我国女性孕早期至孕晚期抑郁症状的发展轨迹

闫盼盼; 刘晓宇; 徐继红

doi:10.16462/j.cnki.zhjbkz.2022.09.006

我国女性孕早期至孕晚期抑郁症状的发展轨迹

doi: 10.16462/j.cnki.zhjbkz.2022.09.006

1.
261053 潍坊，潍坊医学院心理学院
2.
100081 北京，国家卫生健康委科学技术研究所人类遗传资源中心

基金项目:

中央级公益性科研院所基本科研业务费专项资金项目 2019GJZ06

详细信息

通讯作者:
徐继红，E-mail: gracexjh@163.com

中图分类号: R715.3
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出版历程
- 收稿日期: 2021-09-23
- 修回日期: 2022-03-10
- 网络出版日期: 2022-09-17
- 刊出日期: 2022-09-10

The trajectory of depression in Chinese women from early to late pregnancy

1.
School of Psychology, Weifang Medical University, Weifang 261053, China
2.
Centre for Human Genetic Resources, National Research Institute for Health Commission, Beijing 100081, China

Funds:

Special Fund of the Chinese Central Government for Basic Scientific Research Operations 2019GJZ06

More Information

Corresponding author: XU Ji-hong, E-mail: gracexjh@163.com

摘要

摘要: 目的探讨我国女性从孕早期至孕晚期抑郁症状的发展轨迹。方法 2019年8月21日—2020年6月28日，通过自编孕产妇心理健康在线调查系统，采用自编基本信息调查表和爱丁堡产后抑郁量表对国内多家医院的2 485名孕妇分别在孕早期(T1，＜13周)、孕中期(T2，20~28周)和孕晚期(T3，32~36周)进行抑郁症状的追踪调查。使用Mplus 8.3软件对数据进行潜变量增长曲线模型(latent variable growth curve model, LGCM)与增长混合模型(growth mixture model, GMM)分析。结果 531名孕妇完成了孕期3个阶段抑郁症状的测量，孕早期、孕中期和孕晚期抑郁症状检出率分别为31.64%、23.92%、25.61%。模型结果显示孕期抑郁症状整体上从孕早期到孕晚期逐渐缓解，存在正常缓解组(C1，67.42%)、抑郁风险组(C2，28.44%)和抑郁高危组(C3，4.14%)3个轨迹类别。其中，C1组呈现从孕早期到孕晚期逐渐降低的趋势(x_β=-1.15, P＜0.001)；C2组呈现从孕早期到孕晚期平稳升高的趋势(x_β=0.86, P＜0.001)；C3组呈现从孕早期到孕晚期显著升高的趋势(x_β=1.57, P＜0.001)。结论孕期抑郁症状整体上呈现从孕早期到孕晚期逐渐降低的线性发展轨迹，且存在3个潜在类别，具有群体异质性。
- 孕期抑郁症状 /
- 发展轨迹 /
- 异质性 /
- 潜变量增长曲线模型 /
- 增长混合模型
Abstract: Objective To explore the developmental trajectory of depressive symptoms in Chinese women from early to late pregnancy. Methods From 21 August 2019 to 28 June 2020, 2 485 pregnant women from several hospitals in China were conducted the follow-up survey of depressive symptoms in early pregnancy (T1, < 13 weeks), mid pregnancy (T2, 20 to 28 weeks) and late pregnancy (T3, 32 to 36 weeks) through a self-administered maternal mental health online survey system using the self-administered basic information questionnaire and the Edinburgh postnatal depression scale. Besides, the data was analyzed using Mplus 8.3 for both latent variable growth curve model and growth mixture model. Results A total of 531 pregnant women completed the measurement at three time points during pregnancy. The detection rates of depression were 31.64% in early pregnancy, 23.92% in mid-pregnancy and 25.61% in late pregnancy. The results of the model showed an overall gradual decrease in depressive symptoms during pregnancy from early to late pregnancy, with three potential categories of normal remission group (C1, 67.42%), depression risk group (C2, 28.44%) and depression high risk group (C3, 4.14%). Among of them, the C1 group showed a gradual decrease from early to late pregnancy (x_β=-1.15, P < 0.001); the C2 group showed a steady increase (x_β=0.86, P < 0.001); and the C3 group showed a significant increase (x_β=1.57, P < 0.001). Conclusion Depressive symptoms during pregnancy show a linear trajectory of progressive decline from early to late pregnancy as a whole, and there are three potential categories with distinct group heterogeneity.
- Pregnancy depression symptoms /
- Developmental trajectory /
- Heterogeneity /
- Latent variable growth curve model /
- Growth mixture model

