产妇心理灵活性与抑郁焦虑的关系研究

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	产妇心理灵活性与抑郁焦虑的关系研究
其他题名	Research on Postpartum Depression,Anxiety and Psychological Flexibility of Parturient
	祝慧
	2015-07
摘要	近年来，有关产妇抑郁焦虑的发病情况、影响因素及干预方式的研究越来越受到重视。产妇抑郁焦虑不仅严重影响其身心健康，而且对将来婴儿的心理、行为及智力发育有重要影响。产妇抑郁焦虑可使剖宫产率增高，产后出血量增多，胎儿宫内窘迫、新生儿窒息发生率增加，产妇泌乳延迟，自尊心降低，应付能力差，认知功能不全，孤独感加重，母婴间交流出现障碍等。研究表明，产妇抑郁焦虑的危险因素不仅与年龄、身体健康状况、文化水平、家庭经济状况、分娩方式、新生儿性别期望、分娩时痛苦程度、新生儿异常情况、产时并发症、婆媳关系、夫妻关系等生物、社会心理因素有关，还与产妇的心理灵活性（psychological flexibility, PF）这一个体认知因素密不可分。本研究旨在了解产妇经验性回避、认知融合与抑郁焦虑的关系，考察产前心理灵活性(包括经验性回避、认知融合)对产妇抑郁焦虑的影响。为接纳与承诺疗法（Acceptance and Commitment Therapy,简称ACT）在产妇抑郁焦虑的心理治疗中提供实证依据。本研究通过整群取样，在邹城市某医院产科选取309名待产妇女作为被试，采用自编孕产妇一般资料调查表，接纳与行动问卷第二版（Acceptance and Action Questionnaire-2nd Edition, AAQ-Ⅱ），认知融合量表（Cognitive Fusion Questionnaire,CFQ），抑郁自评量表（SDS）,焦虑自评量表（SAS）,分别对其在住院待产期间和产后3-7天内进行测查，其中AAQ-Ⅱ和CFQ是代表心理灵活性的指标。对数据进行描述性统计分析、t检验、Pearson相关分析及层次回归分析。本研究主要结果如下：第一，（1）分娩非常痛苦组、新生儿有异常组的产妇在SDS上的平均得分[ =（52.31±11.75）分，（50.92±12.08）分]分别显著高于痛苦组、新生儿无异常组[ =（47.28±10.36）分，（47.31±10.27）分]，差异有统计学意义（p﹤0.05）。（2）分娩非常痛苦组、新生儿有异常组的产妇在SAS上的平均得分[ =（46.97±11.70）分，（47.37±11.30）分]分别显著高于痛苦组、新生儿无异常组[ =（42.85±9.60）分，（43.32±9.98）分]，差异有统计学意义（p﹤0.05）。（3）婆媳关系总分与产后SDS总分和SAS总分均呈低负相关（r=-0.122，-0.198，p﹤0.05， p﹤0.01）；夫妻关系总分与产后SAS总分呈低负相关（r=-0.129，p﹤0.05）。第二，（1）产前抑郁组在AAQ-Ⅱ上的平均得分[ =（18.54±8.25）分]显著高于非抑郁组[ =（15.47±7.03）分]，差异具有统计学意义（p﹤0.01）；产后抑郁组在AAQ-Ⅱ上的平均得分[ =（19.07±7.82）分]显著高于非抑郁组[ =（14.57±6.57）分]，差异具有统计学意义（p﹤0.001）。（2）产前AAQ-Ⅱ总分与产前SDS总分、产后SDS总分均呈显著正相关关系（r=0.34，0.34，p﹤0.01）。（3）控制孕产妇年龄、婆媳关系、新生儿异常、分娩痛苦程度和产前SDS后，产前AAQ-Ⅱ对产后SDS的解释力仍显著（ΔR2=0.01 ，p﹤0.01）。（4）产前焦虑组在AAQ-Ⅱ上的平均得分[ =（22.12±7.78)分]显著高于非焦虑组[ =（14.49±6.43 )分]，差异具有统计学意义（p﹤0.001）；产后焦虑组在AAQ-Ⅱ上的平均得分[ =（21.18±7.24)）分]显著高于非焦虑组[ =（14.24±6.43）分]，差异具有统计学意义（p﹤0.001）。（5）产前AAQ-Ⅱ总分与产前SAS总分、产后SAS总分均呈显著正相关关系（r=0.53，0.44 ，p﹤0.01）。（6）控制孕产妇年龄、婆媳关系、夫妻关系、新生儿异常、分娩痛苦程度和产前SAS之后，产前AAQ-Ⅱ对产后SAS的解释力仍显著（ΔR2=0.02，p﹤0.01）。第三，（1）产前抑郁组在CFQ上的平均得分[ =（26.74±11.76）分]显著高于非抑郁组[ =（23.13±10.33）分]，差异具有统计学意义（p﹤0.01）；产后抑郁组在CFQ上的平均得分[ =(（26.84±12.11）分]显著高于非抑郁组[ =（21.79±9.90）分]，差异具有统计学意义（p﹤0.001）。（2）产前CFQ总分与产前SDS总分、产后SDS总分均呈显著正相关关系（r=0.26 ，0.32 ，p﹤0.01）。（3）控制孕产妇年龄、婆媳关系、新生儿异常、分娩痛苦程度和产前SDS之后，产前CFQ对产后SDS的解释力仍显著（ΔR2=0.02 ，p﹤0.001）。 (4)产前焦虑组在CFQ上的平均得分[ =（32.18±10.78）分]显著高于非焦虑组[ =（21.55±9.57）分]，差异具有统计学意义（p﹤0.001）；产后焦虑组在CFQ上的平均得分[ =（31.80±11.63）分]显著高于非焦虑组[ =（20.45±8.94）分]，差异具有统计学意义（p﹤0.001）。（5）产前CFQ总分与产前SAS总分、产后SAS总分均呈显著正相关关系（r=0.52，0.45 ，p﹤0.01）。（6）控制孕产妇年龄、婆媳关系、夫妻关系、新生儿异常、分娩痛苦程度和产前SAS之后，产前CFQ对产后SAS的解释力仍显著（ΔR2= 0.02，p﹤0.01）。本研究的结论为：第一，分娩痛苦程度、新生儿异常对产后抑郁焦虑有一定的影响；婆媳关系与产后抑郁焦虑水平呈低负相关。产妇的抑郁焦虑水平与婆媳关系有关。这都提示分娩时的痛苦程度、婴儿出生后的异常情况以及婆媳关系的好坏，对产妇来说是一个应激源，易引发产后抑郁焦虑。第二，心理灵活性（经验性回避）与产后抑郁焦虑有关，心理灵活性越差的产妇抑郁焦虑水平越高。心理灵活性对产后抑郁焦虑具有一定的预测作用，心理灵活性越差，产后抑郁焦虑发生的可能性越大。第三，心理灵活性（认知融合）与产后抑郁焦虑有关，心理灵活性越差的产妇抑郁焦虑水平越高。心理灵活性对产后抑郁焦虑具有一定的预测作用，心理灵活性越差，产后抑郁焦虑发生的可能性越大。
其他摘要	In recent years, there is an increase attention on incidence of maternal depression anxiety, influence factors and intervention method in maternal depression and anxiety reaserch.Maternal depression and anxiety not only seriously affect women's physical and mental health, but also have an important effect on babies’ psychology, behavior and mental development in the future. Maternal depression and anxiety can make the rate of cesarean section increased, increase postpartum haemorrhage amount and incidence of fetal distress and neonatal asphyxia, and also result in delaying maternal lactation, reducing self-esteem, poor cope capcity, cognitive dysfunction, aggravating loneliness and communication problems between mother and baby and so on. Studies have shown that risk factors of maternal depression and