健康与遗传心理学研究室知识库

围产期妇女的心理健康状况由于其影响广泛，一直以来是大量医学与心理学研究者们共同关注的研究领域。越来越多的研究表明，孕妇产前、产后焦虑抑郁情绪存在着较高的关联性，这也提示着医护、心理学工作者们，情绪状况的筛查、心理咨询的及早介入需从孕期开始，并值得持续关注。围产期情绪困扰除与孕产妇生理因素、社会因素相关外，还与其个人心理特质如心理灵活性(psychological flexibility, PF)息息相关。因此，本研究在了解孕妇心理特质的基础上，旨在通过正念练习与理性情绪疗法两种心理干预方式的比较，为孕晚期孕妇人群缓解焦虑、抑郁情绪以帮助孕妇顺利度过分娩这一人生重大事件。

本研究通过整群抽样，选取北京某妇产医院530名孕晚期待产孕妇作为研究对象，采用自编孕妇及产妇一般资料调查表、医院焦虑抑郁量表(Hospital Anxiety and Depression Scale, HAD )、接纳与行动问卷第二版(The Acceptance and Action Questionnaire-II, AAQ-II )、认知融合问卷(Cognitive Fusion Questionnaire , CFQ ) 进行焦虑、抑郁情绪状况及心理灵活性的评估，应用SPSS} 1.0软件对全部数据进行描述性统计分析、T检验、单因素ACT.VA分析、Pearson相关分析及层次回归分析。将其中116名自愿参与团体心理辅导的孕妇根据就诊日期随机分配进入理性情绪疗法组(40人)、正念练习组(39人)及空白对照组(37人)，对两种心理干预组孕妇分别进行1次团体心理辅导及7天自我练习，并于团体辅导后、7天自我练习后和产后2}}天内焦虑、抑郁情绪及心理灵活性进行评估，对空白对照组分别于干预前和产后2}7天内进行评估。应用ShSS21.0, HL1}7.0软件及bootstrap插件对数据进行描述性统计分析、阶层线性模型数据分析及中介效应的检验。

本研究得到的结果如下:

第一，(1)孕晚期孕妇的焦虑、抑郁、经验性回避、认知融合总分在人口学变量年龄、胎次、体重、受教育程度、当前孕周、是否有遗传病史及妊娠合并症、有无医保等因素上均未发现显著差异(P>0.05)。婆媳关系评分与抑郁、经验性回避、认知融合评分均呈低负相关(γ=-0.176，-0.280，-0.201， P<0.01)，而夫妻关系评分与焦虑、抑郁、经验性回避、认知融合得分均呈低负相关(γ=-r0.105，-0.168，-0.302，-0.198， P<0.001)。（2)孕晚期孕妇的经验性回避与焦虑、抑郁均呈正相关(γ=0.53, 0.44, P<0.001)，认知融合与焦虑、抑郁均呈正相关(r=0.45 ,0.42, P<0.001)。( 3)排除夫妻关系评分变量后，经验性回避及认知融合对孕妇焦虑的解释力分别为27.3%和19.5%，且均达到统计意义上的显著水平(△F=173.434, 11.017, P<0.001)。同样，排除婆媳关系、夫妻关系评分变量后，经验性回避及认知融合对孕妇抑郁的解释力分别为18.8%和11.5%，且均达到统计意义上的显著水平. （△F=108.972， 60.919 ， P<0.001)。

