切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (01) : 77 -84. doi: 10.3877/cma.j.issn.1673-5250.2023.01.011

论著

自然流产女性精神健康问题的相关危险因素分析
邹佳桐1, 王颂扬1, 徐薇2, 余婷婷3, 叶红霞4, 谯小勇5,†()   
  1. 1四川大学华西医院急诊科，成都　610041
    2四川大学华西医院老年科，成都　610041
    3四川大学华西第二医院急诊科，成都　610041
    4成都市锦江区妇幼保健院生殖免疫科，成都　610041
    5四川大学华西第二医院妇产科，成都　610041
  • 收稿日期:2022-08-10 修回日期:2023-01-08 出版日期:2023-02-01
  • 通信作者: 谯小勇

Analysis of related risk factors of mental health problems of women with spontaneous abortion

Jiatong Zou1, Songyang Wang1, Wei Xu2, Tingting Yu3, Hongxia Ye4, Xiaoyong Qiao5,†()   

  1. 1Department of Emergency, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    2Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    3Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    4Department of Reproductive Immunology, Chengdu Jinjiang Hospital for Maternal & Child Health Care, Chengdu 610000, Sichuan Province, China
    5Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2022-08-10 Revised:2023-01-08 Published:2023-02-01
  • Corresponding author: Xiaoyong Qiao
  • Supported by:
    Key R&D Projects of Science & Technology Department of Sichuan Province(2019YFS0413)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

邹佳桐, 王颂扬, 徐薇, 余婷婷, 叶红霞, 谯小勇. 自然流产女性精神健康问题的相关危险因素分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 77-84.

Jiatong Zou, Songyang Wang, Wei Xu, Tingting Yu, Hongxia Ye, Xiaoyong Qiao. Analysis of related risk factors of mental health problems of women with spontaneous abortion[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(01): 77-84.

目的

探讨自然流产(SA)育龄女性精神健康问题的相关影响因素。

方法

选择2021年7月1日至12月31日在四川大学华西第二医院急诊科就诊，并既往发生确诊为SA的130例女性为研究对象。采用爱丁堡产后抑郁量表(EPDS)评估抑郁症状及程度，状态焦虑量表(SAI)评估焦虑症状和程度，围产期悲伤量表(PGS)评估围产期悲伤程度，婚姻适应量表(DAS)中的婚姻满意度(DS)子量表评估婚姻满意程度，普莱斯基尼(PG)量表评价对医疗和护理满意程度。通过调查问卷收集这113例SA女性的个人基本信息、精神健康问题(抑郁、焦虑和悲伤)，婚姻及就医满意度等资料，并分析其相关影响因素。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。

结果

①113例SA女性中，55.8%(63/113)存在抑郁可能(EPDS抑郁评分≥10分)、43.4%(49/113)存在明显悲伤(PGS悲伤评分>90分)，SAI、DAS及PG评分平均值分别为31.7分、40.7分及48.8分。②Spearman相关性分析结果显示，EPDS抑郁评分与SAI焦虑评分呈正相关关系(r＝0.306，P＝0.001)。③单因素分析结果显示，PGS悲伤评分在不同学历、有无子女间比较，差异有统计学意义(P<0.05)；既往SA总次数为1次者的SAI焦虑评分显著高于≥2次者，并且差异有统计学意义(P<0.05); EPDS抑郁评分在有无子女和未来有无妊娠计划间比较，差异有统计学意义(P<0.05)。④多重线性回归分析结果显示，无子女及有未来妊娠计划是EPDS抑郁评分增加的主要危险因素，高学历(本科及以上)及无子女是PGS悲伤评分增加的主要危险因素。

结论

精神健康问题在SA女性中普遍存在，既往单次SA、无子女、有未来妊娠计划、高学历是导致SA女性精神健康问题发生和加重的危险因素。

关键词: 精神分析, 流产，自然, 抑郁, 焦虑, 悲痛, 妇女
Objective

To explore the mental health problems of women with spontaneous abortion (SA) and analyze its related influencing factors.

Methods

A total of 130 women who were diagnosed as SA in the Department of Emergency of West China Second University Hospital, Sichuan University from July 1 to December 31, 2021 were enrolled in the study. Edinburgh Postpartum Depression Scale (EPDS), State Anxiety Scale (SAI), Perinatal Sadness Scale (PGS), Marriage Satisfaction Scale (DS) in Marriage Adaptation Scale (DAS) and Preskini Scale (PG) were used to evaluate the symptoms and degrees of depression. The general information, mental health problems (depression, anxiety and sadness), marriage and medical satisfaction of these 113 SA women were collected through questionnaires, and the related influencing factors were analyzed. The procedures followed in this study were in accordance with the Helsinki Declaration of the World Medical Association revised in 2013.

