女性童年创伤经历对孕产期抑郁的影响研究

Study on the impact of childhood traumatic experiences on maternal depression

摘要

目的 探讨女性童年创伤经历对孕产期抑郁的影响,并检验可能的中介因素,为孕产期抑郁的防治提供新思路。方法 本研究于2021年10月至2022年4月采用三阶段抽样的方式抽取甘肃省8个市907例孕产妇为调查对象.采用问卷调查的方法收集资料,通过爱丁堡产后抑郁量表(EPDS)评估孕产期抑郁,使用反刍思维量表(RRS)评估反刍思维水平,采用童年创伤问卷(CTQ)评估女性童年创伤经历.利用Spearman相关分析童年创伤与孕产妇抑郁症状的相关性,使用SPSS 22.0 Process插件分析反刍思维水平在童年创伤经历与孕产期抑郁之间所起的中介作用。结果 Spearman相关分析结果表明,孕产妇抑郁与童年创伤、反刍思维均正相关(r值分别为0.315、0.707,P<0.001),童年创伤与反刍思维正相关(r=0.379,P<0.001);童年创伤对孕产妇抑郁、反刍思维均有显著的预测作用(β值分别为0.131、0.362,P<0.001),将反刍思维作为中介变量放入模型后,童年创伤对孕产妇抑郁的直接预测作用不显著(β=0.005,P>0.05),反刍思维对孕产妇抑郁的预测作用仍然显著(β=0.347,P<0.001)。结论 女性童年创伤经历可以通过提高反刍思维水平而增加其孕产期抑郁的发生.因此,针对有童年创伤经历的孕产妇可重点评估其反刍思维水平,提供及时、综合的干预,预防其孕产期抑郁的发生,以提高孕产期女性的生活质量.

Abstract

Objective To explore the impact of childhood traumatic experiences on maternal depression and examine the potential mediating factors to provide new insights into the prevention and treatment of maternal depression. Methods This study adopted a three-stage sampling method from October 2021 to April 2022 to select 907 pregnant women from 8 cities in Gansu Province as research subjects. Data were collected through questionnaire surveys. Maternal depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Rumination levels were evaluated by the Rumination Response Scale (RRS). Women's childhood trauma experiences was assessed by the Childhood Trauma Questionnaire (CTQ). Spearman correlation analysis was used to examine the correlation between childhood trauma and depressive symptoms in pregnant women and the SPSS 22.0 Process plugin was used to analyze the mediating effect of rumination levels in the relationship between childhood trauma experiences and maternal depression. Results The results of Spearman correlation analysis showed that maternal depression were positively correlated with childhood trauma and rumination levels (r values were 0.315 and 0.707, respectively, P<0.001), and the childhood trauma was positively correlated with rumination levels (r=0.379, P<0.001). Childhood trauma has a significant predictive effect on maternal depression and rumination levels (β values were 0.131 and 0.362, respectively, P<0.001). After including rumination levels as a mediating variable in the model, the direct predictive effect of childhood trauma on maternal depression became non-significant (β=0.005, P>0.05), while the predictive effect of rumination levels on maternal depression remained significant (β=0.347, P<0.001). Conclusion Female childhood traumatic experiences may increase the occurrence of maternal depression by elevating rumination levels. Therefore, pregnant women with a history of childhood trauma should be assessed for their rumination levels, and timely and comprehensive interventions should be provided to prevent the occurrence of perinatal depression, thereby improving the quality of life of maternal women.

关键词

孕产妇 / 抑郁 / 童年创伤 / 反刍思维

Key words

maternal women / depression / childhood trauma / rumination

参考文献

[1] Kessler R C, McLaughlin K A, Green J G, et al. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys[J]. Br J Psychiatry, 2010, 197(5): 378-385.

[2] Nelson J, Klumparendt A, Doebler P, et al. Childhood maltreatment and characteristics of adult depression: meta-analysis[J]. Br J Psychiatry, 2017, 210(2): 96-104.

[3] Negele A, Kaufhold J, Kallenbach L, et al. Childhood Trauma and Its Relation to Chronic Depression in Adulthood[J]. Depress Res Treat, 2015: 650804.

[4] Choi K W, Sikkema K J, Vythilingum B, et al. Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism[J]. J Affect Disord, 2017, 211: 107-115.

[5] Perry A, Gordon-Smith K, DiFlorio A, et al. Adverse childhood experiences and postpartum depression in bipolar disorder[J]. J Affect Disord, 2020, 263: 661-666.

[6] Ren X, Yu S, Dong W, et al. Burden of depression in China, 1990-2017: Findings from the global burden of disease study 2017[J]. J Affect Disord, 2020, 268: 95-101.

[7] 黄瑞瑞, 雷倍美, 付冰, 等. 围产期抑郁评估的研究进展[J]. 中国护理管理, 2019, 19(7): 1105-1109.

[8] 杨业环, 孙梦云, 黄星, 等. 中国孕产妇孕产期抑郁状况与动态变化规律[J]. 中国妇幼健康研究, 2021, 32(8): 1118-1122.

[9] Wang Y N, Yuan Z J, Leng W C, et al. Role of perceived family support in psychological distress for pregnant women during the COVID-19 pandemic[J]. World J Psychiatry, 2021, 11(7): 365-374.

[10] 温忠麟, 叶宝娟. 中介效应分析:方法和模型发展[J]. 心理科学进展, 2014, 22(5): 731-745.

[11] Kim J S, Jin M J, Jung W, et al. Rumination as a mediator between childhood trauma and adulthood depression/anxiety in non-clinical participants[J]. Front Psychol, 2017, 8: 1597.

[12] Eszlari N, Petschner P, Gonda X, et al. Childhood adversity moderates the effects of htr2a epigenetic regulatory polymorphisms on rumination[J]. Front Psychiatry, 2019, 10: 394.

[13] Mlili N E, Ahabrach H, Cauli O. Hair cortisol concentration as a biomarker of symptoms of depression in the perinatal period[J]. CNS Neurol Disord Drug Targets, 2023, 22(1): 71-83.

[14] Swales D A, Stout-Oswald S A, Glynn L M, et al. Exposure to traumatic events in childhood predicts cortisol production among high risk pregnant women[J]. Biol Psychol, 2018, 139: 186-192.

[15] 林萍珍, 龙周婷, 孙继伟, 等. 妊娠期妇女抑郁、焦虑与其儿童期创伤的累积效应的关系[J]. 中国实用护理杂志, 2017, 33(1): 32-36.

[16] De Jong H, Fox E, Stein A. Rumination and postnatal depression: a systematic review and a cognitive model[J]. Behav Res Ther, 2016, 82: 38-49.

[17] 高雅琴, 李玉红, 步仰高, 等. 心理韧性在产妇反刍思维与产后抑郁间的中介效应[J]. 解放军护理杂志, 2020, 37(7): 11-14,19.

[18] 陈琼霞, 罗书, 林娟, 等. 产前心理干预联合动机性访谈对孕产妇抑郁、焦虑情绪的影响[J]. 中国妇幼健康研究, 2021, 32(8): 1166-1171.

[19] 王乐霞. 互动式干预在产妇孕晚期健康教育中的应用价值[J]. 医学理论与实践, 2020, 33(19): 3311-3312.

基金资助

甘肃省科技计划项目(软科学专项)(21CX6ZA033)