山东部分地区农村已婚育龄妇女生殖相关因素与心理健康状况的关联性研究
发布时间：2018-08-11 11:22
【摘要】：背景：妇女的心理健康是妇女精神卫生的重要方面。多项研究表明,目前农村女性的心理健康状况不容乐观,烦恼、焦虑、抑郁等不良情绪在农村妇女中显得较为突出。据报道农村妇女的心理健康问题也是导致中国农村女性自杀率明显高于男性的原因之一,《中国精神卫生工作规划(2002-2010)》中指出,“要加强对妇女特有心理行为问题和精神障碍的研究,积极制定对策,进行综合干预。”育龄妇女作为特殊人群有其自身的特点,育龄期时间跨度大,在此期间妇女要经历婚姻、妊娠、生育、育儿直至绝经等过程。女性本身的生理特点以及各种家庭和社会环境因素等均会对其心理健康状况产生影响,其中与女性生殖相关的月经和生育等因素对妇女的心理健康状况变化起到不可忽视的作用,如围绝经期综合征、产后抑郁症等。与城市妇女相比,农村妇女的文化程度低,生殖保健知识相对缺乏并且农村卫生条件相对落后,致使农村妇女的生殖健康状况相对较差,农村已婚育龄妇女的生殖相关因素可能对其心理健康产生一定影响。 目的：探讨农村已婚育龄妇女月经和生育等生殖相关因素与心理健康状况的关系,寻找影响农村已婚育龄妇女心理健康状况的危险因素,从三级预防角度为提高农村已婚育龄妇女的心理健康水平提供合理建议,为制定有效的针对农村已婚育龄妇女的心理健康干预措施提供科学依据。 方法：在山东大学卫生研究基地的平阴县、梁山县和莒南县三个县内随机选取5个乡镇17个自然村作为研究现场。以被选中的自然村内的常住人口中所有15～49岁已婚育龄妇女作为本次调查的研究对象。采用入户个人问卷调查的方法,于2009年10月至12月由统一培训的调查员对研究对象进行面对面问卷调查并填写调查表。SCL-90量表的填写由研究对象独立完成。采用Access软件进行数据双录入,数据分析采用SPSS16.0软件完成。研究对象SCL-90量表得分与相关影响因素的单因素分析采用两个或多个样本的秩和检验(Kruskal-Wallis检验)进行分析。根据本研究人群SCL-90量表总得分的75分位数将研究对象心理健康状况分为两组,大于等于75分位数的赋值为1,表示心理健康状况较差,小于75分位数的赋值为0,表示心理健康状况相对较好。采用Binary Logistic回归模型分析研究对象月经和生育等生殖相关因素对心理健康状况的影响。 结果 1.研究对象一般情况。研究现场中符合本次研究对象条件并且提供有效数据的农村已婚育龄妇女共3397人,平均38.38±7.43岁(19.33岁～49.75岁)。研究对象不同年龄、不同文化程度、不同职业和不同婚姻状况的人群其SCL-90量表总得分的分布有统计学差异,41～50岁年龄组、高中及以上文化程度、经商和离婚或丧偶的研究对象SCL-90量表总得分的中位数较高。研究对象两周内伤病情况、半年内是否患有慢性疾病、是否患有妇科疾病与SCL-90量表总得分和各维度得分均有统计学关联,两周内有伤病、半年内患有慢性疾病和患有妇科疾病的研究对象SCL-90量表总得分的中位数较高。研究对象社会支持状况、近一年是否经历负性生活事件与SCL-90量表总得分也有统计学关联。 目前有月经的研究对象中月经不规律的比例为10.31%,痛经的比例为46.57%；50岁之前停经的发生率为10.30%(其中自然停经和因手术原因停经的比例分别占44.00%和12.00%),自然停经者平均停经年龄为46.58±2.73岁(42.28岁～49.31岁)。另外,研究对象或配偶不育症占研究对象的0.44%。 2.研究对象月经机能和心理健康状况的关系。单因素分析结果显示,研究对象月经规律性、痛经情况和停经原因与SCL-90量表总得分有统计学关联。①月经规律性与研究对象心理健康状况：多因素分析结果显示,调整了研究对象一般人口学状况、痛经情况、躯体健康状况、社会支持和负性生活事件等因素,月经不规律的研究对象心理健康状况较差,其出现不良心理健康状况的危险性是月经规律的研究对象的1.571倍(OR=1.571,95%CI：1.209～2.043)。②痛经与研究对象心理健康状况：调整了研究对象一般人口学状况、月经规律性、躯体健康状况、社会支持和负性生活事件等因素,有痛经症状的研究对象出现不良心理健康状况的风险明显升高,经常痛经的研究对象出现不良心理健康状况的危险性是没有痛经症状研究对象的1.705倍(OR=1.705,95%CI:1.361-2.136),偶尔痛经的研究对象出现不良心理健康状况的危险性是没有痛经症状研究对象的1.438倍(OR=1.438,95%CI:1.181-1.752),研究对象出现不良心理健康状况的风险随着痛经症状的严重程度而加强。③停经情况与研究对象心理健康状况的关系：单因素分析结果显示,不同停经原因的研究对象SCL-90量表总得分差异有统计学意义。调整了研究对象一般人口学状况、躯体健康状况、社会支持和负性生活事件等因素,与未停经且月经规律的研究对象相比,目前因妊娠而停经的研究对象出现不良心理健康状况的风险降低(OR=0.877,95%CI:0.788-0.974)。目前已自然停经的研究对象出现不良心理健康状况的风险是未停经且月经规律者的1.918倍(OR=1.918,95%CI:1.324-2.777)。