School of Nursing, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
Central Taiwan University of Science and Technology, Taichung, Taiwan.
Int J Nurs Stud. 2016 Jul;59:68-78. doi: 10.1016/j.ijnurstu.2016.02.012. Epub 2016 Feb 26.
The 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.
We 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.
A prospective cohort study design was used.
Maternity unit of a medical center.
This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.
Pain 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.
After 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).
Our 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.
产后疼痛与抑郁症状之间的关系仍存在争议。据我们所知，之前的研究没有使用经过验证的措施和多个量表来评估会阴疼痛，也没有研究其与产后期间抑郁症状的关系。
我们研究了产后 6 个月内疼痛和先前产后疼痛与抑郁之间的关系，以及先前产后抑郁症状的影响。
前瞻性队列研究设计。
医疗中心的产科病房。
这项研究包括 432 名参与者；收集了人口统计学特征、会阴疼痛以及产后 6 个月内任何疼痛和抑郁的数据。
使用简短形式的麦吉尔疼痛问卷和流行病学研究中心抑郁量表分别测量疼痛和抑郁症状。使用广义估计方程来检查与产后抑郁相关的因素。
调整了混杂因素后，在产后 4-6 周时出现会阴疼痛的女性在产后 4-6 周（风险比[RR]：1.9，95%置信区间[CL]：1.2，3.2）和 6 个月（RR：1.9，95% CL：1.1，3.3）时发生抑郁的风险增加，而无会阴疼痛的女性则没有。产后 4-6 周时会阴疼痛的严重程度也预测了产后 6 个月时的抑郁症状（β=0.63，p=0.02）。产后 3-5 天时任何疼痛强度评分均预测了 3 个月时的抑郁（β=0.01，p=0.04）。产后 3-5 天时抑郁评分较高的女性在产后 4-6 周、3 个月和 6 个月时发生抑郁的风险分别增加了两倍或三倍，而抑郁评分较低的女性则没有（RR：3.5，95% CL：2.2，5.4；RR：2.2，95% CL：1.3，3.4；RR：2.8，95% CL：1.7，4.8）。
我们的研究提供了有力的证据，表明产后 4-6 周时的会阴疼痛与产后 4-6 周和 6 个月时的抑郁症状相关；产后 3-5 天时的疼痛预测了产后 3 个月时的抑郁症状；而先前的产后抑郁症状，特别是产后 3-5 天时的抑郁症状，预测了产后 6 个月期间的抑郁症状。
