【作者】 林萍珍； 曹枫林；

【Author】 LIN Ping-Zhen;CAO Feng-Lin;School of Nursing, Shandong University;

【机构】 山东大学护理学院；

【摘要】 目的:了解围产期感知社会支持的动态变化趋势,并探讨产前抑郁、焦虑和儿童期创伤对围产期感知社会支持变化的预测作用。旨在为研究围产期女性感知社会支持的研究提供科学依据。方法:本研究为纵向研究设计,在山东省某三级甲等医院招募孕晚期女性276名。采用领悟社会支持量表(MSPSS)对妊娠期女性在孕晚期(T1)、产后1周(T2)和产后6周(T3)三个时间点的感知社会支持水平进行纵向评估;爱丁堡产后抑郁量表(EPDS)、特质状态焦虑量表(STAI-S))和儿童期创伤问卷(CTQ-SF)在孕晚期(T1)评估研究对象的产前抑郁、焦虑和儿童期创伤。采用重复测量方差分析探讨围产期女性感知社会支持动态变化的时间效应;以围产期感知社会支持的变化为因变量,采用广义估计方程(GEE)探讨,分析产前抑郁、焦虑和儿童期创伤对围产期感知社会支持水平的影响等。协变量包括一般人口学资料(年龄、孕周、民族、婚姻状况、教育水平、工作状况和BMI)和妊娠相关资料(产次、怀孕计划、妊娠并发症)。结果:重复测量方差分析结果表明围产期女性的感知社会支持总分自孕晚期(T1)开始升高,产后1周(T2)达到最高,产后6周(T3)水平逐渐下降[MSPSS总分:(66.09±0.56)] vs.(69.47±0.48) vs.(66.41±0.59), F=24.49,P<0.001]。广义估计方程结果显示在控制了协变量、产前焦虑和儿童期创伤后,产前抑郁仍可以显著负性预测围产期感知社会支持(β=-0.198,P=0.036)、家庭支持(β=-0.080,P=0.023)和朋友支持(β=-0.105,P=0.006)。在控制了协变量、产前抑郁和产前焦虑后,儿童期创伤仍可以显著负性预测围产期感知家庭支持(β=0.016,P=0.041)。产前焦虑对感知社会支持及各维度的预测皆不显著(P=0.098)。结论:围产期女性感知社会支持水平呈现动态发展变化,在产后1周最高,孕晚期和产后6周相对较低。孕产妇在孕晚期抑郁水平越高,感知社会支持越低,家庭支持和朋友支持也越低。儿童期创伤水平越高,感知家庭支持越低。服务人员应针对围产期女性不同时间点的社会支持水平开展针对性的教育、指导,缓解妊娠和分娩对妊娠期女性的影响。更多还原

【Abstract】 Objective: The aims of our study were to investigate the dynamic change trend of the perceived social support across the perinatal period at three time points. To explore the effect of depression, anxiety and childhood maltreatment on the perceived social support across the perinatal period, which will help in tailoring and enhancing the efficacy of interventions aimed at improving perceived social support. Methods: A longitudinal study was carried out among 276 late-stage pregnant women at three time points(Time 1: baseline, Time 2: one week postpartum, and Time 3: six weeks postpartum). Perceived social support was measured at three time points of the study using the 12-item Multidimensional Scale of Perceived Social Support(MSPSS), the Edinburgh Postnatal Depression Scale(EPDS), the State form of the State-Trait Anxiety Inventory(STAI-S), and the childhood trauma questionnaire short form(CTQ-SF) were used to assess depression, anxiety and child maltreatment at Time 1. Repeated measurement analysis of variance(ANOVA) and generalized estimating equations(GEE) was performed. Results: Perceived social support scores increasing significantly from baseline to postpartum one week, and then decreasing significantly postpartum six weeks [MSPSS:(66.09± 0.56)] vs.(69.47± 0.48) vs.(66.41± 0.59), F=24.49,P<0.001 ]. Higher depression scores could significantly negatively predict MPSSS total social support(β=-0.198, P=0.036), family support(β=-0.080, P=0.023) and friend support scores(β=-0.105, P=0.006), independently from anxiety and child maltreatment. higher child maltreatment score could significantly negatively predict MPSSS family support scores(β=0.016, P=0.041), independently from depression and anxiety score. Anxiety failed to predict MPSSS social support(P≥0.098). Conclusion: Perceived social support can differentially alter across perinatal period. Participants with higher depressive symptoms and child maltreatment may be more likely to perceive lower level of social support. The service staff should carry out targeted education and guidance on the social support at different times across the perinatal period to alleviate the influence of pregnancy and childbirth on pregnant women.更多还原