Characteristics And Mechanism Of Prenatal Depression In Women With Threatened Premature Labor

Purpose:Perinatal depression is a major problem with great concern worldwide.Yet information regarding mortality and related affecting factors of women with threatened premature labor(TPL)are scarce currently.This study was based on“Family-centered”nursing mode to include physical,psychological,and social factors,with the aim of investigating Characteristics and related affecting factors of perinatally depressed women with TPL,as well as the predictive role of prenatal depression for postnatal depression for women,to promote psychological well-being of TPL women and provide theoretical basis for the specific prediction and intervention of perinatal maternal depression at an early stage.Methods:From March 2016 to February 2017,hospitalized women with the diagnosis of TPL in the Department of Obstetrics and Gynecology in four tertiary hospitals in Chongqing,as well as their spouses were sampled conventionally and followed prenatally,1 week and 1 month postpartum with questionnaire survey.In this study,236 women were recruited prenatally,98 women 1 week postpartum and 63 women 1 month postpartum.There were 43 women recruited at three time points.There were 210 prenatal spouses,98 spouses 1 week postpartum and 33 spouses 1 month postpartum,with 33 spouses followed at three time points.Prenatal couples were surveyed with self-made general information questionnaire,Connor-Davidsonresilience scale(CD-RISC),simplified coping style questionnaire(SCSQ),social support rating scale(SSRS),pregnancy pressure scale(PPS),Edinburgh postnatal depression scale(EPDS),positive and negative affect scale(PANAS),and postnatal couples were surveyed with CD-RISC,PANAS,and EPDS.Women were grouped according to their EPDS scores,with a depression cutoff of 13.All data were analyzed with SPSS software(version 19.0).Categorical variables were compared with chi-square test or Fisher's exact test.Continuous variables were compared with t test(normally distributed)or Mann-Whitney test(non-normally distributed).Spearman's Rho estimated correlations between psychometric factors.Risk factors of prenatal depression were analyzed with binary unconditioned logistic regression.Depressive mechanisms were analyzed with path diagram.The predictive relationships of depression and related factors were analyzed with crossed hysteresimetry.Results:1.General characteristics of TPL women1.1 Among 236 prenatal TPL women,their age ranged 18 to 42 years old,with mean age of 29.7 ±4.4 years.63(26.7%)women reside in rural areas and 173(73.3%)in urban areas.Their mean gestational week was 33.2 ±2.2;mean duration for fetus protection was 5.4 ± 0.4 days.Among them,153(64.8%)were primiparas and 83(35.2%)were multiparas.2.Status of prenatal depression of TPL womenThe mean prenatal EPDS score of TPL women(10.5 ± 3.0)was significantly higher than norm of Chinese women(P <0.0001).The mortality of prenatal depression of TPL women was 31.1% based on an EPDS cutoff of 13.3.Affecting factors of prenatal depression in TPL women3.1Associated factors of prenatal depression in TPL women include monthly income between 3000 to 4999 Yuan(P < 0.05),3 times of gravidity,resilience,positive and negative affects,pregnancy pressure.Multiple logistic regression analysis reveal that negative affect and pregnancy pressure were risk factors of prenatal depression in TPL women(OR = 1.108,95% CI: 1.057-1.165 and OR = 2.266,95% CI: 1.118-4.591,respectively),resilience was a protective factor(OR = 0.966,95% CI: 0.943-0.989).3.2 Positive correlations were found between maternal and paternal prenatal depression(r = 0.240,P <0.01)and between paternal negative affect and paternal passive coping(r = 0.152,P <0.01).The prenatal EPDS scores of depressed women was higher than those of non-depressed women(P <0.001)and than those of their spouses.Spouses of depressed women also had higher prenatal EPDS scores than those of non-depressed women(P <0.01).4.Mechanism of prenatal depression of TPL women4.1 Resilience,pregnancy pressure,positive and negative affect can predict 41.8% variance of prenatal depression of TPL women.The standardized equation of regression for prenatal depression of TPL women is,depression = 0.373 × negative affect-0.227 × positive affect + 0.193 × pregnancy pressure-0.157 × resilience.4.2 Negative and positive affect only had direct effects on maternal prenatal depression(0.376 and-0.233,respectively),their total effects were 0.376 and-0.233,respectively.4.3 Resilience and pregnancy pressure had both direct effects(-0.154 and 0.189,respectively)and indirect effects(-0.237 and 0.150,respectively)on maternal prenatal depression;their total effects were(-0.391 and 0.339,respectively).4.4 Social support,active and passive coping only had indirect effects on maternal prenatal depression(-0.117,-0.199 and 0.080,respectively).5.The predictive role of related factors on postnatal depression of TPL women5.1 Although there were no significant changes of maternal depression,resilience,positive and negative affects prenatally,1 week and 1 month postpartum,they were all positively correlated prenatally and 1 week postpartum(r = 0.554,0.630,and 0.418,respectively).Positive correlations were found prenatally and 1 month postpartum within resilience(r = 0.353,P =0.004)?maternal negative affect(r = 0.185,P =0.044)and depression(r = 0.306,P = 0.012).5.2 Maternal depression was negatively correlated with resilience(r =-0.397,-0.500,and-0.415,respectively)and positively correlated with negative affect(r = 0.421,0.485,and 0.441,respectively)prenatally,1 week and 1 month postpartum.5.3 For TPL women,prenatal resilience can predict their depression 1 week postpartum(? =-0.192).Prenatal depression can also predict negative affect both 1 week(? = 0.491)and 1 month postpartum(? = 0.507).Conclusion:1.Prenatal depression was highly prevalent in TPL women,and it was positively correlated with maternal negative affect,passive coping,and maternal depression.2.TPL women had moderate pregnancy pressure and those with prenatal depression had severe pregnancy pressure.3.Negative affect,pregnancy pressure were risk factors of prenatal depression of TPL women,whereas resilience was a protective factor.4.Positive and negative affects,pregnancy pressure,and resilience had direct effect on prenatal depression of TPL women,with negative affect having the maximal effect.Besides,pregnancy pressure and resilience also had indirect effects on prenatal depression.Although resilience had the least direct effect,it had the most total effect on maternal prenatal depression.Active and passive coping,social support had indirect effects on prenatal depression of TPL women via resilience,positive and negative affects and pregnancy pressure.5.Temporally,there were no notable change of depression,resilience,and positive and negative affects prenatally,1 week and 1 month postpartum.6.Prenatal depression was negatively correlated with resilience,and positively correlated with negative affect in TPL women.7.For TPL women,resilience can predict depression 1 week postpartum,and prenatal depression can predict negative affect 1 week and 1 month postpartum.