Charrois Elyse M, Mughal Muhammad Kashif, Arshad Muhammad, Wajid Abdul, Bright Katherine S, Giallo Rebecca, Kingston Dawn
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
J Affect Disord. 2022 Jun 15;307:244-253. doi: 10.1016/j.jad.2022.03.055. Epub 2022 Mar 24.
Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns.
A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns.
Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety).
Generalizability may be compromised by attrition, under-reporting, and recall bias.
Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.
针对曾有过产前流产经历的孕期及产后母亲心理困扰模式或预测因素的研究有限。本研究的目的是探讨曾有过产前流产经历的母亲在随后一次怀孕早期直至青春期前抑郁和焦虑症状的纵向轨迹模式，并确定预测症状轨迹升高的早期因素。
来自雅芳亲子纵向研究的2854名母亲自我认定曾有过产前流产经历。潜在类别分析确定了从妊娠18周直至产后134个月的10个时间点的症状轨迹模式，多变量回归分析确定了症状轨迹升高的预测因素，层次回归分析确定了预测因素与升高的轨迹模式之间的预测准确性。
抑郁和焦虑症状的三种不同纵向轨迹模式反映出低症状（54%）、亚临床症状（34%）和临床症状（12%）。比随后怀孕早期症状评分增加更能预测症状轨迹升高的关键因素包括重度抑郁症或其他精神问题史、妊娠中期经历三次或更多应激事件、社会支持不足、人工流产史和虐待史。轨迹升高的预测准确性为0.542（抑郁）和0.432（焦虑）。
损耗、报告不足和回忆偏差可能会影响研究结果的普遍性。
在早期评估中纳入预测长期亚临床或临床抑郁和焦虑症状的因素，将提高临床医生识别可能从产前流产后立即和/或持续监测及心理治疗干预中受益的母亲的能力。
