| 摘要: | 背景:憂鬱症常見於懷孕期及產後期，並造成母親和新生兒極為嚴重的後果。儘管如此的重要，但就我們所知，在台灣尚未有系統性地探討懷孕期/產後憂鬱症的盛行率以及造成懷孕期/產後憂鬱發生和緩解的臨床相關因子。這篇研究的目的，旨在探討懷孕婦女生產前後憂鬱症的盛行率及其可能發生和緩解的相關因子。方法:分別在懷孕期第16週和28週以及產後第4週，評估234位懷孕的台灣婦女。使用結構性臨床會談 (Mini-International Neuropsychiatric Interview, MINI)作為憂鬱症的診斷工具，並估計其發生率及點盛行率。針對所收集的人口學變項，確認與懷孕期/產後憂鬱症相關的臨床因子。結果:在此研究期間，31位懷孕婦女診斷為憂鬱症；其中11位在懷孕期第16週，8位在第28週，而12位在產後第4週被診斷有憂鬱症。結果發現懷孕期/產後憂鬱症與數個因子有關，例如:低教育程度、低年薪、無工作、有飲酒習慣、早產、有精神疾病的家族史、缺乏嬰兒照顧的協助、缺乏坐月子、有來自家庭及其他成員相關的壓力源以及併發焦慮疾患) 。相較於懷孕期發生的憂鬱症，產後出現的憂鬱症與早產和初生兒低體重較有關聯性。懷孕期憂鬱症的19位婦女，其中9 (47%)位，憂鬱症在生產前獲得緩解，10 (53%)位持續到產後。此外，對懷孕期憂鬱症的婦女，施予任何形式精神科的治療介入與憂鬱症的緩解有相關性。結論:此研究結果提供了治療對懷孕期憂鬱症的好處,也提供在懷孕期/產後憂鬱時臨床實作上的應用。
Background: Major depressive episodes (MDEs) are common during pregnancy and the postpartum period, and the consequences can be severe to the mother and child. Despite the severity of this phenomenon, to our knowledge, there are no studies that systematically assessed the prevalence and clinical factors associated with the incidence and remission of depression during pregnancy and the postpartum period in Taiwan. The aim of this study is to explore the prevalence, incidence and associated factors for pregnant women during their perinatal periods.
Method: A total of 234 women were assessed at 16 weeks and 28 weeks of gestation, and at 4 weeks postpartum. The structured mini international neuropsychiatric interview was used to diagnose MDEs and to estimate incidence and point prevalence. Demographic variables were obtained to identify clinical factors associated with perinatal depression.
Results: Thirty-one pregnant women (13.2%) experienced MDEs; 11 (4.7%) at 16 weeks of gestation, 8 (3.4%) at 28 weeks of gestation, and 12 (5.1%) at 4 weeks postpartum. Women with a low level of education, low annual income, no form of employment, history of alcohol use, preterm birth, family history of psychiatric disorders, lack of assistance with newborn care, lack of postpartum recuperation, family-bond stress, and comorbid anxiety disorders were more likely to experience MDEs (p < .05). Preterm birth and low birth weight were more highly associated with postpartum-onset MDEs than with pregnancy-onset MDEs. Among the 19 women with prenatal MDEs, 9 (47%) remitted by the end of pregnancy and 10 (53%) did not remit during the study period. Women diagnosed with depression who had received any form of psychiatric intervention during the perinatal period exhibited remission of MDE during study period.
Conclusion: The findings of this study provide critical implications for the benefit of interventions during prenatal MDEs, and potential applications in clinical practice for the perinatal depression. |
