發(fā)布時間：2018-06-17 04:06

  本文選題：抑郁 + 焦慮�。� 參考：《復(fù)旦大學(xué)》2007年博士論文

【摘要】： [目的]探討孕期心理干預(yù)能否降低產(chǎn)后抑郁的發(fā)生，并探討產(chǎn)后抑郁的相關(guān)危險因素和可能存在的ERβ遺傳易感性。 [方法](1)采用RCT設(shè)計。于2005.3—2006.2部分連續(xù)整群抽樣800例孕16-20周的孕婦，隨機(jī)分配至干預(yù)組(n=386)和對照組(n=414)。干預(yù)組在常規(guī)孕婦保健的基礎(chǔ)上給予以“正確看待產(chǎn)后抑郁”為主題的集體心理干預(yù)(5次孕婦+1次丈夫)課程，對照組予常規(guī)孕婦保健。所有對象每月跟蹤隨訪至產(chǎn)后3天、42天和3月(包括嬰兒氣質(zhì))。孕婦的情緒采用HAD自評，產(chǎn)后采用HAD和EPDS雙重自評。產(chǎn)后在自評的基礎(chǔ)上采用SCID分層臨床會晤。嬰兒氣質(zhì)采用EITQ評估。采用ITT原則分析資料。(2)所有對象每次隨訪時評估自編相關(guān)危險因素表、LES以及產(chǎn)科檢查表，并評估EPQ1次，采用緯度法和類別法多元回歸序慣結(jié)合分析產(chǎn)后抑郁的相關(guān)危險因素。(3)對于產(chǎn)后抑郁者和非抑郁者分別隨機(jī)抽取靜脈血70例和110例，采用聚合酶鏈反應(yīng)—限制性酶切多態(tài)性(PCR-RFLP)的方法進(jìn)行ERβ的2個SNPs(rs1256030和rs3020444)基因分型。分別采用改良式關(guān)聯(lián)分析、病例-對照關(guān)聯(lián)分析以及兩點(diǎn)單體型關(guān)聯(lián)分析獲得產(chǎn)后抑郁的遺傳易感性。 [結(jié)果] 第一部分：(1)在PP數(shù)據(jù)集中，當(dāng)采用HAD評估時，孕婦心理干預(yù)可以減輕孕期和產(chǎn)后的焦慮情緒；當(dāng)采用EPDS評估時，未能發(fā)現(xiàn)干預(yù)效果。在FAS數(shù)據(jù)集中，無論采用HAD還是EPDS評估，都未能發(fā)現(xiàn)干預(yù)效果。孕婦在接受心理干預(yù)課較好的基礎(chǔ)上其丈夫接受心理干預(yù)對產(chǎn)婦的產(chǎn)后焦慮存在干預(yù)作用。孕婦受干預(yù)次數(shù)以及與丈夫受干預(yù)次數(shù)之和與孕32-36周(干預(yù)正好結(jié)束)和孕38-40周的焦慮分值(A項(xiàng)分)呈直線負(fù)相關(guān)。(2)根據(jù)HAD或EPDS劃分界值，未能發(fā)現(xiàn)心理干預(yù)對產(chǎn)后三個時點(diǎn)的焦慮或抑郁癥狀具有影響作用。(3)采用SCID診斷，未能發(fā)現(xiàn)心理干預(yù)對產(chǎn)后三個時點(diǎn)或整個三個月中的重性抑郁障礙、未特定的抑郁障礙或任何抑郁障礙具有干預(yù)作用。在產(chǎn)后三個時點(diǎn)重性抑郁障礙的發(fā)生率(調(diào)整發(fā)生率)干預(yù)組分別為4.04％、14.92％、7.85％，對照組分別為3.61、18.12％、5.39％。產(chǎn)后三個月中總的重性抑郁障礙的發(fā)生率，干預(yù)組為11.79％，對照組為12.68％。產(chǎn)后三個月中總樣本重性抑郁障礙的發(fā)生率為12.24％，未特定的抑郁障礙為12.98％，任何抑郁障礙為27.82％。(4)孕期心理干預(yù)明顯提高小嬰兒“易帶”的(易養(yǎng)型和中間偏易養(yǎng)型)的比例，明顯降低小嬰兒氣質(zhì)維度上的趨避性和反應(yīng)閾。 第二部分：用緯度法分析，在產(chǎn)后三個時點(diǎn)產(chǎn)后抑郁共同的危險因素為：嬰兒看護(hù)應(yīng)激、神經(jīng)質(zhì)人格(EPQ的高N分)、既往抑郁發(fā)作史和對父母不滿意。在產(chǎn)后3天還存在的危險因素有：擔(dān)心產(chǎn)后無人照料自己、新生兒感染、產(chǎn)后休息和產(chǎn)后普通休養(yǎng)室；在產(chǎn)后42天還存在的危險因素有：孕期焦慮、不良生活事件、對丈夫不滿意、產(chǎn)后同事探望不滿意、坐月子不滿意、居住環(huán)境差和產(chǎn)后出血；在產(chǎn)后3月還存在的危險因素有：孕期抑郁、不良生活事件、對以后工作的擔(dān)憂、產(chǎn)后睡眠不滿意和居住環(huán)境差。用類別法考察部分危險因素時，，再次發(fā)現(xiàn)：既往抑郁發(fā)作史、神經(jīng)質(zhì)人格、嬰兒看護(hù)應(yīng)激(擔(dān)憂帶孩子問題)以及孕期抑郁、產(chǎn)后出血成為產(chǎn)后抑郁的危險因素。 第三部分：ERβ基因rs3020444(T／C)多態(tài)“T／T”基因型與產(chǎn)后抑郁關(guān)聯(lián)，導(dǎo)致產(chǎn)婦患產(chǎn)后抑郁的風(fēng)險是對照組的2.91倍(P＜0.05)；病例組“T”等位基因?qū)е庐a(chǎn)婦患產(chǎn)后抑郁的風(fēng)險是對照組的2.72倍(P＜0.05)。未發(fā)現(xiàn)rs1256030(C／T)的等位基因或基因型與產(chǎn)后抑郁存在關(guān)聯(lián)�；�于rs1256030(C／T)和rs3020444(T／C)的單體型“C-C”對產(chǎn)后抑郁具有保護(hù)作用，OR=0.312[0.104-0.942]，P=0.039。 [結(jié)論] 1．孕期心理干預(yù)對預(yù)防孕期和產(chǎn)后的焦慮情緒具有作用。丈夫接受心理干預(yù)可以幫助干預(yù)依從性好的孕婦預(yù)防產(chǎn)后的焦慮情緒。孕婦和其丈夫接受心理干預(yù)的次數(shù)越多，對于預(yù)防孕中-晚期的焦慮情緒就越有作用。 2．孕期心理干預(yù)對預(yù)防產(chǎn)后抑郁的效果不明顯。 3．孕期心理干預(yù)對小嬰兒的心理發(fā)育有著積極意義。 4．產(chǎn)后42天是重性抑郁障礙的高發(fā)時點(diǎn)。其次為產(chǎn)后3月，產(chǎn)后3天最低。 5．相對于SCID診斷來說，用HAD來篩查產(chǎn)后抑郁，8／9劃分界值出現(xiàn)了較低的篩查率；用EPDS來篩查產(chǎn)后抑郁，12／13劃分界值也出現(xiàn)了較低的篩查率，假陰性較高。 6．用緯度法分析產(chǎn)后抑郁的危險因素，不但可以全面的占有資料，具有較高的統(tǒng)計效能，而且推導(dǎo)出的危險因素與類別法推導(dǎo)出的危險因素并無大的差別。 7．嬰兒看護(hù)應(yīng)激、既往抑郁發(fā)作史、神經(jīng)質(zhì)人格以及對父母的不滿意是上海部分女性產(chǎn)后抑郁的重要的危險因素。 8．ERβ基因有可能參與了產(chǎn)后抑郁的發(fā)病。具有rs3020444(T／C)“T／T”基因型的女性在產(chǎn)后隨著雌激素的劇烈撤退，觸發(fā)轉(zhuǎn)錄異常，引發(fā)抑郁，但具體途徑尚不清楚�；�于rs1256030(C／T)和rs3020444(T／C)的單體型“C-C”對產(chǎn)后抑郁卻具有保護(hù)作用。
[Abstract]:[Objective] to explore whether postpartum depression can be reduced by psychological intervention during pregnancy, and to explore the related risk factors of postpartum depression and possible ER beta genetic susceptibility.
