Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, 2318 Yuhangtang Rd, Hangzhou, 311121, Zhejiang, China.
Department of Obstetrics, The Affiliated Hangzhou Women's Hospital, Hangzhou Normal University, Hangzhou, China.
BMC Psychiatry. 2023 Aug 1;23(1):557. doi: 10.1186/s12888-023-05030-1.
Women with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.
This study was carried out in Hangzhou women's Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28-34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.
57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002-3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038-7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052-1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358-4.345), fairly good (OR = 1.836; 95%CI: 1.009-3.340), fairly bad (OR = 3.919; 95%CI:2.072-7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335-36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.
The results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.
产前抑郁的女性在分娩后更有可能患上产后抑郁症（PPD）。已经提出了一些与那些先前报告产前抑郁的人发生 PPD 相关的因素，但需要进一步研究。本研究旨在调查在筛查出产前抑郁的女性中，哪些因素与随后发生产后抑郁有关。
本研究在杭州市妇产科医院进行。从该队列中招募了 578 名经历过产前抑郁的女性。收集参与者的社会人口统计学和临床特征，并与产后抑郁的发生率进行对照。使用二元逻辑回归估计主要潜在变量的影响。使用中文版爱丁堡产后抑郁量表（EPDS）筛查产后抑郁症。在妊娠 28-34 周时对抑郁进行产前筛查，在产后 6 周时评估女性的产后抑郁症状。采用结构方程模型（SEM）路径分析探讨 PPD 的危险因素的直接、间接和总效应。
在我们的研究中，57.6%（n=333）的参与者随后患上了 PPD。逻辑分析的结果表明，年龄≤35 岁（OR=1.852；95%CI：1.002-3.423）、非独生子女家庭（OR=1.518；95%CI：1.047-2.200）和怀孕期间伴侣很少照顾（OR=2.801；95%CI：1.038-7.562）、产前 EPDS 评分（OR=1.128；95%CI：1.052-1.209）、怀孕期间发热（OR=2.43；95%CI：1.358-4.345）、相当好（OR=1.836；95%CI：1.009-3.340）、相当差（OR=3.919；95%CI：2.072-7.414）和非常差的产后睡眠质量（OR=9.18；95%CI：2.335-36.241）与 PPD 风险增加相关（与产后睡眠质量非常好相比）。在路径分析模型中，产前 EPDS 评分（标准化总β=0.173）和怀孕期间发热（标准化总β=0.132）对 PPD 既有直接影响（需要通过其他变量来确定对结果变量的影响），也有间接影响（需要通过其他变量来确定对结果变量的影响）。产后睡眠质量（标准化β=0.226）和独生子女家庭（标准化β=0.088）仅对 PPD 有直接影响。
本研究结果表明，超过 50%经历产前抑郁的女性随后会患上 PPD。抑郁症状和怀孕期间发热会增加 PPD 评分，这些影响部分是通过产后期间的睡眠质量差介导的。