第二，(1)自愿参与团体心理辅导的三组孕妇产前焦虑、抑郁总分在产前人口学变量上均未发现显著差异(P>0.05 )。产后焦虑总分在分娩方式上有显著差异(F=2.682，P<0.005），事后检验结果表明有助产(侧切、产钳)的产妇产后焦虑总分显著高于剖宫产的产妇。（2）两种心理干预方法对缓解孕妇焦虑、抑郁情绪的时间效应显著，且均呈下降趋势，与空白对照组的比较差异均有统计学意义(理性情绪疗法组与空白对照组焦虑得分比较:β11=0.35, P<0.01;正念练习组与空白对照组焦虑得分比较:β11=1.05, P<0.001; 理性情绪疗法组与空白对照组抑郁得分比较:β11=0.29，P<0.01; 正念练习组与空白对照组抑郁得分比较:β11=0.75P<0.01)。而随着时间的推移空白对照组孕妇焦虑、抑郁情绪呈上升趋势。在两种心理干预组中比较发现，理性情绪疗法组与正念练习组的四次焦虑、抑郁情绪得分的差异没有统计学意义(P>0.05)。 (3)经验性回避与认知融合在理性情绪疗法与焦虑、抑郁情绪之间的中介效应均未见显著性，而在正念练习与焦虑、抑郁情绪之间的中介效应均达到了显著性水平。在正念练习的干预组中，经验性回避对焦虑、抑郁情绪的中介效应量分别为47.19% （95% CI=-2.12 ~-0.01)和62.15%(95% CI=-1.69-0.04)，认知融合对焦虑、抑郁的中介效应量分别为47.48%(95%CI=-2. l5~ -0.06)和64.57% (95% CI=-1.79~-0.03)。

本研究得出的结论:

第一，婆媳关系评分与孕晚期孕妇抑郁、经验性回避、认知融合均呈低负相关，夫妻关系评分与孕妇焦虑、抑郁、经验性回避、认知融合各项量表得分均呈低负相关。孕晚期孕妇经验性回避、认知融合与焦虑、抑郁总分均呈正相关。经验性回避、认知融合分别可以在一定程度_L几预测焦虑、抑郁情绪的发生，且婆媳关系、夫妻关系等人口学变量对焦虑、抑郁情绪的预测作用在经验性回避与认知融合进入回归模型后皆消失。

第二，理性情绪疗法和正念练习均对焦虑、抑郁情绪产生了良好的干预效果，随着时间的变化，两种心理干预方法可以缓解孕晚期孕妇的焦虑、抑郁情绪直至分娩后2~7天，而未进行心理干预的空白对照组孕妇则焦虑、抑郁情绪持续上升。相比较空白对照组，两种心理干预方法对焦虑、抑郁情绪均有改善效果，但是两者之间的差异并不显著。经验性回避、认知融合在正念练习与焦虑、抑郁情绪之间均发挥着中介作用，而在理性情绪疗法与负性情绪间未见此类中介作用。正念练习是通过提高个体心理灵活性，降低经验性回避及认知融合这条路径从而减轻焦虑、抑郁症状的，而理性情绪疗法则不是。

Because of its widespread influence, perinatal women's mental health has been the issue of common concern between medical researchers and psychologists. In recent years, more and more studies indicated that there has a high correlation with prenatal and postpartum anxiety and depression. These phenomenon also prompt the medical researchers and psychologists that screening of perinatal women's emotional condition and early intervention of psychological counseling should began from the pregnancy stage and be worthy of persistence. In addition to the maternal physiological factors and social aspects, the personal psychological traits such as psychological flexibility also has affected perinatal women's emotional disturbance. Therefore, this study in view of the basis of psychological traits of pregnant women, with the comparison of mindfulness training and cognitive-behavioral intervention of Rational-Emotive Therapy for women which in late stage of pregnancy to help them reduce anxiety and depression emotions in order to live through childbirth period.

530 parturient women collected by cluster sampling method from a obstetrics and gynecology hospital, were assessed anxiety and depression emotions and psychological flexibility with self-made general information questionnaire, Hospital Anxiety and Depression Scale (HAD), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ). The results were subject to SPSS21.0 software to present the descriptive statistical analysis, T-test, one-way ANOVA analysis, Pearson correlation analysis and regression analysis. 116 pregnant women were voluntarily selected into guidance groups and were randomly divided into Rational- Emotive Therapy (RET) group (40), mindfulness training group (39) and control group (37). In two psychological intervention groups there were once group psychological counseling and one week self exercise for these two groups of pregnant women. The intervention effects of two intervention groups were evaluated by above-mentioned questionnaires among three periods which were after intervention, one week later and 2~7 days after delivery. For control group, anxiety and depression emotions and Psychological flexibility were assessed in 2~7 days after delivery. The results were subject to SPSS21.0 software, HML7.0 software and bootstrap process to present the descriptive statistical analysis, hierarchical linear model analysis and the test of mediation effect.

