Structural Equation Model Study On Post-traumatic Stress Disorder And Its Influencing Factors In High-risk Pregnant Women

High-risk pregnancy refers to pregnancy that may endanger maternal and infant health or lead to poor perinatal prognosis during the perinatal period,including complications during pregnancy and other high-risk pathogenic factors.High-risk pregnancy is an important cause of maternal and perinatal mortality.In the long pregnancy process,high-risk pregnant women not only need to adapt to the increasing physiological load,but also bear the psychological pressure caused by the possible fetal dysplasia,premature birth and various neonatal diseases caused by high-risk pregnancy.Perinatal post-traumatic stress disorder(PPTSD)refers to the stress disorder caused by pregnancy and childbirth.It is a regulated stress response related to the nervous system and endocrine system,represented by re-experiencing thetraumatic event,persistent avoidance of reminders of the event and numbing of general responsiveness and increased arousal.There are many factors influencing perinatal post-traumatic stress disorder.A thorough understanding of the status quo,influencing factors and their interaction mechanism of PTSD in high-risk pregnant women is the premise to carrying out perinatal psychological intervention measures targetedly.At present,only a few studies in China have investigated the situation of post-traumatic stress disorder(PTSD)of common parturient and sick newborn'mother,investgate time focused on the postpartum stage.However,there is no report related to studies of PTSD caused by high-risk pregnancy,the specific effect mechanism and mode of the influencing factors of PTSD are still unclear.Obj ectives:This study,from the perspective of birth trauma,aims to investigate the characteristics of post-traumatic stress disorder in high-risk pregnant women through cross-sectional study,and to identify the influencing factors of post-traumatic stress disorder in high-risk pregnant women and the path relationship between various factors.To construct a predictive model of PTSD and its influencing factors in high-risk pregnant women,and to provide a reference for formulate perinatal psychological intervention programs and meeting the needs of maternal and infant mental health care.Methods:On the basis of literature review and professional knowledge,a hypothetical model for post-traumatic stress disorder and its influencing factors in high-risk pregnant women was established.The convenience sampling method was adopted to select 401 high-risk pregnant women as research subjects,who waiting for delivery in the obstetric department of Drum Tower Hospital affiliated Nanjing University Medical School from April to September 2018.General data questionnaire,the PTSD Checklist-Civilian version(PCL-C),the Eysenck Personality Questionnaire-RSC(EPQ-RSC),Pregnancy stress scale,Mishel's Uncertainty in Illness Scale(MUIS),State Anxiety Inventory(SAI),Trait Coping Style Questionnaire(TCSQ),Chinese version of Perceived Social Support Scale(PSSS)was used to investigate the high-risk pregnant women,and obtain the actual data of post-traumatic stress disorder and its influencing factors in high-risk pregnant women.The data was entered using Epidata3.1,SPSS 17.0 was used to process and analyze the data,and the structural equation model was constructed and verified by AMOS21.0,and the hypothetical model was fitted,discriminated and corrected according to the actual data analysis.Results:A total of 401 questionnaires were collected in this survey,including 382 valid questionnaires,and the effective rate of the questionnaire was 95.3%.In this study,the positive rate of PTSD in high-risk pregnant women was 15.4%.Among the top ten items,the highest proportion of symptoms of increased arousal,followed by the symptoms of trauma re-experience.In general,high-risk pregnant women with low-education background,non-one-child,no fixed work,multipara,twin pregnancy,or with history of illness and trauma,and unsatisfactory sleep quality had higher levels of PTSD.Pearson correlation analysis showed that Psychoticism(P),Neuroticism(N),pregnancy stress,illness uncertainty feeling,anxiety,and negative coping were positively correlated with PTSD scores;and Extrovision(E),positive coping,social support were negatively correlated with PTSD scores.In structural equation model,pregnancy stress had a positive to PTSD,the total effect 0.554,direct effect 0.503,indirect effect 0.052.Illness uncertainty feeling had a positive effect to PTSD,the total effect 0.259,direct effect 0.099,indirect effect 0.259.Anxiety had a positive effect to PTSD directly,the total effect 0.183.Negative coping had a positive effect to PTSD,the total effect 0.282,direct effect 0.157,indirect effect 0.125.Neuroticism(N)had a positive effect to PTSD,with a total effect of 0.466,direct effect 0.121,indirect effect 0.345.Extrovision(E)had a negative effect on PTSD indirectly through pregnancy pressure,with a total effect of-0.101.Social support had a negative effect on PTSD indirectly through illness uncertainly feeling and pregnancy pressure,with a total effect of-0.154.Conclution:The positive rate of PTSD in high-risk pregnant women was 15.4%.The core symptoms were increased arousal and trauma re-experience.Neuroticism(N),pregnancy stress,illness uncertainty feeling,anxiety and negative coping have significant direct effects on PTSD in high-risk pregnant women.In addition,pregnancy stress had an indirect effect on PTSD through anxiety,illness uncertainty feeling had an indirect effect on PTSD through pregnancy stress and anxiety,and negative coping had a positive effect on pregnancy stress through pregnancy stress.Neuroticism(N)had a positive effect on PTSD indirectly through illness uncertainty feeling,anxiety and negative coping,Extrovision(E)had a negative effect on PTSD indirectly through pregnancy pressure,and social support had a negative effect on PTSD indirectly through illness uncertainly feeling and pregnancy pressure.To clarify the path relationship of PTSD and its influencing factors in high-risk pregnant women can provide a theoretical reference for further developing scientific interventions and increasing patient' s mental health.