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与分娩相关的创伤会持续存在吗?极低出生体重早产儿和足月儿出生5年后其父母创伤后应激障碍的患病率及危险因素

Does Birth-Related Trauma Last? Prevalence and Risk Factors for Posttraumatic Stress in Mothers and Fathers of VLBW Preterm and Term Born Children 5 Years After Birth.

作者信息

Barthel Dana, Göbel Ariane, Barkmann Claus, Helle Nadine, Bindt Carola

机构信息

Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Front Psychiatry. 2020 Dec 15;11:575429. doi: 10.3389/fpsyt.2020.575429. eCollection 2020.

Abstract

Previous research suggests that the birth of a preterm child with very low birth weight (VLBW; <1,500 g) can be traumatic for both parents and lead to short-term consequences like clinical levels of posttraumatic stress symptoms (PTSS) or even to the development of a Posttraumatic Stress Disorder (PTSD). However, little is known about possible mid- and long-term psychological consequences in affected parents. The purpose of this study were (a) to examine the prevalence of parental birth-related PTSS and PTSD in a group of parents with VLBW preterm infants compared to parents of full-term infants 5 years after birth and (b) to investigate potential associations with risk factors for parental PTSS at 5 years postpartum. Perinatal factors (VLBW preterm or term, perceived stress during birth), psychological factors (perceived social support and PTSS 4-6 weeks postpartum, psychiatric lifetime diagnosis) and sociodemographic characteristics (number of children, singleton or multiple birth, socio-economic status), were included in the analysis. The sample consisted of 144 families (77 VLBW, 67 term birth) who participated in the prospective longitudinal cohort study "Hamburg study of VLBW and full-term infant development" (HaFEn-study) and were initially recruited at three perinatal care centers in Hamburg, Germany. PTSD prevalence and PTSS of mothers and fathers were assessed with the Impact of Event Scale-Revised (IES-R), social support with the Questionnaire of Social Support (SOZU-K-22), and lifetime psychiatric diagnoses with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I). Data were analyzed by hierarchic multiple regression analyses. Results showed that 5 years after birth none of the parents fulfilled the criteria for a birth-related PTSD diagnosis. For mothers, postnatal PTSS and a VLBW preterm birth significantly predicted PTSS 5 years postpartum. For fathers, psychiatric lifetime diagnosis and postnatal PTSS significantly predicted PTSS 5 years after birth. Early identification of parents with higher risk of PTSS, especially after VLBW preterm birth, and their clinical needs seems beneficial to reduce the risk of long-term consequences. More research is needed on the paternal perspective and on potential effects of preterm birth on both parents and their children's mental health outcomes.

摘要

先前的研究表明,出生体重极低(VLBW;<1500克)的早产儿的出生,对父母双方来说都可能是一种创伤,并会导致短期后果,如创伤后应激症状(PTSS)达到临床水平,甚至发展为创伤后应激障碍(PTSD)。然而,对于受影响父母可能出现的中长期心理后果,人们知之甚少。本研究的目的是:(a)与足月儿的父母相比,调查一组极低出生体重早产儿的父母中与出生相关的PTSS和PTSD的患病率;(b)调查产后5年父母PTSS的危险因素之间的潜在关联。围产期因素(极低出生体重早产儿或足月儿、出生时感知到的压力)、心理因素(产后4至6周感知到的社会支持和PTSS、终生精神疾病诊断)以及社会人口学特征(子女数量、单胎或多胎、社会经济地位)都纳入了分析。样本包括144个家庭(77个极低出生体重儿家庭、67个足月儿家庭),这些家庭参与了前瞻性纵向队列研究“汉堡极低出生体重儿和足月儿发育研究”(HaFEn研究),最初是在德国汉堡的三个围产期护理中心招募的。采用事件影响量表修订版(IES-R)评估母亲和父亲的PTSD患病率和PTSS,采用社会支持问卷(SOZU-K-22)评估社会支持,采用《精神疾病诊断与统计手册》第四版(SCID-I)的结构化临床访谈评估终生精神疾病诊断。数据通过分层多元回归分析进行分析。结果显示,出生5年后,没有一位父母符合与出生相关的PTSD诊断标准。对于母亲来说,产后PTSS和极低出生体重早产儿的出生显著预测了产后5年的PTSS。对于父亲来说,终生精神疾病诊断和产后PTSS显著预测了出生5年后的PTSS。早期识别有更高PTSS风险的父母,尤其是在极低出生体重早产儿出生后,并了解他们的临床需求,似乎有利于降低长期后果的风险。关于父亲的观点以及早产对父母及其子女心理健康结果的潜在影响,还需要更多的研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/edf8/7769835/8eabe787e81a/fpsyt-11-575429-g0001.jpg

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