[method] (1) RCT design. 800 pregnant women with 16-20 weeks of pregnancy in 2005.3 to 2006.2 parts were randomly assigned to the intervention group (n=386) and the control group (n=414). On the basis of the routine maternal health care, the intervention group was given a group psychological intervention (5 pregnant women with pregnant women) on the theme of "the correct treatment of postpartum depression" (5 pregnant women), and the control group. Routine maternal health care. All subjects were followed up to 3 days, 42 days and March (including baby temperament). HAD self evaluation was adopted for pregnant women, HAD and EPDS were adopted after postpartum. After postpartum, the SCID stratified clinical meeting was adopted. The infant temperament was evaluated by EITQ. The ITT principle was used to analyze the data. (2) every object every time. At the time of follow-up, the related risk factors, LES and obstetric checklist were evaluated, and EPQ1 times were evaluated. Latitudes and classification methods were used to analyze the related risk factors of postpartum depression. (3) 70 cases of venous blood and 110 cases were randomly selected for postpartum depression and non depressive, and polymerase chain reaction restrictive enzyme digestion was used. Polymorphism (PCR-RFLP) method was used to classify 2 SNPs (rs1256030 and rs3020444) genotyping of ER beta. The genetic susceptibility of postnatal depression was obtained by modified association analysis, case control correlation analysis and two point haplotype association analysis.
[results]
The first part: (1) in the PP data set, the psychological intervention of pregnant women can reduce the anxiety of pregnancy and postpartum when using the HAD assessment. When the EPDS assessment is used, the intervention effect can not be found. In the FAS data set, the intervention effect is not found by the use of HAD or EPDS assessment. Pregnant women are better on the basis of accepting psychological intervention classes. The intervention of the husband's psychological intervention on puerperal postpartum anxiety had a negative correlation with the number of intervention of the pregnant women and the number of intervention of the husband and the 32-36 weeks of pregnancy (the intervention just ended) and the 38-40 weeks of pregnancy (A score). (2) according to the boundary value of HAD or EPDS, no psychological intervention was found on the three point postpartum focal points. (3) the SCID diagnosis failed to detect the intervention of the psychological intervention on the three time points of postpartum or the whole three months of depressive disorder, no particular depressive disorder or any depressive disorder. At the three time postpartum, the incidence of depressive disorder was 4.04, respectively, in the intervention group. %, 14.92%, 7.85%, the control group was 3.61,18.12%, 5.39%., the incidence of total heavy depressive disorder in three months postpartum, the intervention group was 11.79%, the control group was three months postpartum, the incidence of total depressive disorder was 12.24%, no specific depressive disorder was 12.98%, any depressive disorder was 27.82%. (4) pregnancy. Psychological intervention significantly increased the proportion of "easy to take" (easy to foster and intermediate prone type) in the small infants, and obviously reduced the taxis and reaction threshold in the dimension of the baby's temperament.
