简易应对训练与感恩日记对妊娠期女性抑郁焦虑症状的干预效果研究

发布时间：2018-04-23 06:14

本文选题：妊娠 + 抑郁　；参考：《山东大学》2017年硕士论文

【摘要】：目的:妊娠期女性容易出现抑郁、焦虑症状,对母亲和孩子的身心健康产生严重危害,引发不良分娩结局。目前尚不得知简易应对训练和感恩日记是否可以改善孕妇的抑郁、焦虑症状。本研究将初步探讨这两种自助式心理干预方案对妊娠期女性抑郁、焦虑症状的影响,解析两种干预方式和干预效果关系的潜在调节因素。方法:本研究采用随机对照试验设计。于2016年4月至2016年9月,通过病例查询和问卷调查的方式,在山东省济南市某三级甲等医院产科门诊招募74名妊娠期女性,将其随机化分为简易应对训练组(37人)和感恩日记组(37人),分别进行为期4周的简易应对训练和感恩日记干预。采用一般资料问卷、爱丁堡产后抑郁量表、状态焦虑问卷、压力知觉量表、疲乏程度量表,分别评估孕妇在干预前、后的抑郁、焦虑、压力和疲乏症状并采用配对样本t检验进行组内比较。采用广义估计方程比较两组孕妇的抑郁、焦虑症状随着时间的变化情况。通过匹兹堡睡眠质量指数量表、领悟社会支持量表、反刍思维量表评估孕妇的睡眠质量、社会支持和反刍思维倾向,并探讨孕妇的一般资料和睡眠质量、社会支持和反刍思维倾向是否为两种干预方式和干预效果关系的潜在调节因素。结果:(1)简易应对训练组的孕妇抑郁、焦虑和疲乏症状均得到显著改善(P0.01);而感恩日记组孕妇抑郁和焦虑症状得到显著改善(P0.01),但疲乏症状没有显著性改变(P0.05)。两组干预对孕妇的压力水平均没有显著影响(P0.05)。(2)两组孕妇的抑郁和焦虑症状得分在组别上无显著的主效应(P0.05),而在时间上均存在显著的主效应(P0.01);在疲乏得分上,组别存在显著的主效应(P=0.006),同时组别×时间的交互效应也显著(P=0.011)。孕妇的压力水平在组别×时间的主效应和交互效应均不显著(P0.05)。(3)对于抑郁症状的改善情况,有2次及以下怀孕经历、社会支持水平较低或反刍思维倾向更多的孕妇更适合采用简易应对训练,而有过3次及以上怀孕经历、社会支持水平较高或反刍思维倾向较少的孕妇采用感恩日记的方式更能改善其抑郁症状。(4)对于焦虑症状的改善情况,睡眠质量相对较好或社会支持水平较低的孕妇更适合采用简易应对训练,而睡眠质量很差或社会支持水平较高的孕妇采用感恩日记的方式更能改善其焦虑症状。结论:(1)简易应对训练和感恩日记干预均能够有效改善妊娠期女性的抑郁、焦虑症状,且简易应对训练还能够改善孕妇的疲乏症状。(2)孕妇的怀孕次数、社会支持水平和反刍思维倾向会显著影响两组干预方式与抑郁症状干预效果的关系,而孕妇的睡眠质量和社会支持水平会显著影响两组干预方式与焦虑症状干预效果的关系。
[Abstract]:Objective: women in pregnancy are prone to depression and anxiety, which are harmful to the physical and mental health of mother and child. It is not known whether simple coping training and gratitude diaries can improve depression and anxiety in pregnant women. This study will explore the effects of these two self-help psychological intervention programs on depression and anxiety symptoms in pregnant women, and analyze the potential regulatory factors of the relationship between the two intervention methods and the intervention effect. Methods: a randomized controlled trial was used in this study. From April 2016 to September 2016, 74 pregnant women were recruited from a maternity clinic of Grade 3A Hospital in Jinan, Shandong Province, through case inquiries and questionnaires. They were randomly divided into simple coping training group (37 persons) and gratitude diary group (37 persons). General data questionnaire, Edinburgh postpartum depression scale, state anxiety questionnaire, stress perception scale, fatigue scale were used to evaluate the depression and anxiety of pregnant women before and after intervention, respectively. Stress and fatigue symptoms were compared with paired t-test. Generalized estimation equation was used to compare the changes of depression and anxiety symptoms over time. Pittsburgh Sleep quality Index scale, perceived Social support scale and Ruminant thinking scale were used to evaluate the sleep quality, social support and rumination tendency of pregnant women, and to explore the general information and sleep quality of pregnant women. Whether social support and ruminant thinking tendency are the potential regulatory factors of the relationship between the two intervention modes and the intervention effect. Results in the simple coping training group, the depression, anxiety and fatigue symptoms of pregnant women were significantly improved, while in the gratitude diary group, the symptoms of depression and anxiety were significantly improved (P 0.01), but the fatigue symptoms did not change significantly (P 0.05). The scores of depression and anxiety in both groups had no significant effect on the scores of depression and anxiety, but there were significant major effects on the time of the two groups, and the scores of fatigue, fatigue, and fatigue were not significant in the two groups, but there was no significant effect on the scores of depression and anxiety in the two groups, but there was a significant major effect in the time, and the scores of fatigue were higher than those in the control group, and there was no significant difference between the two groups. There was a significant main effect in the group P0. 006, and the interaction effect of the group 脳 time was also significant (P 0. 011). The main effect and interaction effect of stress level in group 脳 time were not significant (P 0.05). Pregnant women with lower level of social support or more tendency to regurgitate thought were more suitable for simple coping training and had three or more pregnancies. Pregnant women with higher level of social support or less tendency to regurgitate their ruminant thought were more likely to improve their anxiety symptoms by using gratitude diary. The pregnant women with better sleep quality or lower level of social support were more suitable for simple coping training, while those with poor sleep quality or high level of social support could improve their anxiety symptoms by the way of gratitude diary. Conclusion both simple coping training and gratitude diary intervention can effectively improve the depression and anxiety symptoms of pregnant women, and simple coping training can also improve the number of pregnancies of pregnant women with fatigue symptoms. The level of social support and the tendency of ruminant thinking could significantly affect the relationship between the intervention style and the intervention effect of depression symptoms, while the sleep quality and social support level of pregnant women could significantly affect the relationship between the intervention style and the intervention effect of anxiety symptom.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71

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