Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety
Suicidal ideation in depressed postpartum women: Associations with childhood trauma, sleep disturbance and anxiety
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DOI：
10.1016/j.jpsychires.2015.04.021
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发表时间：
2015-07-01
影响因子：
4.8
通讯作者：
Wisner, Katherine L.
中科院分区：
文献类型：
--
作者：
Sit, Dorothy;Luther, James;Wisner, Katherine L.
背景：自杀是产后妇女死亡的主要原因之一。确定与母亲产后自杀风险相关的可改变因素是公共卫生的首要任务。我们的研究目的是探讨产后抑郁女性的自杀意念 (SI) 与可能的危险因素（童年或成年时受虐待的经历、睡眠障碍和焦虑症状）之间的关联。 方法：这项二次分析包括 628 名产后 4-6 周的抑郁母亲。通过 DSM-IV 的结构化临床访谈确认了诊断。我们检查了爱丁堡产后抑郁量表-EPDS 第 10 项的反应中的 SI；汉密尔顿抑郁量表结构化访谈指南非典型抑郁症状 (SIGH-ADS) 的抑郁水平；加上睡眠障碍和焦虑水平，以及来自 EPDS 和 SIGH-ADS 睡眠和焦虑症状项目的分量表。结果：在抑郁母亲中，496 名（79%）“从未”有过自残的想法； 98(15.6%)“几乎没有”； 34 人 (5.4%) 表示“有时”或“经常”。 Logistic回归模型表明，经常有自残的想法与儿童时期的身体虐待有关（比值比-OR = 1.68，95% CI = 1.00，2.81）；在没有童年身体虐待的母亲中，频繁的自残想法与睡眠障碍（OR = 1.15, 95% CI = 1.02, 1.29）和焦虑症状（OR = 1.11, 95% CI = 1.01, 1.23）有关。讨论：由于患有产后抑郁症的女性可能会频繁出现自残的想法，并且临床复杂性很高，因此需要进行详细的安全评估，其中包括对儿童期虐待的评估睡眠障碍和焦虑的病史和当前症状，是抑郁母亲管理的关键组成部分。 (C) 2015 Elsevier Ltd. 保留所有权利。
Background: Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women.Methods: This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms.Results: Of the depressed mothers, 496(79%) 'never' had thoughts of self-harm; 98(15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% Cl = 1.01, 1.23).Discussion: Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers. (C) 2015 Elsevier Ltd. All rights reserved.