| BACKGROUND"The Plan of Health China 2030"pointed out that it is necessary to " strengthen the intervention of common mental disorders and psychological behavior problems such as depression and anxiety,and increase the early detection and timely intervention of psychological problems of key populations." Pregnancy is a special and complicated physiological process for women.Pregnant women will undergo physiological changes and psychological stress processes,which will increase their psychological load,and depression is the most common psychological problem during pregnancy and delivery.Previous studies have shown that the incidence of depression among pregnant women abroad is 13%to 19%,and the incidence of depression among pregnant women in different regions of China is 0.22%to 68.1%,which is quite different.Maternal depression can cause weakened immune function,endocrine disorders,increase the risk of adverse pregnancy outcomes such as prolonged labor,postpartum hemorrhage,and embryo stoppage.Causes problems such as low birth weight of the fetus,abnormal neurodevelopment in infants and young children,cognitive decline,affective disorders and behavioral delay.Most of the previous maternal depression was cross-sectional studies,and slightly obtained the incidence of depression at a single point in time.This study intends to carry out a longitudinal follow-up study of maternal depression,analyze the incidence and change characteristics of maternal depression before and after childbirth,analyze the predictive effect of prenatal depression and related influencing factors on postpartum depression,and initially build a predictive model of maternal depression risk,to provide practical reference for early identification,early screening and early intervention of clinical maternal depression.OBJECTIVE1.To carry out a longitudinal follow-up study of maternal depression,to understand the incidence and characteristics of maternal depression before and after childbirth,as well as the new incidence,recurrence and outcome of postnatal depression.2.Analyze the predictive effects of maternal prenatal depression and related influencing factors on postpartum depression,and initially build a depression risk prediction model to provide a reference for early identification and screening of high-risk groups.METHODSResearch content 1:A longitudinal tracking study of maternal depressionUsing the questionnaire survey method,the Edinburgh Postpartum Depression Scale,Perceived Stress Scale,Cognitive Fusion Questionnaire,Perceived Social Support Scale and Vulnerable Personality Style Questionnaire were applied to a hospital in Guangzhou from June 2019 to January 2020.A total of 211 pregnant women conducted a longitudinal follow-up survey of depression and related factors at 32-34 weeks of pregnancy,1 week after delivery,and 6 weeks after delivery,and analyze the incidence,change characteristics and influencing factors of maternal depression in three periods.Research content 2:Predictive analysis of influencing factors of maternal prenatal depression on postpartum depressionUsing Mplus7.0 software to build a cross-lag model,analyze the predictive relationship between 211 pregnant women’s perceived stress,cognitive fusion and depression,and explore the predictive effect of prenatal depression emotional factors on postpartum depression.Research Content 3:Preliminary construction and validation of a risk predictive model of depression of pregnant womenA questionnaire survey was used to facilitate the extraction of 519 pregnant women in a hospital in Guangzhou from August to October 2019.Logistic regression analysis was used to construct a risk predictive model of depression of pregnant women.The model was evaluated by receiver operating characteristic curve analysis and Hosmer-Lemeshow test.STATISTICS AND ANALYSISData analysis was performed using SPSS 24.0 and Mplus7.0 software.Main statistical methods:①The general data of pregnant women were described by frequency,percentage,and mean±standard deviation;the difference in the incidence of depression in the three periods of pregnancy was analyzed by chi-square test,and the difference in the score of depression in the three periods was analyzed by repeated measurement analysis of variance.②The single factor analysis of the influencing factors of maternal depression was chi-square test,non-parametric test or two independent sample t test,and the multivariate analysis was binary logistic regression analysis;③Using Pearson correlation analysis to explore the correlation between perceived stress,cognitive fusion and depression;④Use Mplus7.0 software to build a cross-lag model to analyze the mutual prediction relationship between perceived stress,cognitive fusion and depression;⑤ Logistic regression analysis was used to build a risk predictive model of depression of pregnant women.The model was evaluated by receiver operating characteristic curve analysis and Hosmer-Lemeshow test.All test significance levels are α=0.05.RESULTS1.The incidence of depression in three periods before and after childbirthThe incidence of depression in pregnant women at 32-34 weeks of pregnancy,1 week postpartum and 6 weeks postpartum were 37%,27%and 26.5%,and the total incidence of prenatal and postpartum depression was 37%and 34.6%.There was a significant difference in the incidence of depression in 3 periods(χ2=6.943,P<0.05).2.Analysis results of influencing factors of depression in three periods before and after childbirthPerceived stress and cognitive fusion are the risk factors for maternal depression in three periods before and after childbirth(perceived stress OR=1.265,1.329,1.309;cognitive fusion OR=1.081,1.069,1.132,P<0.01),poor pregnancy outcome,instability,sensitivity,and anxious personality are also risk factors for maternal depression(OR=7.138,1.706,1.942,1.801,P<0.05),and organizational personality is its protective factor(OR=0.432,P<0.01).3.Results of cross-lag analysis of maternal depression before and after childbirthMaternal prenatal perceived stress significantly predicted depression at 1 week postpartum(β=0.279,SE=0.110,P=0.011)and depression at 6 weeks postpartum(β=0.3 76,SE=0.097,P<0.001);prenatal cognition fusion significantly predicted depression at 1 week postpartum(β=0.388,SE=0.089,P<0.001)and depression at 6 weeks postpartum(β=0.23 7,SE=0.078,P=0.002).4.Construction and verification of a risk predictive model for depression of pregnant womenThe risk predictive model of maternal prenatal depression is Logit(P)=-3.751+1.075*(fetal abnormality)+0.151*(perceived stress)+0.073*(cognitive fusion),the area under curve of the model group is 0.840,95%CI is(0.804～0.877,P<0.001),the prediction probability P≥0.60 is the positive judgment standard,the sensitivity is 88.6%,the specificity is 64%,the maximum Youden index is 0.526;the test group AUC is 0.828,95%CI is(0.793～0.863,P<0.001),the Youden index is 0.504,the sensitivity is 80.7%,and the specificity is 69.7%,which has good discriminant validity.CONCLUSION1.The incidence of depression in pregnant women showed a downward trend from 32-34 weeks of pregnancy to 6 weeks after delivery.Maternal perceived stress and cognitive fusion are risk factors for depression in the three periods before and after childbirth.Adverse pregnancy outcomes,instability,sensitivity,and anxious personality are risk factors for depression in pregnant women,organizational personality is its protective factor.2.Maternal prenatal perceived stress and cognitive fusion can predict the occurrence of depression at 1 week postpartum and 6 weeks postpartum.In this study,the preliminary construction of a predictive model for predicting depression risk of pregnant women is acceptable,and its role in screening,identifying,and diagnosing depression in pregnant women can be further tested through clinical applications. |
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