因子宫或卵巢切除而停经的研究对象心理健康状况与未停经且月经规律的研究对象相比无统计学差异。 3.研究对象生育情况和心理健康状况的关系。①流产或引产次数、分娩次数与研究对象心理健康状况的关系：单因素分析结果显示,研究对象流产或引产次数与SCL-90量表总得分有统计学关联,流产或引产2次及以上的研究对象SCL-90量表总得分较高；研究对象分娩次数和SCL-90量表总得分无统计学关联。多因素分析结果显示,调整了研究对象一般人口学状况、躯体健康状况、社会支持和负性生活事件等因素,研究对象流产或引产经历与心理健康状况有统计学关联。流产或引产2次及以上的研究对象出现不良心理健康状况的风险是没有流产或引产经历的研究对象的1.612倍(OR=1.612,95%CI:1.253-2.074)。②研究对象或配偶不育症和研究对象心理健康状况的关系：单因素分析结果显示,研究对象或配偶不育症和SCL-90量表总得分无统计学关联。调整了研究对象-般人口学状况、躯体健康状况、社会支持和负性生活事件等因素,研究对象或其配偶是否患有不育症和研究对象心理健康状况也无统计学关联。 结论 1.农村已婚育龄妇女月经规律性和痛经情况与心理健康状况相关联,月经不规律和痛经都会增加农村已婚育龄妇女发生不良心理健康状况的风险性,并且发生不良心理健康状况的危险性随着痛经症状的严重程度而增加。 2.流产或引产经历与农村已婚育龄妇女心理健康状况有关联,流产或引产2次及以上是影响农村已婚育龄妇女心理健康状况的危险因素。 3.自然停经对农村已婚育龄妇女心理健康状况有负面影响,使农村已婚育龄妇女出现不良心理健康状况的风险增加。 4.处于妊娠期的农村已婚育龄妇女心理健康水平相对较高。 建议：农村已婚育龄妇女的心理健康状况受到月经和生育等生殖健康因素的影响,应加强对农村育龄妇女月经和生育相关心理卫生问题的宣传、教育和研究,提高农村已婚育龄妇女生殖相关心理健康知识的知晓率,对月经不规律、痛经、处于围绝经期以及流产或引产等重点人群采取有效心理干预措施,从而增强农村已婚育龄妇女的心理健康状况。
[Abstract]:BACKGROUND: Women's mental health is an important aspect of women's mental health. Many studies have shown that women's mental health in rural areas is not optimistic at present. Unhealthy emotions such as worry, anxiety and depression are more prominent among rural women. It is reported that the mental health problems of rural women also lead to a significant suicide rate among rural women in China. One of the reasons is that women of childbearing age have their own characteristics as a special group, and the time span of childbearing age is large. During this period, women have to experience marriage. Marriage, pregnancy, childbearing, childbearing and even menopause. Women's own physiological characteristics and a variety of family and social environment factors will have an impact on their mental health. Among them, menstruation and reproductive factors related to female reproduction play an important role in the change of women's mental health, such as perimenopausal synthesis. Compared with urban women, rural women's educational level is low, reproductive health knowledge is relatively lack and rural health conditions are relatively backward, resulting in relatively poor reproductive health of rural women, rural married women of childbearing age reproductive related factors may have a certain impact on their mental health.
