基于社会心理因素的产后抑郁症模型的建立和评价

发布时间：2018-05-13 20:07

本文选题：产后抑郁症 + 发病率　；参考：《第二军医大学学报》2017年04期

【摘要】：目的调查影响产后抑郁症(PPD)的社会心理因素,探究其对PPD的预测价值,构建并评价PPD的预测模型。方法随机选取2014年9月—2016年6月在重庆医科大学附属第一医院、金山医院、大学城医院进行产前检查、孕周≥28周、拟在该院住院分娩的371例孕妇,采用社会人口学调查表(自定义)、艾森克人格问卷(EPQ)、90项症状自评量表(SCL-90)、汉密尔顿焦虑/抑郁量表(HAMA_(14)/HAMD_(24))、贝克焦虑/抑郁量表(BAI/BDI)对所有孕妇进行产前社会心理因素调查;并在产后的第42天追踪随访完成爱丁堡产后抑郁量表(EPDS),同时进行PPD的评估诊断。分析预测影响PPD的社会心理因素,并采用多因素逐步logistic回归构建预测模型,运用ROC曲线评价该模型的预测价值。结果根据PPD的评估结果,371例产妇中60例(PPD组)符合PPD的诊断标准,311例不符合(N-PPD组);PPD的发生率为16.17%(60/371)。单因素分析两组孕妇产前社会心理因素,结果显示工作稳定与否、文化程度、情绪稳定性、HAMA_(14)得分、HAMD_(24)得分、BAI得分、BDI得分、SCL-90各单因子(除躯体化)得分的差异均有统计学意义(P0.05),对上述指标进行多因素逐步logistic回归,建立了如下数学模型:Logit(PI)=0.042×total score of SCL-90+1.005×fixed work or not+2.498×relative company+0.108×BDI score-1.319×education-8.028。该模型的ROC曲线下面积为0.833(P0.001,95%CI:0.772~0.894)。当以PI=0.141为界点时,约登指数最大,灵敏度为0.900,特异度为0.533。结论 SCL-90总分、产妇有无固定工作、家属陪伴情况、BDI得分是PPD的独立危险因素,文化程度低是PPD的保护因素;本研究建立的基于社会心理因素的PPD预测模型有较高的预测价值,值得进一步研究。
[Abstract]:Objective to investigate the psychosocial factors affecting postpartum depression (PPD), to explore its predictive value for PPD, and to construct and evaluate the prediction model of PPD. Methods 371 pregnant women were randomly selected from September 2014 to June 2016 in the first affiliated Hospital of Chongqing Medical University, Jinshan Hospital and University City Hospital. The gestational weeks were more than 28 weeks. All pregnant women were investigated with self-defined Eysenck Personality questionnaire (Eysenck Personality questionnaire) 90 symptom Checklist (SCL-90), Hamilton anxiety / Depression scale (Hamilton anxiety / Depression scale) and Hamilton anxiety / Depression scale (Hamilton anxiety / Depression scale). After 42 days of postpartum follow-up, the Edinburgh Postpartum Depression scale (EPDS) was completed, and the PPD was evaluated and diagnosed at the same time. The psychosocial factors influencing PPD were analyzed and the prediction model was constructed by multifactor stepwise logistic regression. The predictive value of the model was evaluated by ROC curve. Results according to the results of PPD evaluation, the incidence rate of PPD was 16.1717 / 371g in 60 / 371g / 371P group, which was in accordance with the diagnostic criteria of PPD (n = 311) and non-conformance with N-PPD group (n = 311). Univariate analysis of the two groups of pregnant women prenatal psychosocial factors, the results show whether the job is stable or not, the degree of education, The scores of Bai, BDI and SCL-90 (except somatization) were significantly different (P < 0.05). The multivariate stepwise logistic regression was used to analyze the above indexes. The following mathematical model, 0.042 脳 total score of SCL-90 1.005 脳 fixed work or not 2.498 脳 relative company 0.108 脳 BDI score-1.319 脳 education-8.028, was established. The area under the ROC curve of this model is 0.833 P0.001 and 95% CI: 0.772and 0.894m. When PI=0.141 is taken as the boundary point, the Jorden index is the largest, the sensitivity is 0.900, and the specificity is 0.533. Conclusion the total score of SCL-90, whether the parturient has a fixed job or not, the scores of family companionship are independent risk factors of PPD, and the low education level is the protective factor of PPD. The PPD prediction model based on social and psychological factors has a high predictive value. It is worth further study.
【作者单位】：重庆医科大学附属大学城医院心理卫生中心;重庆医科大学附属第一医院精神科;
【基金】：重庆市渝中区科技计划项目(20120217)~~
【分类号】：R749.4

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