Research On The Stress And Its Correlates Of HIV-infected Pregnant Women

Objective:To understand the mental health status and its correlates of HIV-infected pregnant women in high prevalence regions of AIDS in Yunnan province, and to provide scientific basis for developing appropriate psychological intervention strategies and measures for HIV-infected pregnant women.Methods:A cross-sectional study was conducted, based on psychological stress theory and combination of epidemiological investigation and laboratory testing methods to collect relevant information. The total of 13 counties in high prevalence regions of AIDS in Yunnan were as the research sites. All the HIV-infected pregnant women from January 2010 to December 2010 were choosed as the study group. The total of 160 HIV pregnant women were cruited as the control group. Two groups were questionnaired face to face respectively, including mental health status and correlates in the study group and social demographic situation, the mental health status and knowledges about AIDS in the control group. And one third of the study people were randomly selected to test plasma adreno cortico trophic hormon and serum cortisol concentration with radio-immunity technique.Results:From January 2010 to December 2010, there were a total of 310 HIV+ pregnant women in study sites.307 HIV+ pregnant women and 160 HIV pregnant women were accepted questionnarre investigation, and 114 HIV+ pregnant women and 63 HIV- pregnant women were accepted the detection of ACTH and COR.(1) The social demographic characteristics:Mostly married farmers; age between 16 to 41 years old, nearly 60.0% of subjects aged 20 to 30 years old; Mostly junior secondary education and below; About half and half Han Chinese and ethnic minorities; Household percapita income was 1,500 to 2,000 yuan.(2) The awareness rates of AIDS knowledge:Comprehensive knowledge scores were 13.0±3.0 in the study group and 12.0±2.0 in the control group respectively; The core indicators scores were 7.0±2.0 in the study group and 5.0±3.0 in the control group respectively. The AIDS knowledge scores in the HIV+ pregnant women was higher than the HIV- pregnant women, there were significant differences. The awareness rates of comprehensive knowledge were 86.7% in the study group and 80.0% in the control group respectively; The awareness rates of core indicators were 87.5% in the study group and 62.5% in the control group respectively.(3) The Total Score(159.2±73.18), General Symptomatic Index(1.77±0.81) and factor scores include Somatization, Obsessive-Cpmpulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Photic anxiety, Paranoid ideation and Psychoticism in the study group were significantly higher than those in the control group and those in the nationalnorm as well. The factor scores include Somatization, Depression, Anxiety, Photic anxiety and Psychoticism were significantly higher in the HIV-uninfected pregnant women than those of the nationalnorm.(4) The positive rate of psychological problem of the HIV-infected pregnant women was 37.8%. Among the ten factors, the positive rate of Depression, Interpersonal sensitivity and Paranoid ideation were 31.3%(96/307) at the top; Anxiety and Obsessive-Cpmpulsive followed, being 30.9%(95/307); the Positive rate of the remaining factors were Hostility(30.6%,94/307), Photic anxiety(29.6%,91/307), Somatization(29.3%,90/307) and Psychoticism(29.0%,89/307).(5) The ACTH test values of the HIV+ pregnant women and the HIV-pregnant women were 35.93±30.61 pg/ml,33.00±26.79 pg/ml, respectively. There was no significant difference. The COR test values were 514.80±208.24 ng/ml, 378.84±181.69 ng/ml, respectively. The COR test values of the HIV-infected pregnant women was significantly higher than the HIV-uninfected pregnant women. The confidence interval of the ACTH test values of the two groups were 27.91～43.95 pg/ml,23.71～42.29 pg/ml, respectively. The confidence interval of the COR test values were 476.58～553.02 ng/ml,333.98～423.70 ng/ml, respectively, and higher than the normal reference range.(6) Univariate analysis showed that the Self-Esteem of the HIV-infected pregnant women, fear emotions about pregnancy, severity of vomiting in pregnancy, willing to have a baby or not, with difficulty to decide to have a baby or not and the degree of difficulty, HIV infection was diagnosed before pregnancy or during pregnancy, the HIV test results of husband, whether any unpleasant incidents occurred on the investigate day or not, family pressure, degree of worry about the health and the future of their babies, degree of worry about pregnancy, environment pressure and fearing of AIDS were associated with psychological problems. Self-esteem scores was negative correlation with psychological problems, other factors were positive correlation with psychological problems. In multiple factors analysis, backward stepwise regression was used to fit the main effeets of equation. The results shows that the main factors for psychological problems were fear emotions about pregnancy, HIV infection was diagnosed before pregnancy or during pregnancy, Self-Esteem, degree of worry about the health and the future of their babies, degree of worry about pregnancy.Conclusion:The stress of the HIV-infected pregnant women was higher than those of the nationalnorm, also higher than the HIV-uninfected pregnant women, psychological stress was great. The main factors for psychological problems were fear emotions about pregnancy, HIV infection was diagnosed before pregnancy or during pregnancy, Self-Esteem, degree of worry about the health and the future of their babies, degree of worry about pregnancy. Self-esteem scores was negative correlation with psychological problems, other factors were positive correlation with psychological problems.