Objectives: Pregnancy stress is the psychological confusion or threat caused by various stress events and adverse factors during pregnancy. Pregnant women exposed to many stressors, they will be easy to produce bad mood and prenatal depression if they cannot adapt to their own changes. Prenatal depression is one of the major global public health problems, with a higher incidence in developing countries and a negative impact on the health of pregnant women and fetus. Resilience refers to pregnant women using their own positive psychological capital, can self-emotional adjustment and improve their ability to adapt to the response state. A better level of resilience can enable pregnant women to face various negative and adaptive problems positively. This study aims to investigate the relationship between pregnancy stress, resilience and prenatal depression through a mental health survey of pregnant women.
Methods: A total of 750 pregnant women in a Grade A tertiary hospital in Urumqi were investigated by self-designed demographic questionnaire, Pregnancy Pressure Scale (PPS) and Patient Health Questionnaire-9 (PHQ-9), Connor-Davidson Resilience Scale (CD-RISC), and the levels of stress during pregnancy, prenatal depression and resilience were analyzed. Pearson correlation analysis was used to explore the correlation between the three. Bootstrap mediation effect test was used to test the mediation effect relationship among the three. If the mediation effect was confirmed, AMOS software was used to establish the mediation effect structural equation model to analyze the mediation effect among the three.
Results: Among 750 respondents, 709 (94.53%) had mild or above pregnancy pressure, 459 (61.20%) had mild or above depressive symptoms and 241 (32.13%) had a good or above level of resilience. Pearson correlation analysis showed that prenatal depression was significantly positively correlated with pregnancy stress (P<0.01), prenatal depression and pregnancy stress were significantly negatively correlated with resilience (all P<0.01). Mediation effect test analysis showed that all the pathways were statistically significant (P<0.01). Mediation effect of resilience between pregnancy stress and prenatal depression was significantly found (95% CI 0.022-0.068, P<0.001). Pregnancy pressure negatively affected resilience (β=-0.38, P<0.01), and resilience negatively affected prenatal depression (β=-0.10, P<0.01). The mediation effect of resilience was 6.5%.
Conclusions: Pregnant women's pregnancy pressure, resilience and prenatal depression are significantly correlated, and the mediation variable resilience plays a partial mediating role in the impact of pregnancy pressure on prenatal depression. Pregnant women can reduce the incidence of prenatal depression and promote their physical and mental health by exercising their resilience.
目的: 妊娠压力是指在孕妇妊娠期间，各种应激事件和不利因素对孕妇心理上造成的困惑或威胁。孕妇暴露在众多压力源下，若不能及时适应自身变化，容易产生不良情绪，发生产前抑郁。产前抑郁是全球主要的公共卫生问题之一，在发展中国家的发病率较高，给孕妇和胎儿的健康带来负面影响。心理弹性是指孕妇利用自身积极的心理资本，能进行自我情绪调整并提高自身适应能力的反应状态。较好的心理弹性水平可以使孕妇积极面对各种负面和适应性问题。本研究旨在通过对孕妇进行心理健康调查来探讨妊娠压力、心理弹性和产前抑郁之间的关系。方法: 采用自编一般人口学资料调查表、妊娠压力量表(Pregnancy Pressure Scale，PPS)、患者健康问卷抑郁量表(Patient Health Questionnaire-9，PHQ-9)、心理弹性量表(Connor-Davidson Resilience Scale，CD-RISC)对乌鲁木齐市某三甲医院750例孕妇进行心理健康调查，分析其妊娠压力、产前抑郁和心理弹性水平；并采用Pearson相关性分析探究三者之间的相关性。采用Bootstrap中介效应检验法检验三者的中介效应关系，若中介效应显示成立，采用AMOS软件建立中介效应结构方程模型对三者的中介效应进行分析。结果: 在750例调查对象中，709例(94.53%)存在轻度及以上的妊娠压力，459例(61.20%)存在轻度及以上的抑郁症状，241例(32.13%)具有较好及以上的心理弹性水平。Pearson相关性分析结果显示：产前抑郁与妊娠压力呈显著正相关 (P<0.01)，产前抑郁、妊娠压力与心理弹性均呈显著负相关(均P<0.01)。经过中介效应检验分析，发现各个路径均具有统计学意义(均P<0.01)，心理弹性在妊娠压力与产前抑郁之间存在中介效应(95% CI 0.022~0.068，P<0.001)。妊娠压力负向预测心理弹性(β=-0.38，P<0.01)，心理弹性负向预测产前抑郁(β=-0.10，P<0.01)。心理弹性的中介效应值为6.5%。结论: 孕妇妊娠压力、心理弹性与产前抑郁都显著相关，中介变量心理弹性在妊娠压力对产前抑郁影响中起部分中介作用。可通过锻炼孕妇心理弹性，降低孕妇产前抑郁发生率，促进孕妇的生理和心理健康。.
Keywords: mediation effect; pregnancy pressure; pregnant women; prenatal depression; resilience.