Hudson Charlotte, Spry Elizabeth, Borschmann Rohan, Becker Denise, Moran Paul, Olsson Craig, Coffey Carolyn, Romaniuk Helena, Bayer Jordana K, Patton George C
Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
Population Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia.
J Affect Disord. 2017 Feb;209:169-176. doi: 10.1016/j.jad.2016.11.022. Epub 2016 Nov 29.
Prior anxiety and depression have been identified as risk factors for maternal perinatal mental health problems, but other preconception mental disorders have not been prospectively examined. This study investigated prospectively whether women with preconception personality disorder have increased rates of antenatal anxiety and/or depressive symptoms.
244 women in a population cohort were assessed for personality disorder at age 24 using the Standardised Assessment of Personality. Five to twelve years later, women were screened with the Clinical Interview Schedule, Revised Anxiety Subscale and the Edinburgh Postnatal Depression Scale during the third trimester of 328 pregnancies.
Preconception personality disorder was associated with a three-fold increase in the odds of antenatal anxiety symptoms, which remained with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 2.84, 95% CI 1.31-6.15). Preconception personality disorder was associated with doubled odds of antenatal depressive symptoms, however this was attenuated with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 1.98, 95% CI 0.81-4.81).
Our findings are restricted to pregnant women aged 29-35 years. Anxiety and depression may have been under-identified because they were assessed at a single antenatal time point. Residual confounding of the associations by preconception common mental disorder at other time points may have occurred.
Women with personality disorder are at heightened risk of anxiety symptoms in pregnancy, over and above risks associated with prior common mental disorder. This raises a possibility that pregnancy brings particular emotional challenges for women with personality disorders.
既往焦虑和抑郁已被确定为孕产妇围产期心理健康问题的风险因素，但其他孕前精神障碍尚未进行前瞻性研究。本研究前瞻性调查了孕前患有精神障碍的女性产前焦虑和/或抑郁症状的发生率是否增加。
对244名队列人群中的女性在24岁时使用标准化人格评估进行人格障碍评估。五至十二年后，在328次妊娠的孕晚期，使用临床访谈量表、修订版焦虑分量表和爱丁堡产后抑郁量表对这些女性进行筛查。
孕前人格障碍与产前焦虑症状的几率增加三倍相关，在对孕前背景因素和孕前常见精神障碍进行调整后，该相关性依然存在（调整后的比值比为2.84，95%置信区间为1.31-6.15）。孕前人格障碍与产前抑郁症状的几率翻倍相关，然而，在对孕前背景因素和孕前常见精神障碍进行调整后，这种相关性有所减弱（调整后的比值比为1.98，95%置信区间为0.81-4.81）。
我们的研究结果仅限于年龄在29至35岁的孕妇。焦虑和抑郁可能未被充分识别，因为它们是在单一产前时间点进行评估的。在其他时间点，孕前常见精神障碍可能对这些关联产生残余混杂影响。
患有精神障碍的女性在孕期出现焦虑症状的风险更高，超过了既往常见精神障碍相关的风险。这增加了一种可能性，即怀孕给患有精神障碍的女性带来了特殊的情感挑战。
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