To Explore The Predictive Factors Of Postpartum Depression And Evaluate The Clinical Value Of The Group Behavioral Therapy Intervention

Objectives:1.The study was performed to investigate the occurrence of the postpartum depression(PPD)and its influencing factors,in Chongqing.2.To investigate the social psychological factors influencing postpartum depression(PPD),and to explore its predictive value for PPD,so as to establish and evaluate the prediction model of PPD.3.To explore the group cognitive behavioral therapy in mild to moderate postpartum depression.Methods:We randomly selected 371 pregnent women(pregnency?28weeks)from 3 hospitals(The university-town hospital affiliated to Chongqing Medical University,the First affiliated hospital of Chongqing Medical University and Jinshan hospital)completed the designed questionnaire and the HAMA,HAMD,BDI,BAI,EPQ,SCL-90 et al questionnaires in prenatal.the maternal were followed 42 days after delivery and completedthe EPDS.The data were collected from September 2014 to June 2016.Then the evaluation and diagnosis were conducted.371 pregnant women(pregnancy?28 weeks)which We randomly selected,who received antenatal examination and would be hospitalized for delivery in the First Hospital Affiliated of Chongqing Medical University,Jinshan Hospital,and University-Town Hospital from Sep.2014 to Jun.2016.The social demographic questionnaire(self-define),the Eysenck personality questionnaire(EPQ),the symptom checklist-90(SCL-90),the Hamilton anxiety scale/Hamilton depression rating scale(HAMA14/HAMD24),and the Beck anxiety inventory/Beck depression inventory(BAI/BDI)were used to assess the prenatal social psychological factors of pregnant women,and the Edinburgh postnatal depression scale(EPDS)was completed on the 42 th days after delivery.Then the evaluation of PPD was conducted to analyze and predict the social psychological factors influencing PPD.Multivariate stepwise logistic regression analysis was used to establish the prediction model,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model.According to the DSM-IV's puerperal depression disorder(SCID)standard in the diagnosis of postpartum depression,60 cases of maternal(mild-moderate 59 cases,1 case of severe),met inclusion criteria.Using the beck depression inventory(BDI),the Edinburgh Postpartum DepressionScale(EPDS)assessment of depressive symptoms and its severity,and using of RCT,by random 2(intervention group and control group)× 5(before intervention,the second weekend,the fourth weekend,the sixth weekend,the eighth weekend after intervention),Before and after their matching study.Giving the Intervention group the professional group cognitive behavior therapy,such as general psychological support,explaining support,PPD's knowledge,the reasonable way of emotional catharsis,relaxation training,defense lawyers,challenge the wrong polarised thought,hypothesis testing methods,the purpose of the interventions is to solve the emotional problems.The intervention measures once a week,40 minutes every time,eight weeks in all,the control group only observed,and respectively get the two groups' BDI score,EPDS score.Using SPSS 22.0 to analysis the data.Results: 60 women was diagnosed with the PPD,the incidence of the PPD was 16.17%.Multivariate stepwise logistic regression analysis show that EPQ score(OR=1.038,95%CI 1.013 to 1.065),HAMA score(OR=1.119,95%CI 1.052 to 1.190),Unilateral family company(OR=17.998,95%CI 6.715 to 48.241),Abnormal in childbirth(OR=66.279,95%CI 23.307 to 188.476),the High degree of social utilization are influence factors of PPD.According to the evaluation results of PPD,60 cases of 371 met the diagnostic criteria of PPD(PPD group),311 cases did not meet(NPPDgroup),the incidence of PPD was 16.17%(60/371).Single factor analysis of two groups of pregnant women prenatal psychosocial factors,the results showed that the differences in having a foxed work or not,the level of education,emotional stability,HAMA14 score,HAMD24 score,BAI score,BDI score,and each single factor score of the SCL-90 were statistically significant(P < 0.05),the above indexes were selected out for further Multivariate logistic regression analysis,the prediction model was established: logit(PI)=0.042×SCL-90's total score+1.005×Having a Fixed work or not + 2.498×Relative company + 0.108×BDI score-1.319×the level of Education-8.028,the area under the curve(AUC)was0.833(P<0.001,95%CI: 0.772-0.894),when the cut-off point is 0.141(PI),the Youden index is maximum,the sensitivity is 0.900% and the specificity is 0.533%.After the intervention,the two groups' BDI score and the EPDS' score have a downward trend,but there was no statistically significant difference in the 2th weekend(P > 0.05),but in the 4th weekend,6th weekend,8th weekend's differences were significantly(P < 0.01).The proportion of mild and moderate depression changed obviously,mild symptoms increased,the proportion of moderate scale reducing,and in the4 th,6th,8th weekend,the mild and moderate depression's proportion were significantly.different(P <0.01).Two groups with the increase of number of intervention,the BDI score,the EPDS score gradually decline,the EPDS score and BDI scorein intervention group are different significantly(P < 0.01),but the control group has no statistically significant difference(P > 0.05).Conclusions:1.Unilateral family company,Abnormal in childbirth,EPQ score,HAMA score are independent risk factors for PPD,and the High degree of social utilization is the protect factor for PPD.2.The total score of SCL-90,having a fixed work or not,,relative company and BDI score are independent risk factors of PPD,low level of education is a protective factor of PPD.3.The prediction model was established successfully which based on the social psychological factors,have an important clinical value.More samples should be included in further research.4.The Group Cognitive Behavior Therapy in mild to moderate in the clinical treatment of postpartum depression has the feasibility,effectiveness,which can effectively alleviate the symptoms of postpartum depression,reduce the severity of PPD.5.Beside that,there are some deficiency in the study,such as the number of the sample is small,There are many confounding factors fixed in the study,the study have no biological factors,the observation time is short,et al.In further research need more sample in it with based on the conclusion.