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图 2 孕期抑郁症状的线性变化趋势

Figure 2. Linear trends of depressive symptoms during pregnancy

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图 1 孕期抑郁症状的LGCM路径图

注：^a P < 0.001。

Figure 1. Path diagram of the LGCM for depressive symptoms during pregnancy

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图 3 孕早期至孕晚期三种类别抑郁症状发展轨迹

Figure 3. Three developmental trajectories of depression symptoms from early to late pregnancy

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表 1 孕期各时点的抑郁症状得分及相关性

Table 1. Depressive symptom scores and correlations at three time points during pregnancy

测量时点	T1	T2	T3	得分(x±s)	F值
T1	1.00			10.96±3.67	11.881 ^b
T2	0.52 ^a	1.00		9.97±3.85
T3	0.56 ^a	0.64 ^a	1.00	9.94±4.13
注：^a P < 0.01；^b P < 0.001。

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表 2 孕期抑郁症状增长混合模型拟合信息

Table 2. Fitting indicators for growth mixture model of depressive symptoms during pregnancy

类别	K ^a	LLV^b	AIC ^c	BIC ^d	aBIC ^e	Entropy ^f	LMR ^g	BLRT ^h	条件概率(%)
1	8	-4 165.78	8 347.55	8 381.74	8 356.35	—	—	—	—
2	11	-4 117.49	8 256.97	8 304.00	8 269.08	0.80	0.003	< 0.001	78/22
3	14	-4 079.56	8 187.12	8 246.97	8 202.53	0.88	0.001	< 0.001	67/29/4
4	17	-4 057.63	8 149.26	8 221.93	8 167.97	0.86	0.015	< 0.001	26/3/14/57
5	20	-4 043.90	8 127.80	8 213.30	8 149.81	0.87	0.423	< 0.001	3/24/17/51/5
注：^a模型中自由估计的参数数目；^b对数似然值(log likelihood value, LLV); ^c赤池信息准则(Akaike information criterion, AIC)；^d贝叶斯信息准则(Bayesian information criterion, BIC)；^e校正的BIC；^f信息熵(Entropy)，代表个体对潜在类别的分类质量；^g似然比检验指标: 罗森戴尔鲁比(Lo-Mendell-Rubin, LMR)；^h基于Bootstrap的似然比检验(Bootstrapped likelihood ratio test, BLRT)。

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表 3 3类别增长混合模型的参数信息

Table 3. Parameter information for the 3-category growth mixture modeling

类别	n(%)	截距(α)		斜率(β)
类别	n(%)	均值	方差	均值	方差
C1:正常缓解组	358(67.42)	9.84 ^a	3.67 ^a	-1.15 ^a	0.12
C2:抑郁风险组	151(28.44)	12.06 ^a	3.67 ^a	0.86 ^a	0.12
C3:抑郁高危组	22(4.14)	17.63 ^a	3.67 ^a	1.57 ^a	0.12
注：^a P < 0.001。

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表 4 三个轨迹类别的人口学信息[n(%)]

Table 4. Demographic information across the three trajectories [n(%)]

变量	正常缓解组	抑郁风险组	抑郁高危组	F/χ²值	P值
年龄(x±s, 岁)	29.58±4.06	28.56±3.99	25.86±3.60	11.016 ^a	< 0.001
受教育程度				0.270	0.874
高中及以下	86(24.02)	39(25.83)	6(27.27)
本科及以上	272(75.97)	112(74.17)	16(72.73)
家庭月收入(元)				8.455	0.207
＜5 000	94(26.26)	39(25.83)	9(40.91)
5 000~＜10 000	102(28.49)	47(31.13)	9(40.91)
10 000~＜20 000	104(29.05)	48(31.79)	3(13.64)
≥20 000	58(16.20)	17(11.26)	1(4.55)
职业				3.394	0.494
事业单位人员	51(14.25)	21(13.91)	5(22.73)
公司企业职员	184(51.39)	77(50.99)	7(31.82)
个体/农民	123(34.36)	53(35.09)	10(45.45)
胎次				2.368	0.306
一胎	257(71.79)	112(74.17)	19(86.36)
二胎及以上	101(28.21)	39(25.83)	3(13.64)
计划怀孕				1.148	0.563
否	84(23.46)	42(27.81)	6(27.27)
是	274(76.54)	109(72.19)	16(72.73)
注：^a为F值。

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