Results

① A total of 113 women with SA were included, of which 55.8% (63 / 113) had the possibility of depression (EPDS depression score ≥ 10 points), 43.36% (49 / 113) had obvious sadness (PGS sadness score>90 points), and the average score of SAI, DAS and PG were 31.7, 40.7, and 48.8 points. ②Spearman correlation analysis showed that EPDS depression score was positively correlated with SAI anxiety score (r=0.306, P=0.001). ③The results of univariate analysis were as follows. PGS score was statistically significant (P<0.05) compared with different educational qualifications, and the presence or absence of children, and SAI anxiety score of those who had SA once in the past was significantly higher than those who had SA twice or more, and the difference was statistically significant (P<0.05). The difference in EPDS depression score was statistically significant between the presence or absence of children and the planned future pregnancy (P<0.05). ④ The results of multiple linear regression analysis showed that childlessness and future pregnancy plans were the main risk factors for the increase of EPDS depression score, and advanced education (bachelor degree or above) and childlessness were the main risk factors for the increase of PGS sadness score.

Conclusions

Mental health problems are prevalent among SA women. Previous SA, childlessness, future pregnancy plans, and high education level are risk factors for the occurrence and aggravation of mental health problems in women with SA.

Key words: Psychoanalysis, Abortion, spontaneous, Depression, Anxiety, Grief, Women
表1 113例SA育龄女性的一般情况及各量表得分
项目 结果 项目 结果
年龄[岁，M(Q1，Q3)] 30.0(24.0，35.5) 末次SA发生时间[月，例数(%)]  
最高学历[例数(%)]   ≤6 27(23.9)
初中及以下 14(12.4) 6~12 54(47.8)
初中至本科 60(53.1) ≥12 32(28.3)
本科及以上 39(34.5) 有无子女[例数(%)]  
工作性质[例数(%)]   有 45(39.8)
全职 33(29.2) 无 68(60.2)
兼职 45(39.8) 有无未来妊娠计划[例数(%)]  
无业 35(30.9) 有 40(35.4)
家庭年收入[万元，例数(%)]   无 44(38.9)
≤8 27(23.9) 无明确计划 29(25.7)
8~30 52(46.0) EPDS得分[分，M(Q1，Q3)] 41.0(35.0，46.5)
≥30 34(30.1) SAI得分[分，M(Q1，Q3)] 51.0(43.5，56.5)
既往SA总次数[次，例数(%)]   PGS得分[分，M(Q1，Q3)] 11.0(7.0，11.0)
1 98(86.7) DAS得分[分，M(Q1，Q3)] 33.0(26.0，37.0)
≥2 15(13.3) PG得分[分，M(Q1，Q3)] 84.0(58.5，110.5)
表2 各因素与SA育龄女性精神健康问题的Spearman相关性分析
项目 DAS婚姻满意度 PG就医满意度 EPDS抑郁评分 SAI焦虑评分 PGS悲伤评分
r P r P r P r P r P
年龄 0.162 0.087 0.089 0.351 －0.013 0.889 0.017 0.859 －0.120 0.206
DAS婚姻满意度 — — 0.016 0.869 －0.141 0.137 0.113 0.233 －0.017 0.859
PG就医满意度 — — — — －0.065 0.496 0.102 0.281 0.158 0.094
EPDS抑郁评分 — — — — — — 0.306 0.001 －0.065 0.497
SAI焦虑评分 — — — — — — — — －0.086 0.364
表3 不同个体情况SA育龄女性的EPDS、SAI、PGS 3项量表总分比较(分)]
指标 例数 EPDS抑郁评分 SAI焦虑评分 PGS悲伤评分
±s 统计值 ±s或M(Q1, Q3) 统计值 ±s 统计值
最高学历              
初中及以下 14 10.6±5.8 F＝1.299 28.9±6.8 F＝1.107 76.6±23.2 F＝3.883
初中至本科 60 10.9±6.6 P＝0.277 32.1±7.0 P＝0.334 79.2±27.4 P＝0.023 a
本科及以上 39 12.9±6.9   31.9±8.0   94.3±31.3  
工作性质              
全职 33 11.6±6.9 F＝0.085 30.9±8.1 F＝1.373 93.1±31.0 F＝2.308
兼职 45 11.4±6.4 P＝0.919 30.9±7.2 P＝0.258 79.8±27.8 P＝0.104
无业 35 11.9±6.9   33.4±6.8   81.1±27.8  
家庭年收入(×104元)              
≤8 27 13.3±7.4 F＝1.232 32.3±7.2 F＝1.388 74.6±27.5 F＝2.010
8~30 52 11.3±6.4 P＝0.296 32.5±8.2 P＝0.254 88.1±28.0 P＝0.139