Objective:To explore the relationship between reproductive factors and mental health of rural married women of childbearing age, such as menstruation and reproduction, and to find out the risk factors affecting the mental health of rural married women of childbearing age, so as to provide reasonable suggestions for improving the mental health level of rural married women of childbearing age from the perspective of three-level prevention, and to formulate effective countermeasures for agriculture. It provides a scientific basis for mental health interventions of married women of childbearing age in the village.
Methods: Seventeen natural villages in five townships and towns were randomly selected from Pingyin County, Liangshan County and Junan County of Shandong University Health Research Base. From October to December, 2009, a face-to-face questionnaire survey was conducted and completed by uniformly trained investigators. The SCL-90 scale was completed independently by the subjects. Access software was used to double-input the data, and SPSS16.0 software was used to analyze the data. The SCL-90 scale scores of the subjects and the single factors related to the influencing factors were analyzed. Two or more samples were used for the analysis using the Kruskal-Wallis test. According to the 75-digit total score of SCL-90 scale, the subjects'mental health status was divided into two groups. The assignment value greater than or equal to 75-digit was 1, indicating that the mental health status was poor, and the assignment value less than 75-digit was 0, indicating mental health. Binary Logistic regression model was used to analyze the effects of reproductive factors such as menstruation and reproduction on mental health.
Result
1. General information of the subjects. 3397 rural married women of childbearing age who met the conditions of the subjects and provided valid data in the study site, with an average age of 38.38 + 7.43 years (19.33-49.75 years). The total scores of SCL-90 were distributed among the subjects of different ages, educational levels, occupations and marital status. The median score of SCL-90 was higher in subjects aged 41-50 years, senior high school and above, business and divorce or widowhood. The median score of SCL-90 was higher in subjects with chronic diseases and gynecological diseases within half a year. The social support status of subjects, whether they had experienced negative life events in the past year were also statistically correlated with the total score of SCL-90.
At present, the proportion of irregular menstruation and dysmenorrhea was 10.31% and 46.57% respectively. The incidence of menopause before 50 years old was 10.30% (44.00% and 12.00% respectively). The average age of menopause was 46.58 (+ 2.73) years old (42.28-49.31 years old). Elephant or spousal infertility accounted for 0.44%. of the subjects.
2. Relationship between Menstrual Function and Mental Health Status. Univariate analysis showed that the subjects'menstrual regularity, dysmenorrhea and menopausal causes were statistically related to the total score of SCL-90. 1. Menstrual regularity and the subjects' mental health status: Multivariate analysis showed that the subjects'general population was adjusted. Menstrual disorders were associated with poor mental health. The risk of adverse mental health was 1.571 times higher than that of menstrual disorders (OR = 1.571,95% CI: 1.209-2.043). 2 Menstrual disorders and mental health status of the study subjects. Conditions: Adjusted the subjects'general demographic status, menstrual regularity, physical health status, social support and negative life events, the study subjects with dysmenorrhea had a significantly higher risk of poor mental health. The study subjects with dysmenorrhea often had a risk of poor mental health without dysmenorrhea symptoms. 1.705 times (OR = 1.705, 95% CI: 1.361-2.136) and 1.438 times (OR = 1.438, 95% CI: 1.181-1.752) of the subjects with occasional dysmenorrhea were more dangerous than those without dysmenorrhea. The risk of poor mental health increased with the severity of dysmenorrhea. The results of univariate analysis showed that there was significant difference in the total score of SCL-90 between the subjects with different menopausal causes. The risk of poor mental health in subjects with menopause due to pregnancy was 1.918 times higher (OR = 1.918, 95% CI: 1.324-2.777) than that in those without menopause (OR = 1.918, 95% CI: 1.324-2.777). There was no significant difference in mental health status between menopausal subjects and non-menopausal subjects with regular menstruation.
