Study On The Influencing Factors Of Stress, Anxiety And Depression In Early Pregnancy Based On Structural Equation Modeling

Objective: In the prenatal period,mental disorders are common among pregnant women,and the association between mental disorders and adverse maternal and fetal outcomes has been verified in numerous studies at home and abroad.The current research mainly focuses on the relationship between mental disorders and pregnancy outcomes,the impact on fetal and child development,and the effectiveness of intervention trials,while few studies have been performed on the influencing factors.This study aimed to investigate the prevalence and influencing factors of maternal stress,anxiety and depression in early pregnancy through structural equation modeling and provide scientific basis for the screening and intervention of prenatal mental disorders in Chinese medical institutions.Methods: Participants were recruited from the department of gynecology and obstetrics at Yubei Maternity and Child Healthcare Hospital,the Jiangjin Maternity and Child Healthcare Hospital,the Yunyang County Maternity and Child Healthcare Hospital and the Dianjiang People's Hospital.Pregnant women who participated in the initial examination of pregnancy in these hospitals and volunteered to participate in the study were included in this study.Qualified pregnant women were recruited according to the inclusion and exclusion criteria,and basic information such as sociodemographic characteristics,pregnancy-related behavior and obstetric characteristics were collected.Early pregnancy stress,anxiety and depressive symptoms were assessed using the pregnancy pressure scale(PPS),Hamilton anxiety scale(HAMA)and self-rating depression scale(SDS).The level of family care and social support were measured by the family adaptation partnership growth affection and resolve index(APGAR)and the social support rating scale(SSRS).A total of 1,161 questionnaires were completed from January 2018 to September 2018.Descriptive analysis,univariate analysis,correlation analysis and factor analysis were analyzed by SAS 9.4 and AMOS 24.0 was used to construct the structural equation model to explore the association between stress,anxiety,depression and influencing factors.Results: The detection rate of prenatal stress,anxiety and depression in early pregnancy was 91.99%,14.90% and 5.25%,respectively.Age,family and social support and exercise had a direct impact on the occurrence of anxiety symptoms in early pregnancy.Among them,family and social support was the most important factor,with a path coefficient of-0.332;the effects of exercise and age were relatively small,with path coefficients of-0.127 and-0.082,respectively.Sociodemographic characteristics(education level and housewife/unemployment)had an indirect effect on anxiety through family and social support(path coefficient-0.176).And the direct effect of anxiety on depression was 0.189.The sociodemographic characteristics(education level and housewife/unemployment)also had a protective effect on early pregnancy stress,with a path coefficient of-0.167.Therefore,the risk factors for anxiety and depression in early pregnancy are younger age,lower level of maternal education,no exercise during pregnancy,not working during pregnancy,lower-level family care and lower-level social support;and the occurrence of early pregnancy stress is only related to lower level of maternal education and not working during pregnancy.Conclusion: Symptoms of mental disorders characterized by prenatal stress are prevalent in early pregnancy.The occurrence of pregnancy stress,anxiety and depression is not only related to personal factors such as age,education level,work and exercise during pregnancy,but also related to family and social support.Therefore,screening for maternal mental disorders from the early pregnancy and considering family and social support in interventions and missions may have great significance for preventing the occurrence of mental diseases in high-risk populations and further reducing adverse maternal and child outcomes.