≥30 34 10.7±6.2   29.9±5.9   85.4±31.0  
末次SA距本次调查时间(月)              
≤6 27 11.3±6.3 F＝0.408 32.1±7.8 F＝0.100 85.5±32.6 F＝0.106
6~12 54 11.2±6.4 P＝0.666 31.7±7.6 P＝0.905 84.5±29.0 P＝0.900
≥12 32 12.5±7.4   31.2±6.8   82.2±26.7  
既往SA总次数(次)              
1 98 11.8±6.8 t＝0.710 37(31，42) Z＝－2.039 85.2±28.3 t＝－1.070
≥2 15 10.5±5.8 P＝0.479 28(23，33) P＝0.041 76.6±33.9 P＝0.287
有无子女              
有 45 9.4±6.9 t＝2.902 30.0±7.4 t＝1.924 71.2±27.1 t＝4.081
无 68 13.0±6.1 P＝0.004* 32.7±7.2 P＝0.057 92.6±27.3 P<0.001
未来有无妊娠计划              
有 40 14.2±6.0 F＝5.144 33.3±8.8 F＝1.512 85.6±34.1 F＝1.466
无 44 10.5±6.6 P＝0.007 b 30.9±6.7 P＝0.225 78.7±27.5 P＝0.235
无明确计划 29 9.7±6.7   30.6±6.0   90.2±22.7  
表4 基于EPDS抑郁量表与PGS悲伤量表评分的SA育龄女性精神健康问题相关危险因素的多重线性回归分析
因变量 自变量 偏回归系数 偏回归系数标准误 标准化偏回归系数 偏回归系数95%CI t值 P值
EPDS抑郁评分 有无子女(vs有子女) 3.045 1.219 0.226 0.628~5.462 2.497 0.014
  有无未来妊娠计划(vs无明确计划)            
  有 4.367 1.529 0.316 1.335~7.400 2.855 0.005
  无 1.012 1.503 0.075 －1.967~3.992 0.674 0.502
PGS悲伤评分 最高学历(vs初中及以下)            
  初中至本科 6.637 8.094 0.114 9.410~22.683 0.820 0.414
  本科及以上 18.578 8.339 0.305 2.044~35.111 2.228 0.028
  有无子女(vs有子女) 19.391 5.208 0.328 9.066~29.716 3.723 <0.001
[1]
自然流产诊治中国专家共识编写组. 自然流产诊治中国专家共识(2020年版)[J]．中国实用妇科与产科杂志，2020，36(11): 1082-1090. DOI: 10.19538/j.fk2020110113.
[2]
Ye HX, Liao GN, Dong YJ, et al. miR-146a-5p enhances embryo survival in unexplained recurrent spontaneous abortion by promoting M2 polarization of decidual macrophages[J]. Int Immunopharmacol, 2022, 110: 108930. DOI: 10.1016/j.intimp.2022.108930.
[3]
Davoudian T, Gibbins K, Cirino NH. Perinatal Loss: The Impact on Maternal Mental Health[J]. Obstet Gynecol Surv, 2021, 76(4): 223. DOI: 10.1097/OGX.0000000000000874.
[4]
Galeotti M, Mitchell G, Tomlinson M, et al. Factors affecting the emotional wellbeing of women and men who experience miscarriage in hospital settings: a scoping review[J]. BMC Pregnancy Childbirth, 2022, 22(1): 270. DOI: 10.1186/s12884-022-04585-3.
[5]
Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study[J]. Am J Obstet Gynecol, 2020, 222(4): 367. e1-367. e22. DOI: 10.1016/j.ajog.2019.10.102.
[6]
deMontigny F, Verdon C, Meunier S, et al. Protective and risk factors for women′s mental health after a spontaneous abortion[J]. Rev Lat Am Enfermagem, 2020, 28: e3350. DOI: 10.1590/1518-8345.3382.3350.
[7]
Tseng YF, Cheng HR, Chen YP, et al. Grief reactions of couples to perinatal loss: a one-year prospective follow-up[J]. J Clin Nurs, 2017, 26(23-24): 5133-5142. DOI: 10.1111/jocn.14059.
[8]
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale[J]. Br J Psychiatry, 1987, 150: 782-786. DOI: 10.1192/bjp.150.6.782.
[9]
Toedter LJ, Lasker JN, Janssen HJ. International comparison of studies using the perinatal grief scale: a decade of research on pregnancy loss[J]. Death Stud, 2001, 25(3): 205-228. DOI: 10.1080/07481180125971.
[10]
王颖，王玉琼，郭秀静，等. 孕晚期妇女婚姻适应调查[J/OL]．中华妇幼临床医学杂志(电子版)，2010, 6(6): 417-420. DOI: 10.3877/cma.j.issn.1673-5250.2010.06.007.
[11]
秦峰，李丽娟，肖利军，等. 孕产期心身障碍临床路径(2017版)[J/OL]. 中华妇幼临床医学杂志(电子版)，2017，13 (6): 640-644. DOI: 10.3877/cma.j.issn.1673-5250.2017.06.004.
[12]