3. The relationship between the fertility and mental health of the subjects. 1. The relationship between the number of abortions or induced labor and the mental health of the subjects. The univariate analysis showed that the number of abortions or induced labor was statistically correlated with the total score of SCL-90. The SCL-90 scale was used for the subjects who had abortions or induced labor twice or more. The results of multivariate analysis showed that the subjects'general demographic status, physical health status, social support and negative life events were adjusted, and their abortion or induced labor experiences were statistically correlated with their mental health status. (OR = 1.612, 95% CI: 1.253-2.074). 2) The relationship between the infertility of the subjects or spouses and the mental health status of the subjects: Univariate analysis showed that the subjects or spouses had infertility. There was no significant correlation between SCL-90 and the total score of SCL-90. The subjects'general demographic status, physical health status, social support and negative life events were adjusted. There was no significant correlation between the infertility of the subjects or their spouses and the mental health status of the subjects.
conclusion
1. Menstrual regularity and dysmenorrhea of rural married women of childbearing age are related to mental health. Irregular menstruation and dysmenorrhea both increase the risk of unhealthy mental health of rural married women of childbearing age, and the risk of unhealthy mental health increases with the severity of dysmenorrhea symptoms.
2. The experience of abortion or induced abortion is related to the mental health status of rural married women of childbearing age. Abortion or induced abortion twice or more is a risk factor affecting the mental health status of rural married women of childbearing age.
3. Natural menopause has a negative impact on the mental health of rural married women of childbearing age, and increases the risk of unhealthy mental health of rural married women of childbearing age.
4. the mental health level of married women of childbearing age in rural areas is relatively high.
Suggestions: The mental health status of married women of childbearing age in rural areas is affected by reproductive health factors such as menstruation and reproduction. It is necessary to strengthen the publicity, education and Research on the menstruation and reproductive related mental health problems of rural women of childbearing age so as to raise the awareness rate of reproductive related mental health knowledge of married women of childbearing age in rural areas, irregular menstruation and dysmenorrhea. In order to improve the mental health status of rural married women of childbearing age, effective psychological intervention measures should be taken among the key population in perimenopausal period, abortion or induced abortion.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R173
本文编号：2176853
[Abstract]:BACKGROUND: Women's mental health is an important aspect of women's mental health. Many studies have shown that women's mental health in rural areas is not optimistic at present. Unhealthy emotions such as worry, anxiety and depression are more prominent among rural women. It is reported that the mental health problems of rural women also lead to a significant suicide rate among rural women in China. One of the reasons is that women of childbearing age have their own characteristics as a special group, and the time span of childbearing age is large. During this period, women have to experience marriage. Marriage, pregnancy, childbearing, childbearing and even menopause. Women's own physiological characteristics and a variety of family and social environment factors will have an impact on their mental health. Among them, menstruation and reproductive factors related to female reproduction play an important role in the change of women's mental health, such as perimenopausal synthesis. Compared with urban women, rural women's educational level is low, reproductive health knowledge is relatively lack and rural health conditions are relatively backward, resulting in relatively poor reproductive health of rural women, rural married women of childbearing age reproductive related factors may have a certain impact on their mental health.
Objective:To explore the relationship between reproductive factors and mental health of rural married women of childbearing age, such as menstruation and reproduction, and to find out the risk factors affecting the mental health of rural married women of childbearing age, so as to provide reasonable suggestions for improving the mental health level of rural married women of childbearing age from the perspective of three-level prevention, and to formulate effective countermeasures for agriculture. It provides a scientific basis for mental health interventions of married women of childbearing age in the village.
Methods: Seventeen natural villages in five townships and towns were randomly selected from Pingyin County, Liangshan County and Junan County of Shandong University Health Research Base. From October to December, 2009, a face-to-face questionnaire survey was conducted and completed by uniformly trained investigators. The SCL-90 scale was completed independently by the subjects. Access software was used to double-input the data, and SPSS16.0 software was used to analyze the data. The SCL-90 scale scores of the subjects and the single factors related to the influencing factors were analyzed. Two or more samples were used for the analysis using the Kruskal-Wallis test. According to the 75-digit total score of SCL-90 scale, the subjects'mental health status was divided into two groups. The assignment value greater than or equal to 75-digit was 1, indicating that the mental health status was poor, and the assignment value less than 75-digit was 0, indicating mental health. Binary Logistic regression model was used to analyze the effects of reproductive factors such as menstruation and reproduction on mental health.
