孕期心理干预对产后焦虑、抑郁的影响
【摘 要】目的：探讨孕期心理干预能否减少产后焦虑、抑郁的发生。方法：采用随机对照研究设计。于2005年3月至2006年2月部分连续抽取800例孕16~20周的孕妇，随机分配至干预组(n=386)和对照组(n=414)。干预组在常规孕妇保健的基础上给予集体心理干预(5次孕妇+1次丈夫)课程，对照组予常规孕妇保健。对所有对象每月采用综合性医院焦虑/抑郁量表(Hospital Anxiety and Depression scale, HAD)自评，产后3天、42天和3月采用HAD和爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale，EPDS)双重自评，并采用DSM-IV-TR轴I障碍临床定式检查(研究版)中文版 (Structured Clinical Interview For DSM-IV-TR Axis I Disorders, Research Version；SCID-I)分层盲法临床诊断。采用意向性分析(Intention-To-Treat，ITT)原则分析资料。结果：(1)在符合方案数据集(Per-protocol sets，PPs)中，孕妇心理干预可以明显减轻产后的焦虑情绪,干预组HAD的A项分从产后3天的0-2-4(四分位数)下降到产后3月的0-2-3，而对照组从产后3天的0-2-4下降到产后3月的0-2-3.5；在产后三个月中，干预组焦虑症状的比例3.2%(5/158)明显低于对照组的比例7.8%(30/383)(χ2=4.029，P=0.045)。但HAD或EPDS评估都未能发现干预对产后抑郁情绪降低具有明显效果。(2)采用SCID-I诊断，在产后三个时点重性抑郁障碍的发生率(调整发生率)干预组分别为4.04%、14.92%、7.85%，对照组分别为3.61%、18.12%、5.39%，两组差异无统计学意义。结论：孕期心理干预对预防产后的焦虑情绪具有作用，对产后抑郁作用不明显。
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【关键词】 抑郁；焦虑；产后抑郁；心理干预；随机对照研究
doi:10.3969/j.issn.1000-6729.2009.02.002
中图分类号：B844.5，R749.4 文献标识码：A 文章编号：1000-6729(2009)002-0083-07
Prenatal Psychological Prevention Trial on Postpartum Anxiety and Depression
TANG Yue-Fen1, SHI Shen-Xun1@，LU Wen2, CHEN Yan2, WANG Qing-Qing2,ZHU Yong-Yong1,YANG Jie1, YU Wen2, LUO Jian-Feng3, CHENG Li-Nan2
, 百拇医药
1Fudan University Affiliated Hospital, Shanghai 200040
2Department of Obstetrics and Gynecology，the International Peace Maternity & Child Health Hospital of
the China Welfare Institute，Shanghai 200030
3Department of Medsocial & Statistic，Fu Dan University，Shanghai 200433
@ Corresponding author,Email:shenxun@online.sh.cn
, http://www.100md.com 【Abstract】 Objective：To explore the efficacy of prenatal psychological intervention in anxiety and depression in postpartum period. Methods：A randomized controlled trial design was used in this study. A total of 800 pregnant women at 16~20 weeks gestation were selected continually from clinic. All the women were randomly divided into intervention group (n=386) or control group (n=414).The intervention consisted of six sessions (five sessions for the pregnant women+one session for the husbands).Both of the two groups attended the normal hospital education equally. All the subjects were evaluated with the Hospital Anxiety and Depression scale (HAD) once a month prenatally, and with the Edinburgh Postnatal Depression Scale (EPDS) additionally at 3 days, 42 days, and 3 month postpartum. The SCID-I Chinese version 2004 (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version) was used for clinical diagnosis. Analysis of the mental health outcomes, by intention-to-treat, was adjusted for the correlated structure of the data. Results：(1)According to the HAD score changes,in the per-protocol sets (PP sets),the intervention could relieve the anxious emotion in postpartum period. The "anxiety" item scores of HAD in intervention group dropped from 0-2-4(quartile) at 3 days postpartum to 0-2-3 at 3 months postpartum, while that in control group dropped from 0-2-4 to 0-2-3.5. During 3 months postpartum, the rate of anxiety in intervention group was significantly lower than that in control group (3.2% vs. 7.8%, P=0.045). However, the intervention had no efficacy on depressive emotion according to neither HAD or EPDS. (2) In SCID-I interview, there was no significantly difference in incidence of major depressive disorder between the two groups at each time-point postpartum.Conclusion:The prenatal psychological intervention can prevent postpartum anxious emotion to some extent. How to prevent the postpartum depression needs to be studied further., http://www.100md.com(汤月芬 施慎逊 陆 雯 陈 焱 王青青 朱雍雍 杨 杰 余 )
, http://www.100md.com
【关键词】 抑郁；焦虑；产后抑郁；心理干预；随机对照研究
doi:10.3969/j.issn.1000-6729.2009.02.002
中图分类号：B844.5，R749.4 文献标识码：A 文章编号：1000-6729(2009)002-0083-07
Prenatal Psychological Prevention Trial on Postpartum Anxiety and Depression
TANG Yue-Fen1, SHI Shen-Xun1@，LU Wen2, CHEN Yan2, WANG Qing-Qing2,ZHU Yong-Yong1,YANG Jie1, YU Wen2, LUO Jian-Feng3, CHENG Li-Nan2
, 百拇医药
1Fudan University Affiliated Hospital, Shanghai 200040
2Department of Obstetrics and Gynecology，the International Peace Maternity & Child Health Hospital of
the China Welfare Institute，Shanghai 200030
3Department of Medsocial & Statistic，Fu Dan University，Shanghai 200433
@ Corresponding author,Email:shenxun@online.sh.cn
, http://www.100md.com 【Abstract】 Objective：To explore the efficacy of prenatal psychological intervention in anxiety and depression in postpartum period. Methods：A randomized controlled trial design was used in this study. A total of 800 pregnant women at 16~20 weeks gestation were selected continually from clinic. All the women were randomly divided into intervention group (n=386) or control group (n=414).The intervention consisted of six sessions (five sessions for the pregnant women+one session for the husbands).Both of the two groups attended the normal hospital education equally. All the subjects were evaluated with the Hospital Anxiety and Depression scale (HAD) once a month prenatally, and with the Edinburgh Postnatal Depression Scale (EPDS) additionally at 3 days, 42 days, and 3 month postpartum. The SCID-I Chinese version 2004 (Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version) was used for clinical diagnosis. Analysis of the mental health outcomes, by intention-to-treat, was adjusted for the correlated structure of the data. Results：(1)According to the HAD score changes,in the per-protocol sets (PP sets),the intervention could relieve the anxious emotion in postpartum period. The "anxiety" item scores of HAD in intervention group dropped from 0-2-4(quartile) at 3 days postpartum to 0-2-3 at 3 months postpartum, while that in control group dropped from 0-2-4 to 0-2-3.5. During 3 months postpartum, the rate of anxiety in intervention group was significantly lower than that in control group (3.2% vs. 7.8%, P=0.045). However, the intervention had no efficacy on depressive emotion according to neither HAD or EPDS. (2) In SCID-I interview, there was no significantly difference in incidence of major depressive disorder between the two groups at each time-point postpartum.Conclusion:The prenatal psychological intervention can prevent postpartum anxious emotion to some extent. How to prevent the postpartum depression needs to be studied further., http://www.100md.com(汤月芬 施慎逊 陆 雯 陈 焱 王青青 朱雍雍 杨 杰 余 )