Bayrampour Hamideh, McDonald Sheila, Tough Suzanne
Department of Pediatrics, Faculty of Medicine, University of Calgary, Alberta Centre for Child, Family & Community Research - Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8.
Maternal-Child Health, Research and Innovation, Population, Public, and Aboriginal Health, Alberta Health Services, Southport Atrium, ♯ 2240, 10101 Southport Rd. SW, Calgary, AB, Canada T2W 3N2.
Midwifery. 2015 Jun;31(6):582-9. doi: 10.1016/j.midw.2015.02.009. Epub 2015 Mar 6.
chronic poor mental health over the course of pregnancy contributes to greater adverse maternal and child outcomes. Identifying women with chronic depressive or anxiety symptoms can provide opportunities to reduce distress and improve pregnancy outcomes. The objective of this study was to determine risk factors of chronic antenatal depressive and anxiety symptoms using a longitudinal pregnancy cohort in Alberta, Canada.
women with singleton pregnancies were included (N=3021). Anxiety and depressive symptoms were measured in the second and third trimesters using the Spielberger State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale, respectively. On the basis of the timing and persistence of symptoms, the following three mutually exclusive subgroups for each anxiety and depressive symptoms were created: never symptomatic, symptomatic only in the second trimester, and symptomatic at both time points. Separate logistic regression models were used to derive risk factors for each subgroup.
women with chronic anxiety or depressive symptoms were distinguished from those with transient symptoms or no symptoms by their optimism scores, in which less optimistic pregnant women had a four-fold increased risk for developing chronic depressive or anxiety symptoms compared with more optimistic women (AOR varied from 4.30 to 4.93). Additionally, high perceived stress, low social support, history of mental health issues were common predictors of chronic anxiety and depressive symptoms in pregnancy. Partner tension was the exclusive predictor of anxiety symptoms (AOR varied from 1.94 to 2.31) and poor physical health (AOR 2.54; 95% CI 1.32-4.89), unplanned pregnancy (AOR 3.05; 95% CI 1.61-5.79), and infertility treatments (AOR 4.98; 95% CI 1.85-13.39) were unique predictors of chronic depressive symptoms.
knowledge of the risk factors of chronic poor mental health during pregnancy might inform the development of effective strategies within the limited resources of health-care systems to target populations with greater needs for interventions.
孕期长期心理健康状况不佳会导致更严重的母婴不良结局。识别患有慢性抑郁或焦虑症状的女性可为减轻痛苦和改善妊娠结局提供机会。本研究的目的是利用加拿大艾伯塔省的一个纵向妊娠队列确定慢性产前抑郁和焦虑症状的风险因素。
纳入单胎妊娠女性（N = 3021）。分别在孕中期和孕晚期使用斯皮尔伯格状态-特质焦虑量表和爱丁堡产后抑郁量表测量焦虑和抑郁症状。根据症状出现的时间和持续情况，为每种焦虑和抑郁症状创建以下三个相互排斥的亚组：从未有症状、仅在孕中期有症状、在两个时间点均有症状。使用单独的逻辑回归模型得出每个亚组的风险因素。
慢性焦虑或抑郁症状的女性与短暂症状或无症状的女性在乐观得分上存在差异，与更乐观的女性相比，不太乐观的孕妇出现慢性抑郁或焦虑症状的风险增加四倍（调整后比值比从4.30到4.93不等）。此外，高感知压力、低社会支持、心理健康问题史是孕期慢性焦虑和抑郁症状的常见预测因素。伴侣关系紧张是焦虑症状的唯一预测因素（调整后比值比从1.94到2.31不等），身体健康不佳（调整后比值比2.54；95%可信区间1.32 - 4.89）、意外怀孕（调整后比值比3.05；95%可信区间1.61 - 5.79）和不孕治疗（调整后比值比4.98；95%可信区间1.85 - 13.39）是慢性抑郁症状的独特预测因素。
了解孕期慢性心理健康不佳的风险因素可能有助于在医疗保健系统资源有限的情况下制定有效的策略，以针对更需要干预的人群。
