Effect Of Prenatal Mental Health Education On Depression And Anxiety During Pregnancy And Postpartum

Objectives: Pregnant women are prone to depression and anxiety,which will have adverse effects on maternal and infant health.This study aims to explore the effects of mental health education and self-care on alleviating mild depression and anxiety in pregnant women.Methods: This study was carried out in 3 women's and children's hospitals in Shanghai and Zhejiang.From August to December 2018,the pregnant women who received prenatal examination,delivered or postpartum follow-up in the above maternal and child institutions were selected as the research objects for the intervention study.The study was designed as a randomized controlled intervention study.The screening criteria for screening are: pregnant women and women who are born 1 month after childbirth;education level in junior high school and above;mothers living in this city during the maternity period,and prenatal examination,childbirth and postpartum follow-up in the area where the research unit is involved.The exclusion criteria for screening are: those with major physical illnesses and limited mobility,unable to complete the intervention of the project;have received some form of medication or psychotherapy due to mental disorders;there are obstacles in audiovisual or verbal.If they meet EPDS ? 9,or GAD-7 ? 5,or ANRQ ? 23,or obstetricianas believe pregnant women with possible emotional problems should be included in research group.According to above criteria,753 pregnant women were screened,and 153 pregnant women who met the inclusion criteria of the study group were randomly divided into three groups,Group 1,group 2 and group 3 included 50,56 and 47 pregnant women respectively,and the remaining 600 pregnant women were included in the universal group.Universal group and group 1 received regular mental health education,that is,to give "Psychological Health Books for Pregnancy and Maternity" for self-study and one section maternal mental health course.Group 2 received the regular mental health education,and to set up WeChat group to receive peer communication and group support services.Group 3 studied the "Psychological Health Books for Pregnancy and Maternity" and eight maternal mental health classes(mental health education+music therapy/progressive muscle relaxation therapy/massage therapy),and joined Group 3's WeChat group for peer communication and group support services.In this study,basic information form,prenatal risk questionnaire(ANRQ),edinburgh postpartum depression scale(EPDS),7-tiem generalized anxiety disorder(GAD-7)and Chinese perceived stress scale(CPSS)were used for pre-enrollment screening.EPDS,GAD-7 and CPSS were the main outcome indexes,Secondary indicators are the evaluation of "Reading Book" and lectures.SPSS 22.0 software was used for statistical analysis of the data.Standard deviation of measurement data using mean ± standard deviation,comparison between groups using analysis of variance;The adoption rate of count data was expressed,and t test was used for comparison between groups.The follow-up data of the EPDS,GAD-7,and CPSS scores were filled by the Expectation Maximization Algorithm(EM),and the multi-factor repeated measures analysis of variance was used to compare the intervention effects of different interventions on the EPDS,GAD-7,and CPSS scores of the study group.Use LSD for post-mortem comparisons.Results:During the study,A total of 457 pregnant women,36 pregnant women,40 pregnant women and 35 pregnant women were followed up in the universal group and 3 research groups.The results showed that(1)Among the 753 pregnant women screened,the positive rate of depressive symptoms was 15.0%(113),the positive rate of depressive symptoms was 11.6%(87),the ratio of depression or anxiety was 18.1%(136).Logistic regression analysis showed that high school education(OR=0.450,95%CI:0.221-0.916),bachelor degree or above(OR=0.470,95%CI:0.266-0.830),poor relationship between husband and wife(OR=6.999,95%CI:3.208-15.268),poor relationship with parents(OR=3.122,95%CI:1.269-7.684),poor relationship with the in-laws(OR=3.603,95%CI:2.204-5.890)are risk factors for depressive symptoms,bad relationship between husband and wife(OR=7.623,95%CI:3.427-16.973),unexpected pregnancy(OR=1.956,95%CI:1.218-3.139),poor relationship with parents(OR=3.878,95%CI:1.544-9.737),poor relationship with the in-laws(OR=4.620,95%CI:2.778-7.683)are risk factors for anxiety symptoms,previous 3 pregnancies(OR=0.461,95%CI:0.218-0.975),poor relationship(OR=10.344,95% CI:3.971-26.943),and unintentional pregnancy(OR=1.589,95% CI:1.042-2.423)were risk factors for depression or anxiety.(2)The pregnant and parturient women are very satisfied with the content,professionalism and benefits of the book(median: 9-10,total: 10 points);The pregnant women were very satisfied with the teaching method,class hour,content and benefits of one session of maternal mental health course(median: 9?10,total:10 points),and satisfied with the way,necessity and benefits of group support service(median: 7?9,total:10 points).The pregnant and parturient women are generally satisfied with the teaching method,class hour,content and the benefits of the eight maternal mental health classes(median: 6.5?10,total:10 points).(3)There were significant differences in EPDS,GAD-7 and CPSS scores between the three groups in the study group,P<0.001,but there was no interaction between follow-ups and the intervention method,P>0.05.There were no significant differences in the scores of EPDS,GAD-7 and CPSS between the study group 1 and the study group 3,the study group 2 and the study group 3,P>0.05.The differences in EPDS,GAD-7,and CPSS scores in the study group 1 were significantly lower than those in the study group 2,P<0.05.Conclusion: Mild depression,anxiety and stress are more common in women during pregnancy.Pregnant women who have a bad relationship with their parents and in-laws and bad relationship between husband and wife are prone to depression and anxiety.Highly educated pregnant women are prone to depressive symptoms;unintended pregnancies are more prone to anxiety;previous multiple pregnancy,poor husband and wife relationship and unwanted pregnancy Pregnant women are more prone to depression or anxiety.Maternal women have higher satisfaction and acceptance of the " Psychological Health Books for Pregnancy and Maternity ",the single-term psychological health care class,the eight-phase psychological health care class and the group support service,and the applicability is strong.Regular mental health education,regular mental health education combined with group support,and multiple mental health education combined with group support are beneficial to improve maternal depression,anxiety and stress symptoms.