anxiety not only associated with biological social psychological factors,such as age, physical health, cultural level, family economic condition, delivery mode, neonatal gender expectations, childbirth pain degree, the abnormal situation of newborn babies, intrapartum complication, the relationship between mother-in-law and daughter-in-law and couple relationship, but also with psychological flexibility (PF),inseparably,which is individual cognitive factors. This study explores the relationship between depression ,anxiety, experiential avoidance and cognitive fusion; investigate effect of psychologcal flexibility (including experiential avoidance, cognitive fusion) on maternal depression and anxiety , to provided empirical evidences for acceptance and commitment therapy in mental treatment of postpartum depression and. anxiety. 309 parturient women collected by cluster sampling method, were assessed with self-made general information questionnaire, Self﹣Rating Depression Scale(SDS) , Self﹣Rating Anxiety Scale(SAS), Acceptance and Action Questionnaire-2nd Edition(AAQ-Ⅱ) and Cognitive Fusion Questionnaire(CFQ), in two periods, predelivery periods and 3-7 days after childbirth respectively. The AAQ-Ⅱ and CFQ represent psychological flexibility. The main results were as follows: Firstly, (1) maternal average score of SDS in childbirth great painful group and neonatal disorder group was respectively significant higher than that in childbirth painful group and Normal newborn group[(52.31±11.75)VS.(47.28±10.36),(50.92±12.08)VS.(47.31±10.27),p﹤0.05];(2) maternal average score of SAS in childbirth great painful group and neonatal disorder group was respectively significant higher than that in childbirth painful group and Normal newborn group[(46.97±11.70)VS.(42.85±9.60),(47.37±11.30)VS.(43.32±9.98), p﹤0.05]; (3) The score of relationshio between mother-in-law and daughter-in-law was negative correlation with postpartum scores of SDS and SAS respectively(r = -0.122,-0.198, p﹤0.05, p﹤0.01). The scores in couple relationship was negative correlation with postpartum scores of SAS(r=-0.129, p﹤0.05). Secondly, (1) Average score of AAQ-Ⅱ in predelivery depression group was significant higher than that in predelivery normal group[(18.54±8.25)VS.(15.47±7.03), p﹤0.01];average score of AAQ-Ⅱ in postpartum depression group was significant higher than that in postpartum normal group[(19.07±7.82)VS.(14.57±6.57), p﹤0.001]. (2) It was found that the aggregate score of AAQ-Ⅱwas positively associated with the SDS scores of predelivery periods and postpartum periods respectively(r =0.34, 0.34, p﹤0.01). (3) The score of AAQ-Ⅱ in predelivery periods still had a significant effect on the explaining power of SDS scores in postpartum periods（ΔR2=0.01，p﹤0.01),despite control the age of pregnant and parturient women, the relationship between mother-in-law and daughter-in-law, neonatal exceptional, the degree of painful childbirth conditions and the SDS of predelivery periods. (4) Average score of AAQ-Ⅱ in predelivery anxiety group was significant higher than that in predelivery normal group[(22.12±7.78)VS.(14.49±6.43),p﹤0.001];average score of AAQ-Ⅱ in postpartum anxiety group was significant higher than that in postpartum normal group[(21.18±7.24)VS.