Result
1. General information of the subjects. 3397 rural married women of childbearing age who met the conditions of the subjects and provided valid data in the study site, with an average age of 38.38 + 7.43 years (19.33-49.75 years). The total scores of SCL-90 were distributed among the subjects of different ages, educational levels, occupations and marital status. The median score of SCL-90 was higher in subjects aged 41-50 years, senior high school and above, business and divorce or widowhood. The median score of SCL-90 was higher in subjects with chronic diseases and gynecological diseases within half a year. The social support status of subjects, whether they had experienced negative life events in the past year were also statistically correlated with the total score of SCL-90.
At present, the proportion of irregular menstruation and dysmenorrhea was 10.31% and 46.57% respectively. The incidence of menopause before 50 years old was 10.30% (44.00% and 12.00% respectively). The average age of menopause was 46.58 (+ 2.73) years old (42.28-49.31 years old). Elephant or spousal infertility accounted for 0.44%. of the subjects.
2. Relationship between Menstrual Function and Mental Health Status. Univariate analysis showed that the subjects'menstrual regularity, dysmenorrhea and menopausal causes were statistically related to the total score of SCL-90. 1. Menstrual regularity and the subjects' mental health status: Multivariate analysis showed that the subjects'general population was adjusted. Menstrual disorders were associated with poor mental health. The risk of adverse mental health was 1.571 times higher than that of menstrual disorders (OR = 1.571,95% CI: 1.209-2.043). 2 Menstrual disorders and mental health status of the study subjects. Conditions: Adjusted the subjects'general demographic status, menstrual regularity, physical health status, social support and negative life events, the study subjects with dysmenorrhea had a significantly higher risk of poor mental health. The study subjects with dysmenorrhea often had a risk of poor mental health without dysmenorrhea symptoms. 1.705 times (OR = 1.705, 95% CI: 1.361-2.136) and 1.438 times (OR = 1.438, 95% CI: 1.181-1.752) of the subjects with occasional dysmenorrhea were more dangerous than those without dysmenorrhea. The risk of poor mental health increased with the severity of dysmenorrhea. The results of univariate analysis showed that there was significant difference in the total score of SCL-90 between the subjects with different menopausal causes. The risk of poor mental health in subjects with menopause due to pregnancy was 1.918 times higher (OR = 1.918, 95% CI: 1.324-2.777) than that in those without menopause (OR = 1.918, 95% CI: 1.324-2.777). There was no significant difference in mental health status between menopausal subjects and non-menopausal subjects with regular menstruation.
3. The relationship between the fertility and mental health of the subjects. 1. The relationship between the number of abortions or induced labor and the mental health of the subjects. The univariate analysis showed that the number of abortions or induced labor was statistically correlated with the total score of SCL-90. The SCL-90 scale was used for the subjects who had abortions or induced labor twice or more. The results of multivariate analysis showed that the subjects'general demographic status, physical health status, social support and negative life events were adjusted, and their abortion or induced labor experiences were statistically correlated with their mental health status. (OR = 1.612, 95% CI: 1.253-2.074). 2) The relationship between the infertility of the subjects or spouses and the mental health status of the subjects: Univariate analysis showed that the subjects or spouses had infertility. There was no significant correlation between SCL-90 and the total score of SCL-90. The subjects'general demographic status, physical health status, social support and negative life events were adjusted. There was no significant correlation between the infertility of the subjects or their spouses and the mental health status of the subjects.
conclusion
1. Menstrual regularity and dysmenorrhea of rural married women of childbearing age are related to mental health. Irregular menstruation and dysmenorrhea both increase the risk of unhealthy mental health of rural married women of childbearing age, and the risk of unhealthy mental health increases with the severity of dysmenorrhea symptoms.
2. The experience of abortion or induced abortion is related to the mental health status of rural married women of childbearing age. Abortion or induced abortion twice or more is a risk factor affecting the mental health status of rural married women of childbearing age.
3. Natural menopause has a negative impact on the mental health of rural married women of childbearing age, and increases the risk of unhealthy mental health of rural married women of childbearing age.
4. the mental health level of married women of childbearing age in rural areas is relatively high.
Suggestions: The mental health status of married women of childbearing age in rural areas is affected by reproductive health factors such as menstruation and reproduction. It is necessary to strengthen the publicity, education and Research on the menstruation and reproductive related mental health problems of rural women of childbearing age so as to raise the awareness rate of reproductive related mental health knowledge of married women of childbearing age in rural areas, irregular menstruation and dysmenorrhea. In order to improve the mental health status of rural married women of childbearing age, effective psychological intervention measures should be taken among the key population in perimenopausal period, abortion or induced abortion.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R173
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