodological and knowledge gaps that need to be addressed in future research. These include examining specific risk factors in women of lower socioeconomic status, risk factors pertaining to teenage mothers, and the use of appropriate instruments assessing postpartum depression for use within different cultural groups.     

性激素、催乳素与产后抑郁的相关研究

目的：本研究主要探讨产后雌二醇（Ｅ２）、催乳素（ＰＲＬ）变化和产后抑郁症状间的关系。方法：对３８名产妇在产程开始前和产后第７２小时分别抽取血标本,使用放射免疫法检测产后Ｅ２、Ｐ和ＰＲＬ的数量变化,同时用Ｅｄｉｎｇｂｕｒｇｈ产后抑郁量表（ＥＰＤＳ）、Ｂｅｓｋ抑郁量表（ＢＤＩ）、一般健康问卷（ＧＨＱ）对产妇在产后第３天和产后第４２天进行评定。结果：产后第３天ＥＰＤＳ和ＢＤＩ量表分值显著高于产后第４２天,产后Ｅ２变化与ＥＰＤＳ、ＢＤＩ量表分呈显著负相关,产后Ｐ变化和产后第４２天ＧＨＱ量表分呈显著正相关,ＰＲＬ变化和产后情绪状况无明显关系。结论：产后内分泌激素变化可能是产后抑郁的病因之一。     

Silent suicide: suicide among people not in contact with mental health services

The evidence relating postpartum mood disorder to endocrine factors is reviewed, with particular reference to thyroid hormones, progesterone, cortisol and oestrogen. The findings on non-psychotic depression and thyroid dysfunction are the most robust, but such biological changes have to be seen as interacting with psychological and social factors to produce depression. Hormone treatment trials in specific subgroups of postnatal women would enhance our understanding of aetiology