School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou, Liaoning Province, China.
Qingdao Municipal Hospital, Qingdao, China.
BMC Psychiatry. 2024 Oct 23;24(1):721. doi: 10.1186/s12888-024-06144-w.
Postpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.
Recruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.
A total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.
With its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.
产后创伤后应激障碍（PTSD）作为一种心理应激障碍，具有长期和广泛的危害。然而，与其他产后精神障碍相比，产后 PTSD 在我国受到的关注相对较少。本研究旨在探讨产后 PTSD 的危险因素，并开发一种方便快捷的列线图筛查工具，帮助临床工作人员及时识别高危孕妇，采取预防和管理措施。
采用便利抽样法，选取 2022 年 11 月至 2023 年 10 月在青岛市市立医院和锦州市妇婴医院住院分娩的孕妇作为研究对象进行问卷调查。产后 42 天进行电话随访。对单因素分析、多重共线性分析和 logistic 回归分析后的结果进行分析，得出产后 PTSD 的危险因素，利用 R 软件建立预测模型并绘制列线图。G*power3.1.9.7 计算检验效能。采用 Bootstrap 方法对内进行模型验证，采用验证组进行外部验证。通过曲线下面积、校准图和决策曲线分析评估模型的预测准确性及其临床应用价值。
本研究共纳入 602 名女性，产后 PTSD 的发生率为 11.1%（67/602）。多因素 logistic 回归分析显示，孕晚期自我评估睡眠状况较差（OR=5.336）、剖宫产（OR=2.825）、器械助产（OR=5.994）、对分娩恐惧（OR=4.857）、五因素人格量表神经质维度得分较高（OR=1.244）是发生产后 PTSD 的独立危险因素，而良好的关系质量指数评分（OR=0.891）是产后 PTSD 的保护因素。在训练集和验证集中，列线图模型的 ROC 曲线下面积分别为 0.928 和 0.907。校准曲线显示，该列线图模型拟合良好，决策曲线分析表明该列线图模型具有良好的临床应用价值。
该预测模型具有较强的预测能力，可帮助临床医护人员早期识别高危孕妇，及时实施预防干预策略。