The second part: the latitudinal analysis showed that the common risk factors for postpartum depression at three postpartum periods were baby care stress, neuroticism (EPQ N), history of previous depression and dissatisfaction with parents. The risk factors for the 3 day postpartum were: fear of postpartum no one, neonatal infection, postpartum rest and postpartum. The risk factors of 42 days postpartum were: pregnancy anxiety, bad life events, dissatisfaction with the husband, dissatisfaction of postpartum visit, dissatisfaction of the month, poor living environment and postpartum hemorrhage; the risk factors for postpartum March were depression in pregnancy, bad life events, worry about future work and postpartum. Sleep dissatisfaction and poor living conditions. When examining some of the risk factors with the category method, the history of previous depression, neuroticism, baby care (worrying about children) and depression in pregnancy, and postpartum hemorrhage are the risk factors for postpartum depression.
The third part: the ER beta gene rs3020444 (T / C) polymorphism "T / T" genotype was associated with postpartum depression. The risk of postpartum depression was 2.91 times as high as that of the control group (P < 0.05). The risk of postpartum depression in the case group was 2.72 times as high as the control group (P < 0.05). The allele of rs1256030 (C / T) was not found. Or genotypes associated with postpartum depression. Rs1256030 (C / T) and rs3020444 (T / C) haplotype "C-C" has a protective effect on postpartum depression, OR=0.312[0.104-0.942], P=0.039.
[Conclusion]
1. pregnancy psychological intervention has a role in preventing pregnancy and postpartum anxiety. The husband's psychological intervention can help the intervention of pregnant women with good compliance to prevent postpartum anxiety. The more times the pregnant women and their husbands receive psychological intervention, the more effective it is to prevent the middle and late pregnancy anxiety.
2. the effect of psychological intervention during pregnancy is not obvious in preventing postpartum depression.
3. psychological intervention during pregnancy has positive significance for psychological development of infants.
4. postpartum 42 days is the high incidence point of major depressive disorder, followed by postpartum March, the lowest 3 days after delivery.
5. compared with the SCID diagnosis, HAD was used to screen postpartum depression, and the 8 / 9 boundary values had a lower screening rate; EPDS was used to screen postpartum depression, and the 12 / 13 boundary values also had a lower screening rate, and the false negative was higher.
6. the latitudinal analysis of the risk factors of postpartum depression can not only take full possession of the data, but also have high statistical efficiency, and there is no significant difference between the risk factors and the risk factors derived from the category method.
7. baby care stress, past history of depression, neuroticism and dissatisfaction with parents are important risk factors for postpartum depression in some women in Shanghai.
The 8.ER beta gene may be involved in the onset of postpartum depression. Women with rs3020444 (T / C) "T / T" genotype have a severe withdrawal of estrogen after postpartum, triggering transcriptional abnormalities and causing depression, but the specific way is not clear. The monosomatograph based on rs1256030 (C / T) and rs3020444 (T / C) is protected by postpartum depression. Effect.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2007
【分類號】：R395.5

