背景:爱丁堡产后抑郁量表(EPDS)通常用于筛查严重产后抑郁症(PPD)。我们探讨了与评分变化相关的临床因素。
方法:对2018-2019年期间在日本小仓医学中心分娩一名活产婴儿的母亲(n=1,287)进行分析。EPDS-日语版本在分娩后的第一周和第四周进行。≥9分被认为表明PPD风险增加。
结果:在4周期间,评分有所改善(5.03±0.12至3.79±0.10)。初生,剖宫产术(CS),低Apgar评分被确定为初始风险因素,然而,初产妇仍处于多变量分析中(aOR2.02,95%CI1.37-2.97)。年龄≥35岁与评分恶化相关(aOR1.88,95CI1.01-3.51),但CS改善(aOR0.38,95CI0.21-0.70)。初生,CS,和新生儿呼吸支持是最初的危险因素,而婴儿异常是婴儿入住新生儿重症监护病房(NICU)的母亲的晚期危险因素(aOR3.35,95CI1.31-8.56).在NICU住院时间≥4周的婴儿的母亲中,婴儿异常与评分恶化相关(aOR6.61,95CI1.11-39.3),而呼吸支持与评分改善相关(aOR0.09,95CI0.01-0.65).26名得分恶化的飞蛾获得了精神病学支持;三个患有PPD。三人中有两人年龄≥35岁,他们的婴儿都没有异常。
结论:母亲年龄和婴儿异常是PPD的危险因素。PPD发生在心理护理后EPDS评分恶化的母亲中。应针对危险因素恶化的产妇控制PPD。
The Edinburgh postnatal depression scale (EPDS) is commonly used in screening for major postpartum depression (PPD). We explored the clinical factors associated with score changes.
Mothers (n=1,287) who delivered a single live-born infant in Kokura Medical Center in Japan during 2018-2019 were analyzed. The EPDS-Japanese version was conducted at the first and fourth weeks after childbirth. Scores of ≥9 were considered to indicate an increased risk of PPD.
The scores improved during the four-week period (5.03±0.12 to 3.79±0.10). Primiparity, Cesarean section (CS), and a low Apgar score were identified as initial risk factors, however, primiparity remained in the multivariate analysis (aOR 2.02, 95% CI 1.37-2.97). Age ≥35 years was associated with worsened scores (aOR 1.88, 95%CI 1.01-3.51), but CS improved (aOR 0.38, 95%CI 0.21-0.70). Primiparity, CS, and neonatal respiratory support were the initial risk factors, while infant anomaly was a late risk factor in mothers whose infants were admitted to the neonatal intensive care unit (NICU) (aOR 3.35, 95%CI 1.31-8.56). In mothers of infants with an NICU stay of ≥4 weeks, infant anomaly was associated with worsened scores (aOR 6.61, 95%CI 1.11-39.3), while respiratory support was associated with improved scores (aOR 0.09, 95%CI 0.01-0.65). Twenty-six mothrs with worsened scores received psychiatric support; three developed PPD. Two of the three were ≥35 years of age, neither of their infants had anomalies.
Maternal aging and infant anomaly were risk factors for PPD. PPD occurred in mothers with worsened EPDS scores after mental care. Puerperants with worsening risk factors should be targeted to control PPD.