CAJ | 학술논문

目的分析孕晚期综合性医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HAD)评分对产后抑郁症的预测效果,为孕晚期识别产后抑郁症高危孕妇提供依据.方法采用一般情况调查表及自编相关因素调查表和HAD,在孕晚期对1 230例孕妇进行测评,并于产后4周内采用HAD、爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)再次对其进行测评,经受试者工作特征曲线法分析孕晚期HAD分值对产后抑郁症的预测效果.结果 (1)孕晚期焦虑、抑郁症状发生率为5.20％ (64/1 230)、4.07％ (50/1 230);产后抑郁症发生率为9.98％ (121/1 213).(2)根据两步筛查法确诊产后抑郁症患者121例(患者组)和健康对照者1 092名(对照组),2组在年龄、夫妻感情、工作学习压力、分娩育儿及产后抑郁知识的了解程度、产妇对胎儿的性别歧视及入组时HAD评分(A和D评分)以及产后EPDS评分上差异均有统计学意义(x2=6.54、6.92、8.07、23.82、21.88、10.24、9.26、6.63、5.66,均P＜0.05),而婚姻状况、性格、文化程度、职业、不良产史、孕期并发症、丈夫及家人对胎儿性别的歧视方面差异均无统计学意义.(3)经受试者工作特征曲线法分析,孕晚期HAD最佳临界值为9分,预测产后抑郁症的敏感度、特异度分别为86.21％和87.64％、95.43％和94.72％.(4)受试者工作特征曲线下面积分别为0.941和0.914.(5)孕晚期HAD最佳临界值和产后EPDS分值相关(r=0.852、0.846,均P＜0.01).(6)孕晚期HAD≥9分孕妇发生产后抑郁症的相对危险度分别增加15.891、18.264倍.结论孕晚期可将HAD作为产后抑郁症高危孕妇的常规筛查工具,对HAD分值≥9分的孕妇应同时进行产后抑郁危险因素的综合评估.
목적 분석잉만기종합성의원초필억욱량표(Hospital Anxiety and Depression Scale,HAD)평분대산후억욱증적예측효과,위잉만기식별산후억욱증고위잉부제공의거.방법 채용일반정황조사표급자편상관인소조사표화HAD,재잉만기대1 230례잉부진행측평,병우산후4주내채용HAD、애정보산후억욱량표(Edinburgh Postnatal Depression Scale,EPDS)재차대기진행측평,경수시자공작특정곡선법분석잉만기HAD분치대산후억욱증적예측효과.결과 (1)잉만기초필、억욱증상발생솔위5.20％ (64/1 230)、4.07％ (50/1 230);산후억욱증발생솔위9.98％ (121/1 213).(2)근거량보사사법학진산후억욱증환자121례(환자조)화건강대조자1 092명(대조조),2조재년령、부처감정、공작학습압력、분면육인급산후억욱지식적료해정도、산부대태인적성별기시급입조시HAD평분(A화D평분)이급산후EPDS평분상차이균유통계학의의(x2=6.54、6.92、8.07、23.82、21.88、10.24、9.26、6.63、5.66,균P＜0.05),이혼인상황、성격、문화정도、직업、불량산사、잉기병발증、장부급가인대태인성별적기시방면차이균무통계학의의.(3)경수시자공작특정곡선법분석,잉만기HAD최가림계치위9분,예측산후억욱증적민감도、특이도분별위86.21％화87.64％、95.43％화94.72％.(4)수시자공작특정곡선하면적분별위0.941화0.914.(5)잉만기HAD최가림계치화산후EPDS분치상관(r=0.852、0.846,균P＜0.01).(6)잉만기HAD≥9분잉부발생산후억욱증적상대위험도분별증가15.891、18.264배.결론 잉만기가장HAD작위산후억욱증고위잉부적상규사사공구,대HAD분치≥9분적잉부응동시진행산후억욱위험인소적종합평고.
Objective To explore the possibility of predicting postnatal depression based on Hospital Anxiety and Depression (HAD) scale for women during the third trimester of pregnancy.Methods 1 230 pregnant women were evaluated during their third trimester of pregnancy using HAD scale deriving from common questionnaire and self-related questionnaire,and again 4 weeks postnatal using Edinburgh Postnatal Depression Scale (EPDS).Results (1) The incidences for depression and anxiety during the third trimester of pregnancy were 5.20％ (64 /1 230) and 4.07％ (50 /1 230),respectively.The incidence of postnatal depression was 9.98％ (121 /1 213).(2) According to the two step screening diagnosis for severe postnatal depression,the 1 230 cases were categorized into patient group (121 cases) and normal group (1 092 cases).There were statistically significant differences between the two groups in age,the relationship of the couple,work and study pressure,knowledge of childbirth,parenting and postnatal depression,maternal gender discrimination,group HAD score and EPDS score (x2 =6.54,6.92,8.07,23.82,21.88,10.24,9.26,6.63,5.66,P ＜ 0.05 for all).There were no significant differences between the two groups in marital status,personality,level of education,occupation,history of abnormal delivery,complications of pregnancy,gender discrimination from the husband and/or family.(3) In ROC curve the optimal critical value of the HAD during postnatal depression was 9 symptoms.For the cases who got an A or D in the HAD scale,the sensitivity and specificity of predicting postnatal depression were 86.21％/87.64％,95.43％/94.72％,respectively.(4) For the cases who got an A or D in the HAD scale,the area under the ROC curve were 0.941 and 0.914,respectively.(5) The optimal critical value of HAD was related to the scores of EPDS after delivery (r =0.852,0.846,both P ＜ 0.01).(6) For the cases with HAD ≥ 9 points,the probability for the risk of postnatal depression will be increased by 15.891 and 18.264 times,respectively.Conclusion HAD scale can be used as a routine screening method for women in late stage pregnancy.Women with HAD ≥ 9 points should be comprehensively evaluated for the risk of postnatal depression.