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1 湯月芬;孕期心理干預(yù)對產(chǎn)后抑郁影響、相關(guān)危險因素和雌激素受體的關(guān)聯(lián)研究[D];復(fù)旦大學(xué);2007年

2 段書;抑郁影響高血壓病預(yù)后的心理學(xué)和生物學(xué)機(jī)制[D];中南大學(xué);2009年

3 吳淑雯;靳三針治療老年功能性便秘臨床研究[D];廣州中醫(yī)藥大學(xué);2009年

4 趙玲玲;新生鼠暴露亞中毒閾劑量毒死蜱誘導(dǎo)黑質(zhì)多巴胺能神經(jīng)元損傷和神經(jīng)行為改變[D];中南大學(xué);2006年

5 金一波;抑郁個體情緒認(rèn)知機(jī)制及干預(yù)性研究[D];華東師范大學(xué);2008年

6 姜峰;大學(xué)生團(tuán)體心理干預(yù)的實(shí)驗(yàn)流行病學(xué)研究[D];山西醫(yī)科大學(xué);2008年

7 何梅;燒傷并發(fā)抑郁情緒認(rèn)知加工特點(diǎn)的研究[D];第三軍醫(yī)大學(xué);2008年

8 孫東輝;圍手術(shù)期病人心理應(yīng)激的臨床心理學(xué)和精神免疫學(xué)研究[D];吉林大學(xué);2005年

9 魏義梅;大學(xué)生抑郁的心理社會機(jī)制及認(rèn)知應(yīng)對干預(yù)[D];吉林大學(xué);2007年

10 崔芳;肌萎縮側(cè)索硬化/運(yùn)動神經(jīng)元病患者的橫斷面調(diào)查、神經(jīng)傳導(dǎo)以及情感障礙分析[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2010年

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2 薛文霞;中學(xué)生自豪感、外顯自尊及抑郁的關(guān)系研究[D];東北師范大學(xué);2008年

3 趙彬;心理康復(fù)對腦卒中后抑郁患者運(yùn)動功能障礙的影響[D];黑龍江中醫(yī)藥大學(xué);2009年

4 李娜;肝腎陰虛型類風(fēng)濕關(guān)節(jié)炎伴抑郁癥的臨床研究[D];遼寧中醫(yī)藥大學(xué);2009年

5 胡壘;抗癲癇藥物與焦慮、抑郁對成年癲癇患者生活質(zhì)量的影響[D];福建醫(yī)科大學(xué);2008年

6 李芳;舍曲林治療急性冠脈綜合征伴發(fā)抑郁和/或焦慮癥狀的研究[D];大連醫(yī)科大學(xué);2008年

7 王慧娟;初中生的學(xué)業(yè)成績與抑郁：父母教養(yǎng)方式、同伴關(guān)系的調(diào)節(jié)作用[D];華中師范大學(xué);2007年

8 張星;綜合醫(yī)院住院患者焦慮抑郁癥狀調(diào)查[D];新疆醫(yī)科大學(xué);2008年

9 王楊;跳繩運(yùn)動對三本醫(yī)學(xué)生抑郁情緒的影響[D];大連醫(yī)科大學(xué);2008年

10 左滿花;中風(fēng)后抑郁患者多維感知社會支持與簡易應(yīng)對方式的相關(guān)研究[D];湖北中醫(yī)學(xué)院;2009年

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