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

doi:10.3877/cma.j.issn.1673-5250.2023.01.011

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
项目	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
项目	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
指标	例数	±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
指标	例数	±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

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

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