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DSM-5 时代的分娩恐惧:基于临床表现的 Wijma 分娩期望/体验问卷新截断分析的结果。

Tocophobia in the DSM-5 era: Outcomes of a new cut-off analysis of the Wijma delivery expectancy/experience questionnaire based on clinical presentation.

机构信息

Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.

Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.

出版信息

J Psychosom Res. 2019 Jan;116:37-43. doi: 10.1016/j.jpsychores.2018.11.012. Epub 2018 Nov 20.

Abstract

INTRODUCTION AND AIMS

Diagnosis of tocophobia using existing instruments is an area of active investigation. Although a range of Wijma Delivery Experience Questionnaire (W-DEQ) cut-off scores has been suggested for detecting tocophobia, there is no consensus among researchers about an optimal cut-off score. The primary goal of the present study was to identify a cut-off value while referring to the DSM-5 Specific Phobia criteria as a gold standard, and to accordingly evaluate how the fearful component of the childbirth experience and psychopathology in the post-natal period are affected by tocophobia.

METHODS

We conducted an observational, longitudinal study on nulliparous women (n = 106). Routine pregnancy data and data from psychometric questionnaires investigating depression, anxiety, and fear of childbirth were collected. A psychiatric Structured Clinical Interview for DSM-5 (SCID-5) was also conducted. The same parameters were re-evaluated one month after parturition.

RESULTS

A W-DEQ score of 85 was found to be the optimal cut-off score for detecting tocophobia, with sound sensitivity (100%) and specificity (93.8%). We found substantial agreement between the W-DEQ A and SCID-5 Specific Phobia Criteria (Cohen's Kappa coefficient, κ = 0.720).

CONCLUSIONS

A W-DEQ cut-off value of 85 is a reliable tool for detecting clinically relevant fear of childbirth according to the DSM-5 diagnosis of Specific Phobia. Therefore, accurate psychopathological investigation must be administered to women with W-DEQ scores greater than this cut-off score.

摘要

简介与目的

使用现有的工具来诊断恐孕症是一个活跃的研究领域。尽管已经提出了一系列 Wijma 分娩经历问卷(W-DEQ)的截断分数来检测恐孕症,但研究人员对最佳截断分数没有达成共识。本研究的主要目标是在参考 DSM-5 特定恐惧症标准作为金标准的情况下确定一个截断值,并相应评估分娩经历的恐惧成分和产后期间的精神病理学如何受到恐孕症的影响。

方法

我们对初产妇(n=106)进行了一项观察性、纵向研究。收集常规妊娠数据和心理测量问卷中调查抑郁、焦虑和对分娩恐惧的数据。还进行了精神病学 DSM-5 结构临床访谈(SCID-5)。分娩一个月后,重新评估相同的参数。

结果

发现 W-DEQ 得分为 85 是检测恐孕症的最佳截断值,具有良好的敏感性(100%)和特异性(93.8%)。我们发现 W-DEQ A 与 SCID-5 特定恐惧症标准之间存在实质性一致(Cohen's Kappa 系数,κ=0.720)。

结论

W-DEQ 截断值为 85 是根据 DSM-5 特定恐惧症诊断检测临床相关分娩恐惧的可靠工具。因此,必须对 W-DEQ 得分高于该截断值的女性进行准确的精神病理学调查。

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