关注流产/宫外孕女性心理健康问题
  • 纳入537名自然流产及116名异位妊娠的女性作为早期妊娠丢失组,并纳入171名正常对照组,分别在“产后”1、3、9个月进行精神状况测评;
  • 对于早期妊娠丢失的女性,1个月后产后应激、中/重度焦虑、中/重度抑郁的发生率分别为29%、24%、11%;
  • 而9个月后,仍分别有18%、17%、6%的女性有上述三种问题;
  • 异位妊娠者9个月后三种心理问题的发病率高于自然流产者(21%vs17%、23%vs17%、11%vs7%);
  • 应重视妊娠丢失女性的心理健康状况。
主编推荐语
小笋干儿
本研究通过队列调查,发现在发生流产和宫外孕的女性中,其创伤后应激、焦虑、抑郁等心理问题的发生率较高,虽然随着时间的推迟,其患病率有所降低,但直至9个月后,其比例仍不容小觑。关注这部分女性的心理健康,为下一次的备孕做好准备。
关键字
延伸阅读本研究的原文信息和链接出处,以及相关解读和评论文章。欢迎读者朋友们推荐!

Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study

流产和宫外孕后创伤后应激、焦虑、抑郁:多中心前瞻性队列研究

10.1016/j.ajog.2019.10.102

2019-12-13, Article

Abstract & Authors:展开

Abstract:收起
Background: Early pregnancy losses are common, but their psychological sequalae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of post-traumatic stress symptoms, and the psychological response specifically to ectopic pregnancies, has not been investigated.
Objectives: To investigate levels of post-traumatic stress, depression, and anxiety in women in the nine months following early pregnancy loss, with focus on miscarriage and ectopic pregnancy. Morbidity at one month was compared to a control group in healthy pregnancy.
Study design: This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at three London hospitals, and emailed surveys containing standardised psychological assessments, including the Hospital Anxiety and Depression Scale and Post-traumatic stress Diagnostic Scale, one, three and nine months after loss. Controls were assessed after a dating scan. We assessed the proportion of participants meeting screening criteria for post-traumatic stress and moderate/severe anxiety or depression. We used logistic regression to calculate adjusted odds ratios (aOR).
Results: 737/1098 (67%) women with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies), and 171/187 (91%) controls, agreed to participate. 492 (67%) of those with losses completed the Hospital Anxiety and Depression Scale after one month, 426 (58%) after three months, and 338 (46%) after nine months. 87 (51%) controls participated. Criteria for post-traumatic stress were met in 29% of women with early pregnancy loss after one month, and in 18% after nine months (aOR per month, 0.80; 95% CI, 0.72 to 0.89). Moderate/severe anxiety was reported in 24% after one month, and in 17% after nine months (aOR per month, 0.69; 95% CI, 0.50 to 0.94). Moderate/severe depression was reported in 11% after one month, and 6% after nine months (aOR per month, 0.87; 95% CI, 0.53 to 1.44). After miscarriage, proportions after nine months were 17% for post-traumatic stress, 17% for anxiety, and 5% for depression. Corresponding figures after ectopic pregnancy were 21%, 23% and 11%. In contrast, among women with viable pregnancies, 13% reported moderate to severe anxiety (aOR loss at one month vs controls: 2.14; 95% CI, 1.14-4.36) and 2% moderate to severe depression (aOR loss at one month vs controls: 3.88; 95% CI, 1.27 to 19.2).
Conclusion: Women experience high levels of post-traumatic stress, anxiety and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at nine months.

First Authors:
Jessica Farren

Correspondence Authors:
Tom Bourne

All Authors:
Jessica Farren,Maria Jalmbrant,Nora Falconieri,Nicola Mitchell-Jones,Shabnam Bobdiwala,Maya AL-Memar,Sophie Tapp,Ben Van Calster,Laure Wynants,Dirk Timmerman,Tom Bourne

评论