The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai
The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai
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DOI：
10.1016/j.jad.2019.02.058
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发表时间：
2019-05-01
影响因子：
6.6
通讯作者：
Shi Huijing
中科院分区：
文献类型：
--
作者：
Ma Xuemei;Wang Ying;Shi Huijing
背景：产前焦虑/抑郁一直是全球主要的公共卫生问题，在发展中国家患病率较高，这给母亲和儿童带来负面的健康结果。母亲的压力在怀孕过程中会发生变化，而怀孕早期发生的压力最为关键。然而，很少有研究关注压力弹性对孕妇心理健康的影响。目的：探讨压力弹性对孕妇产前焦虑/抑郁的影响。方法：本研究从上海母子配对队列（上海MCPC）招募2813名参与者。孕妇生活事件量表（LESPW）分别用于评估怀孕 12-16 周和怀孕 32-36 周时的压力。在怀孕 12-16 周时，通过修订后的成人复原力量表 (RSA) 评估复原力。分别采用焦虑自评量表（SAS）和流行病学调查中心抑郁量表（CES-D）评估孕32-26周的产前焦虑和抑郁情况。进行分层线性回归分析，探讨压力和复原力对产前焦虑和抑郁的直接影响。采用结构方程模型分析中介的间接效应，并采用分层分析检验修正的间接效应。结果：上海MCPC中分别有11.1%和10.3%的孕妇表现出焦虑和抑郁情绪。孕32-36周时主观和客观事件造成的压力均小于孕12-16周。我们发现，心理弹性是孕产妇心理健康的保护因素，同时它也是压力与产前焦虑/抑郁关系的效应修正因子和中介因子，中介效应比分别为15.1%和23.8%。 局限性：回忆偏差、数据缺失和参与者居住区域受限的存在可能会限制研究的普适性。心理弹性、产前焦虑和抑郁的测量并不是专门针对孕妇设计的，因此可能会错过一些仅与孕妇相关的心理问题的重要指标。结论：心理弹性可能是妊娠应激引起的产前焦虑和抑郁的直接和间接保护因素。
Background: Prenatal anxiety/depression has been a major public health problem globally with higher prevalence in developing countries, which leads to negative health outcomes for both mothers and children. Maternal stress varies over the course of pregnancy and the stress occurring in early pregnancy is the most critical. However, few studies have focused on the impact of resilience to stress on mental health of pregnant women.Aims: To explore the effect of resilience to stress on prenatal anxiety/depression in pregnant women.Methods: 2813 participants were recruited from Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) in this study. The Life Event Scale for Pregnancy Women (LESPW) was used to assess stress at 12-16 weeks of pregnancy and at 32-36 weeks of pregnancy, respectively. Resilience was assessed by the revised Resilience Scale for Adults (RSA) at 12-16 weeks of pregnancy. The prenatal anxiety and depression were assessed at 32-26 weeks of pregnancy by Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey, Depression Scale (CES-D), respectively. Hierarchical linear regression analyses were conducted to explore the direct effect of stress and resilience on prenatal anxiety and depression. The indirect effects of mediation were analyzed by structural equation models, and the indirect effect of modification was examined by stratification analysis.Results: There were 11.1% and 10.3% of pregnant women in Shanghai MCPC indicating anxiety and depressive mood, respectively. The stress caused by both subjective and objective events at 32-36 weeks of pregnancy is less than that at 12-16weeks of pregnancy. We found that resilience was a protective factor for maternal mental health and meanwhile it was both an effect modifier and a mediator to the association between stress and prenatal anxiety/depression, with the mediating effect ratio of 15.1% and 23.8%, respectively.Limitations: The existence of recall bias, missing data, and restricted residential areas of the participants may limit the generalizability of the study. The measurements of resilience, prenatal anxiety, and depression were not designed specifically for pregnant women, so that they might have missed some important indications of mental issues related to pregnant women only.Conclusions: Resilience could be a direct and indirect protective factor for prenatal anxiety and depression caused by pregnancy stress.