孕期早期感知到的社会支持对产后 6 周抑郁症状的影响：一项前瞻性研究。
The effect of perceived social support during early pregnancy on depressive symptoms at 6 weeks postpartum: a prospective study.
机构信息
Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
出版信息
BMC Psychiatry. 2019 Jul 29;19(1):232. doi: 10.1186/s12888-019-2188-2.
BACKGROUND
Postpartum depression was associated with maternal suffering and diminished functioning, increased risk of marital conflict as well as adverse child outcomes. Perceived social support during pregnancy was associated with postpartum depression among women. However, its causal relationship remains unclear. Therefore, we prospectively evaluate the association between perceived social support during early pregnancy and postpartum depressive symptoms.
METHODS
We prospectively examined whether perceived social support during early pregnancy affected depressive symptoms at 6 weeks postpartum in a cohort of 3310 women. Perceived social support and postpartum depression were assessed by ENRICHD Social Support Instrument (ESSI) and the postpartum Edinburgh Postpartum Depression Scale (EPDS), respectively. Prevalence of postpartum depressive symptoms was 11.4% (EPDS cutoff≥10). As a test of heterogeneity of association in subpopulations, logistic regression models were performed to analyze the association between social support and postpartum depressive symptoms in strata which were defined by the potential confounder candidates. After multiple imputation, multivariable logistic regression was performed to assess the effect of social support on postpartum symptoms in individual items and total score. Two models were built. Model I adjusted for the variables associated with social support or postpartum depression and changed the association estimates by ≥10%. Model II adjusted for all variables that may be related to social support or postpartum depression.
RESULTS
Significant associations between low perceived social support and postpartum depressive symptoms was found(Model I odds ratio: 1.63, 95% confidence interval: 1.15, 2.30; Model II odds ratio: 1.77, 95% confidence interval: 1.24-2.52). Stratified analyses showed that there was little evidence of heterogeneity of association in subpopulations by basic characteristics of participants.
CONCLUSIONS
These findings suggest that early intervention may be able to help protect against depression symptoms at 6 weeks postpartum.
背景
产后抑郁症与产妇痛苦和功能下降、婚姻冲突风险增加以及儿童不良结局有关。怀孕期间感知到的社会支持与女性产后抑郁症有关。然而，其因果关系尚不清楚。因此，我们前瞻性评估了孕早期感知到的社会支持与产后抑郁症状之间的关系。
方法
我们前瞻性地检查了 3310 名女性中，孕早期感知到的社会支持是否会影响产后 6 周时的抑郁症状。感知到的社会支持和产后抑郁分别通过 ENRICHD 社会支持量表（ESSI）和产后爱丁堡产后抑郁量表（EPDS）进行评估。产后抑郁症状的患病率为 11.4%（EPDS 截取值≥10）。为了检验亚人群关联的异质性，我们使用逻辑回归模型分析了社会支持与产后抑郁症状之间的关联在潜在混杂因素候选者定义的亚人群中的情况。在多重插补后，使用多变量逻辑回归评估了社会支持对个体项目和总分产后症状的影响。构建了两个模型。模型 I 调整了与社会支持或产后抑郁相关的变量，并改变了≥10%的关联估计值。模型 II 调整了所有可能与社会支持或产后抑郁相关的变量。
结果
在模型 I 中，低感知社会支持与产后抑郁症状之间存在显著关联（比值比：1.63，95%置信区间：1.15，2.30）；在模型 II 中，这种关联依然显著（比值比：1.77，95%置信区间：1.24-2.52）。分层分析显示，参与者的基本特征在亚人群中的关联异质性很小。
结论
这些发现表明，早期干预可能有助于预防产后 6 周时的抑郁症状。
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