Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention.
Pregnancy stressors and postpartum symptoms of depression and anxiety: the moderating role of a cognitive-behavioural therapy (CBT) intervention.
复制标题
妊娠压力源以及产后抑郁和焦虑症状：认知行为疗法（CBT）干预的调节作用。
DOI：
10.1136/gpsych-2023-101136
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发表时间：
2024
影响因子：
11.9
通讯作者：
Surkan,PamelaJ
中科院分区：
文献类型：
--
作者：
Sun,Yunxiang;Park,Soim;Malik,Abid;Atif,Najia;Zaidi,Ahmed;Rahman,Atif;Surkan,PamelaJ
背景 人们对怀孕期间的压力源（尤其是积极的压力源）与产后抑郁和焦虑之间的关联知之甚少。目的 我们调查了巴基斯坦有焦虑症状的低收入孕妇在怀孕不同阶段的积极和消极压力事件与产后心理健康结果之间的关联，并评估了基于认知行为疗法（CBT）的干预措施是否具有调节作用。方法 参与者为 621 名患有轻度焦虑的巴基斯坦孕妇。使用怀孕体验量表简要版，创建了六个分数来评估积极和消极的压力源。我们进行了多元线性回归，以检查在基线和妊娠晚期测量的这六个分数是否与产后焦虑和抑郁症状相关。通过向回归模型添加交互项来检查干预对这种关系的影响。结果 妊娠晚期测量的麻烦频率与抑郁（B=0.22，95%置信区间（CI）：0.09至0.36）和焦虑（B=0.19，95% CI：0.08至0.30）呈正相关。在同一时间点，振奋强度与抑郁症状（B=-0.82，95% CI：-1.46至–0.18）和焦虑症状（B=-0.70，95% CI：-1.25至–0.15）呈负相关，而烦恼强度与抑郁症状（B=1.02，95% CI：0.36至1.67）和焦虑呈正相关。 （B=0.90，95% CI：0.34 至 1.47）。妊娠晚期报告的麻烦与振奋的强度比与抑郁（B=1.40，95% CI：0.59至2.20）和焦虑（B=1.26，95% CI：0.57至1.96）呈正相关。干预措施增强了提升的总体积极影响和麻烦的消极影响。怀孕早期到怀孕中期的基线怀孕经历与心理健康结果无关。结论 妊娠晚期而非妊娠早期的压力源与产后焦虑和抑郁症状相关。 CBT 干预改变了妊娠压力源与产后心理健康结果之间的关联。促进积极经历并减少消极经历的计划，尤其是在怀孕后期，可能会减轻产后心理健康的影响。试用注册号NCT03880032。
Background Little is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety. Aims We investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive–behavioural therapy (CBT) had a regulatory effect. Methods Participants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model. Results Hassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=−0.82, 95% CI: −1.46 to –0.18) and anxiety (B=−0.70, 95% CI: −1.25 to –0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes. Conclusions Stressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences. Trial registration number NCT03880032.