Lanes A, Kuk JL, Tamim H. Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study[J]. BMC Public Health, 2011, 11: 302. DOI: 10.1186/1471-2458-11-302.
[13]
Chojenta C, Harris S, Reilly N, et al. History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the postpartum[J]. PLoS One, 2014, 9(4): e95038. DOI: 10.1371/journal.pone.0095038.
[14]
Lee C, Rowlands IJ. When mixed methods produce mixed results: integrating disparate findings about miscarriage and women′s wellbeing[J]. Br J Health Psychol, 2015, 20(1): 36-44. DOI: 10.1111/bjhp.12121.
[15]
Lok IH, Yip AS, Lee DT, et al. A 1-year longitudinal study of psychological morbidity after miscarriage[J]. Fertil Steril, 2010, 93(6): 1966-1975. DOI: 10.1016/j.fertnstert.2008.12.048.
[16]
Emond T, de Montigny F, Guillaumie L. Exploring the needs of parents who experience miscarriage in the emergency department: a qualitative study with parents and nurses[J]. J Clin Nurs, 2019, 28(9-10): 1952-1965. DOI: 10.1111/jocn.14780.
[17]
Baird S, Gagnon MD, deFiebre G, et al. Women′s experiences with early pregnancy loss in the emergency room: a qualitative study[J]. Sex Reprod Healthc, 2018, 16: 113-117. DOI: 10.1016/j.srhc.2018.03.001.
[18]
Whisman MA, Bruce ML. Marital dissatisfaction and incidence of major depressive episode in a community sample[J]. J Abnorm Psychol, 1999, 108(4): 674-678. DOI: 10.1037//0021-843x.108.4.674.
[1] 罗丹, 孔为民, 陈姝宁, 赵小玲, 谢云凯. 子宫内膜异位症患者在位及异位内膜上皮细胞-间充质转化相关生物标志物的变化[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 530-539.
[2] 刘星辰, 刘娟, 魏宝宝, 刘洁, 刘辉. XIAP与XAF1异常表达与卵巢癌的相关性分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 419-427.
[3] 杨一君, 董雯, 刘晓平, 石灿, 张磊, 谷琎, 龚咪, 华馥. 腹腔镜折叠对接缝合联合宫腔镜憩室开渠法治疗剖宫产瘢痕憩室的疗效[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 330-337.
[4] 吴晶晶, 胡倩, 李华凤. 围产期焦虑/抑郁与分娩疼痛相关性的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 156-161.
[5] 王琦, 陈新, 闵捷, 方露, 刘志奇, 孙伟, 于德新. 膀胱软镜镜检术中改良"Bag Squeeze"法的应用与疼痛焦虑影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 237-241.
[6] 戴玮, 江桂林, 车兆平, 张姣, 王星星, 赵海涛. 无缝手术护理在腹股沟疝腹腔镜手术围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 778-781.
[7] 蒋丽, 王晓慧, 李维益, 苟双芸, 丁敏, 杨丽. 创新智能健康教育与随访管理对肺结节患者焦虑的影响随机对照研究[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 485-489.
[8] 张荷连, 刘禹, 李丹妮, 彭茹, 杨彩蝶, 窦恒, 吴红梅. 心理障碍对重度哮喘患者的疾病控制及生活工作质量的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 589-591.
[9] 赵晓红, 修翠萍, 张瑜, 吴珂. 大康复理念在COPD稳定期肺康复治疗的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 424-426.
[10] 陈冀, 邓才霞, 张厚丽, 祝冰晶, 刘攀, 何建, 唐春兰, 周向东, 罗虎. 高危肺结节患者认知及焦虑状况调查分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 164-168.
[11] 吴玥琳, 欧泳琳, 肖海燕, 段业英, 陆翠薇, 李德阳, 王懿春, 唐灏珂. 危重症孕产妇的心理状况及其影响因素的调查[J]. 中华重症医学电子杂志, 2023, 09(02): 198-204.
[12] 付强, 秦丽媛, 李全波. 神经病理性疼痛患者血清miR-15a水平及意义分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 293-298.
[13] 潘惠, 王明, 杨忠, 杜向东. 低频重复经颅磁刺激辅助治疗伴不同特征抑郁症的对照研究[J]. 中华临床医师杂志(电子版), 2023, 17(05): 562-568.
[14] 李琼蔚, 苏怡, 卢喆, 李谦, 孙伟. 内蒙古赤峰地区高中生睡眠问题现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(02): 117-124.
[15] 郭梦, 雷蕾, 杨春霞, 孙宁, 张爱霞, 张克让. 抑郁症患者静息态脑电功能连接的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(02): 210-214.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号