The results of the study are as follows:

Firstly, (1) There were found no significant difference on the anxiety, depression, experiential avoidance and cognitive fusion of late-stage pregnant women with the presence of general factors such as age, number of birth, weight, level of education, current gestational weep, whether has genetic history, pregnancy complications health insurance (P>O.OS). The score of relationship with mother-in-law was significant negative correlation with depression, experiential avoidance and cognitive fusion (Y=-0.176，-0.280，-0.201，P<0.01). The score of relationship with husband was significant negative correlation with anxiety, depression, experiential avoidance and cognitive fusion (r=-0.105，-0.168，-0.302，-0.198，P<0.01). (2) The score of experiential avoidance of late-stage pregnant women was significant positive correlation with anxiety and depression (r=0.53，0.44，P<0.001), meanwhile there was significant positive correlation among cognitive fusion, anxiety and depression (γ=0.45，0.42，P<0.001). (3) Excluded the effect of relationship with husband, the interpretations of experiential avoidance and cognitive fusion to pregnant women anxiety were 27.3% and 19.5% (△F=173.434，112.017，P<0.001). Meanwhile, excluded the effects of relationship with mother-in-law and relationship with husband, the interpretations of experiential avoidance and cognitive fusion to pregnant women depression were 18.8% and 11.5% (△F=108.972，60.919，P<0.001).

Secondly， (1) there were found no significant difference on the anxiety, depression of 116 pregnant women who were voluntarily selected into guidance groups with the presence of general factors (P>0.05). But there was found significant difference on the anxiety after delivery on the way of delivery (F=2.682，P<0.05)，which man that the score of puerperal women anxiety in the process of midwife (side cut, forceps) wart higher than cesarean delivery women. (2) To compare with the control group, anxiety and depression of two intervention groups wart kept falling and control group was β11=0.35(P<0.01), and β11=0.29(P<0.01) in depression. The results of comparison in anxiety between the mindfulness training group and control group was β11=0.35(P<0.01), and β11=0.29(P<0.01) in depression. The results of comparison in anxiety between the mindfulness training group and control group was β11=1.05(P<0.001), and β11=0.75 (P<0.01) in depression. And anxiety and depression were kept climbed in control group at the same time There was no significant difference in two intervention groups (P>0.05). (3) Under the analysis of Bootstrap process, both experiential avoidance and cognitive fusion had partial mediating effects on the relationship between mindfulness training and anxiety, depression emotions. There was found no mediating effects in RET group. The amount of mediating effect between mindfulness training method and anxiety, experiential avoidance was 47.19% (95% CI=-2.12~-0.01), cognitive fusion was 47.4% (95% CI=-2.15~ -0.06), meanwhile the amount of mediating effect between mindfulness training method and depression, experiential avoidance was 62.15% (95%CI=-1.69~ -0.04), cognitive fusion was 64.57% (95% CI=-1.79 ~-0.03).

The conclusions of the study are ad follows:

Firstly, the score of relationship with mother-in-law was significant negative correlation with depression, experiential avoidance and cognitive fusion of late-stage pregnant women. The score of relationship with husband was significant negative correlation with anxiety, depression, experiential avoidance and cognitive fusion of late-stage pregnant women. The score of experiential. avoidance of late-stage pregnant women was significant positive correlation with anxiety and depression; meanwhile there was significant positive correlation among cognitive fusion, anxiety and depression. The experiential avoidance and cognitive fusion have some predictive effects on anxiety. Likewise, the experiential avoidance and cognitive fusion have a certain prediction on depression. Secondly, Rational emotional therapy and mindfulness gaining have both good intervention effects on anxiety and depression emotions. To compare with the control group, anxiety and depression of two intez0vcntion groups were kept falling with the process of time until 2~7 days after delivery. And anxiety and depression were kept climbed in control group at the same time. There was no significant difference in two intervention groups. Both experiential avoidance and cognitive fusion had partial mediating effects on the relationship between mindfulness training and anxiety, depression emotions. There was found no mediating effects in RET group. That means in the process of reducing anxiety and depression emotions， mindfulness training was realized it through improving the personal psychological flexibility. But National emotional therapy was not.