Ai F-F, Zhu L, Mao M, Zhang Y, Kang J
a Department of Obstetrics and Gynecology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College , Beijing , PR China.
Climacteric. 2018 Apr;21(2):184-188. doi: 10.1080/13697137.2018.1430130. Epub 2018 Feb 3.
This study aimed to investigate the impact of depressive symptoms on successful pessary treatment for postmenopausal women with symptomatic pelvic organ prolapse (POP).
We performed a prospective study involving postmenopausal women with POP who visited our clinic seeking pessary treatment. Demographic information and medical histories were collected. The participants completed the following questionnaires at baseline and after 3 months of successful pessary use: (1) the Pelvic Floor Impact Questionnaire-7 (PFIQ-7); (2) the Pelvic Floor Distress Inventory (PFDI-20); and (3) the Patient Health Questionnaire-9 (PHQ-9). The data were analyzed with the independent samples t-test, Mann-Whitney U-test, χ test, Fisher's exact test, paired t-test or Wilcoxon signed-rank test as appropriate.
In total, 102 (92.7%) participants who completed the entire study were included in the analysis. No significant differences were found in the sociodemographic or clinical characteristics between the 'positive' and 'negative' depressive symptom groups (p > 0.05). After 3 months of successful pessary treatment, the scores of the PFIQ-7 (including the Urinary Incontinence Questionnaire-7, the Colon Rectal Anal Impact Questionnaire-7 and the Pelvic Organ Prolapse Impact Questionnaire-7 subscales) and PFDI-20 (including the Pelvic Organ Prolapse Distress Inventory-6, the Colon Rectal Anal Distress Inventory-8 and the Urinary Distress Inventory-6 (UDI-6) subscales) were significantly decreased in all participants (p < 0.05). The PHQ-9 score was also significantly decreased (p < 0.001). However, the participants with depressive symptoms reported significantly less improvement post-treatment than those without depressive symptoms in the score of the PFDI-20 subscale UDI-6, which represented the degree of distress due to the lower urinary tract symptoms (p = 0.022).
Both the quality of life and depressive symptom scores were significantly improved after 3 months of successful pessary use. We advocate making depressive symptom screening a regular indicator for assessing the effectiveness of conservative POP treatment.
本研究旨在调查抑郁症状对有症状的绝经后盆腔器官脱垂（POP）妇女子宫托治疗成功的影响。
我们进行了一项前瞻性研究，纳入了前来我们诊所寻求子宫托治疗的绝经后POP妇女。收集了人口统计学信息和病史。参与者在基线时以及成功使用子宫托3个月后完成了以下问卷：（1）盆底影响问卷-7（PFIQ-7）；（2）盆底困扰量表（PFDI-20）；以及（3）患者健康问卷-9（PHQ-9）。根据情况，数据使用独立样本t检验、曼-惠特尼U检验、χ检验、费舍尔精确检验、配对t检验或威尔科克森符号秩检验进行分析。
共有102名（92.7%）完成整个研究的参与者被纳入分析。“阳性”和“阴性”抑郁症状组之间的社会人口统计学或临床特征未发现显著差异（p>0.05）。成功使用子宫托治疗3个月后，所有参与者的PFIQ-7（包括尿失禁问卷-7、结肠直肠肛门影响问卷-7和盆腔器官脱垂影响问卷-7子量表）和PFDI-20（包括盆腔器官脱垂困扰量表-6、结肠直肠肛门困扰量表-8和尿路困扰量表-6（UDI-6）子量表）得分均显著降低（p<0.05）。PHQ-9得分也显著降低（p<0.001）。然而，有抑郁症状的参与者在代表下尿路症状所致困扰程度的PFDI-20子量表UDI-6得分上，治疗后改善程度明显低于无抑郁症状的参与者（p=0.022）。
成功使用子宫托3个月后，生活质量和抑郁症状评分均显著改善。我们主张将抑郁症状筛查作为评估POP保守治疗效果的常规指标。
