Westdahl Claire, Milan Stephanie, Magriples Urania, Kershaw Trace S, Rising Sharon Schindler, Ickovics Jeannette R
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Obstet Gynecol. 2007 Jul;110(1):134-40. doi: 10.1097/01.AOG.0000265352.61822.1b.
To estimate how social support and social conflict relate to prenatal depressive symptoms and to generate a brief clinical tool to identify women at increased psychosocial risk.
This is a prospective study following 1,047 pregnant women receiving care at two university-affiliated clinics from early pregnancy through 1 year postpartum. Structured interviews were conducted in the second trimester of pregnancy. Hierarchical and logistic regressions were used to examine potential direct and interactive effects of social support and conflict on prenatal depressive symptoms measured by the Center for Epidemiologic Studies-Depression Scale.
Thirty-three percent of the sample reported elevated levels of depressive symptoms predicted from sociodemographic factors, social support, and social conflict. Social support and conflict had independent effects on depressive symptoms although social conflict was a stronger predictor. There was a "dose-response," with each increase in interpersonal risk factor resulting in consequent risk for probable depression based on symptom reports (Center for Epidemiologic Studies-Scale greater than or equal to 16). A composite of one social support and three conflict items were identified to be used by clinicians to identify interpersonal risk factors for depression in pregnancy. Seventy-six percent of women with a composite score of three or more high-risk responses reported depressive symptoms.
Increased assessment of social support and social conflict by clinicians during pregnancy can identify women who could benefit from group or individual interventions to enhance supportive and reduce negative social interactions.
评估社会支持和社会冲突与产前抑郁症状之间的关系，并生成一种简短的临床工具，以识别心理社会风险增加的女性。
这是一项前瞻性研究，对1047名在两家大学附属医院诊所接受孕期护理直至产后1年的孕妇进行跟踪。在妊娠中期进行结构化访谈。采用分层回归和逻辑回归分析社会支持和冲突对通过流行病学研究中心抑郁量表测量的产前抑郁症状的潜在直接和交互作用。
33%的样本报告称，根据社会人口统计学因素、社会支持和社会冲突预测，抑郁症状水平升高。社会支持和冲突对抑郁症状有独立影响，尽管社会冲突是更强的预测因素。存在“剂量反应”关系，人际风险因素每增加一项，根据症状报告（流行病学研究中心量表大于或等于16），患可能抑郁症的风险就相应增加。确定了一个由一项社会支持和三项冲突项目组成的综合指标，供临床医生用于识别孕期抑郁症的人际风险因素。综合得分有三项或更多高风险反应的女性中，76%报告有抑郁症状。
临床医生在孕期加强对社会支持和社会冲突的评估，可识别出能从团体或个体干预中受益的女性，这些干预有助于增强支持性并减少负面社会互动。