(14.24±6.43), p﹤0.001]. (5) It was found that the aggregate score of AAQ-Ⅱwas positively associated with the SAS scores of predelivery periods and postpartum periods respectively(r =0.53, 0.44, p﹤0.01). (6) The score of AAQ-Ⅱ in predelivery periods still had a significant effect on the explaining power of SAS scores in postpartum periods(ΔR2=0.02，p﹤0.01),despite control the age of pregnant and parturient women, the relationship between mother-in-law and daughter-in-law, spousal relationship, neonatal exceptional, the degree of painful childbirth conditions and the SAS of predelivery periods. Thirdly, (1) Average score of CFQ in predelivery depression group was significant higher than that in predelivery normal group[(26.74±11.76)VS.(23.13±10.33), p﹤0.01];average score of CFQ in postpartum depression group was significant higher than that in postpartum normal group[(26.84±12.11)VS.(21.79±9.90), p﹤0.001]. (2) It was found that the aggregate score of CFQ was positively associated with the SDS scores of predelivery periods and postpartum periods respectively(r =0.26, 0.32, p﹤0.01). (3) The score of CFQ in predelivery periods still had a significant effect on the explaining power of SDS scores in postpartum periods(ΔR2=0.02, p﹤0.001),despite control the age of pregnant and parturient women, the relationship between mother-in-law and daughter-in-law, neonatal exceptional, the degree of painful childbirth conditions and the SDS of predelivery periods. (4) Average score of CFQ in predelivery anxiety group was significant higher than that in predelivery normal group[(32.18±10.78)VS.(21.55±9.57), p﹤0.001];average score of CFQ in postpartum anxiety group was significant higher than that in postpartum normal group[(31.80±11.63)VS.(20.45±8.94), p﹤0.001]. (5) It was found that the aggregate score of CFQ was positively associated with the SAS scores of predelivery periods and postpartum periods respectively(r=0.52, 0.45, p﹤0.01). (6) The score of CFQ in predelivery periods still had a significant effect on the explaining power of SAS scores in postpartum periods(ΔR2=0.02，p﹤0.01),despite control the the age of pregnant and parturient women, the relationship between mother-in-law and daughter-in-law, spousal relationship, neonatal exceptional, the degree of painful childbirth conditions and the SAS of predelivery periods. The conclusions of this study are as follows: Firstly, Painful childbirth and newborn anomaly respectively has certain influence on postpartum depression and anxiety. Maternal depression and anxiety level respectively relate to the relationship bewteen mother-in-law and daughter-in-law, which indicate that all of these for maternal are sources of stress that cause postpartum depression and anxiety. Secondly，The psychological flexibility（experiential avoidance） is poor in the depressed or anxietied parturient women. The poorer psychological flexibility can result in a higher level of maternal depression or anxiety. A function to predict the occurrence of maternal postpartum depression and anxiety is obtained from the psychological flexibility attributed to the risk of maternal postpartum depressionand anxiety defined by the poor psychological flexibility. Lastly，The psychological flexibility( cognitive fusion) is poor in the depressed or anxietied parturient. The poorer psychological flexibility can result in a higher level of maternal postpartum depression or anxiety. A function to predict the occurrence of maternal postpartum depression and anxiety is also obtained from the psychological flexibility attributed to the risk of maternal postpartum depression and anxiety defined by the poor psychological flexibility.
学科领域	健康心理学
关键词	心理灵活性抑郁焦虑产妇
学位类型	同等学力硕士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/20564
专题	健康与遗传心理学研究室
作者单位	中国科学院心理研究所
推荐引用方式 GB/T 7714	祝慧. 产妇心理灵活性与抑郁焦虑的关系研究[D]. 北京. 中国科学院研究生院,2015.

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