产妇二元应对与精神心理症状群的交叉滞后分析

doi:10.12280/gjszjk.20250253

摘要/Abstract

摘要：

目的：探讨产妇二元应对及精神心理症状群（疲劳、睡眠障碍及焦虑抑郁症状）的发展变化趋势，并分析两者的相关性及预测关系。方法：采用便利抽样的方法，选取2023年7月—2024年6月于东南大学医学院附属南京同仁医院住院的170例产妇为研究对象，分别于产后1个月（T1）、产后2个月（T2）、产后3个月（T3）对产妇二元应对及精神心理症状群进行问卷调查，使用Pearson相关分析和交叉滞后模型对二者的相关性和预测关系进行分析。结果：剔除8份无效问卷，本研究共回收有效问卷162份，有效回收率为95.29%。3个时间节点的二元应对得分（F=8.338，P<0.001）、疲劳得分（F=8.126，P<0.001）、睡眠质量得分（F=4.110，P=0.032）和焦虑抑郁得分（F=9.317，P<0.001）比较，差异均有统计学意义。产妇二元应对及精神心理症状群得分在3个时间节点存在显著相关关系（均P<0.05）。交叉滞后模型结果显示，二元应对水平显著负向预测下一节点的精神心理症状群（均P<0.05），而精神心理症状群对下一节点的二元应对纵向预测作用不显著（均P>0.05）。结论：产妇的二元应对能力与其精神心理症状群密切相关，建议临床工作者动态监测各阶段产妇的二元应对状况及心理症状变化，并对应对能力欠佳者实施早期干预。

关键词: 产后期, 疲劳, 睡眠障碍, 焦虑, 抑郁, 问卷调查, 纵向研究, 二元应对

Abstract:

Objective: To explore the developmental trends of maternal dyadic coping and psychosomatic symptom clusters (fatigue, sleep disorders, and anxiety and depressive symptoms), and to analyze the correlation and predictive relationship between the two. Methods: The convenience sampling method was used to select 170 women who were hospitalized and gave birth in Affiliated Nanjing Tongren Hospital of Southeast University School of Medicine, from July 2023 to June 2024. The follow-up surveys of maternal dyadic coping and psychosomatic symptom clusters were carried out in the first month after delivery (T1), the second month after delivery (T2), and the third month after delivery (T3), respectively. The Pearson correlation analysis and cross-lagged mode were used to analyze the correlation and predictive relationship. Results: Excluding 8 invalid questionnaires, a total of 162 valid questionnaires were collected in this study (95.29% recovery rate). Dyadic coping scores (F=8.338, P<0.001), fatigue scores (F=8.126, P<0.001), sleep quality scores (F=4.110, P=0.032), and anxiety and depression scores (F=9.317, P<0.001) at the 3 time points. Pearson correlation analyses showed that the maternal at the 3 time points dyadic coping and psychosomatic symptom clusters were significantly correlated at three time points (all P<0.05). Cross-lagged modeling showed that the dyadic coping levels on average had the negatively predicted correlation with the psychosomatic symptom clusters at the next node (all P<0.05), and that the psychosomatic symptom clusters did not have the predicted correlation with the dyadic coping longitudinally at the next node (all P>0.05). Conclusions: The dyadic coping ability of parturients is closely related to their mental and psychological symptom clusters. It is recommended that clinical workers dynamically monitor the dyadic coping status and changes in psychological symptoms of parturients at each stage, and implement early intervention for those with poor dyadic coping ability.

Key words: Postpartum period, Fatigue, Sleep disorders, Anxiety, Depression, Surveys questionnaires, Longitudinal studies, Dyadic coping

许金金, 郑利. 产妇二元应对与精神心理症状群的交叉滞后分析[J]. 国际生殖健康/计划生育杂志, 2025, 44(6): 448-452.

XU Jin-jin, ZHENG Li. Cross-Lagged Analysis of Maternal Dyadic Coping and Psychosomatic Symptom Clusters[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(6): 448-452.

图/表 4

参考文献 24

[1]	Ceriani Cernadas JM. Postpartum depression: Risks and early detection[J]. Arch Argent Pediatr, 2020, 118(3):154-155. doi: 10.5546/aap.2020.eng.154.
[2]	杨怀洁, 杨虹, 鲜文滢, 等. 孕产妇睡眠质量及产后睡眠的影响因素[J]. 中华疾病控制杂志, 2021, 25(2):176-179,239. doi: 10.16462/j.cnki.zhjbkz.2021.02.011.
[3]	Zacher Kjeldsen MM, Bang Madsen K, Liu X, et al. Identifying postpartum depression: Using key risk factors for early detection[J]. BMJ Ment Health, 2024, 27(1):e301206. doi: 10.1136/bmjment-2024-301206.
[4]	Gopalan P, Spada ML, Shenai N, et al. Postpartum Depression-Identifying Risk and Access to Intervention[J]. Curr Psychiatry Rep, 2022, 24(12):889-896. doi: 10.1007/s11920-022-01392-7.
[5]	Deligiannidis KM, Meltzer-Brody S, Maximos B, et al. Zuranolone for the Treatment of Postpartum Depression[J]. Am J Psychiatry, 2023, 180(9):668-675. doi: 10.1176/appi.ajp.20220785.
[6]	Vine T, Brown GM, Frey BN. Melatonin use during pregnancy and lactation: A scoping review of human studies[J]. Braz J Psychiatry, 2022, 44(3):342-348. doi: 10.1590/1516-4446-2021-2156.
[7]	Miller MA, Mehta N, Clark-Bilodeau C, et al. Sleep Pharmacotherapy for Common Sleep Disorders in Pregnancy and Lactation[J]. Chest, 2020, 157(1):184-197. doi: 10.1016/j.chest.2019.09.026. pmid: 31622589
[8]	Svensson F, Zwick S, Exner C, et al. Dyadic coping and illness adjustment after stroke: A longitudinal prospective study[J]. Rehabil Psychol, 2024, 69(4):384-394. doi: 10.1037/rep0000548. pmid: 38358713
[9]	Landolt SA, Weitkamp K, Roth M, et al. Dyadic coping and mental health in couples: A systematic review[J]. Clin Psychol Rev, 2023,106:102344. doi: 10.1016/j.cpr.2023.102344.
[10]	李贤, 刘桂芬, 何大卫, 等. 重复测量设计样本含量估计[J]. 中国卫生统计, 2001, 18(4):204-206. doi: 10.3969/j.issn.1002-3674.2001.04.004.
[11]	Xu F, Hilpert P, Randall AK, et al. Validation of the Dyadic Coping Inventory with Chinese couples: Factorial structure, measurement invariance, and construct validity[J]. Psychol Assess, 2016, 28(8):e127-140. doi: 10.1037/pas0000329.
[12]	韩秋凤, 田俊. 多维疲劳量表应用于肿瘤患者的信度和效度验证[J]. 中华护理杂志, 2012, 47(6):548-550. doi: 10.3761/j.issn.0254-1769.2012.06.024.
[13]	刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2):103-107. doi: 10.1007/BF02951625.
[14]	Molgora S, Saita E, Barbieri Carones M, et al. Predictors of Postpartum Depression among Italian Women: A Longitudinal Study[J]. Int J Environ Res Public Health, 2022, 19(3):1553. doi: 10.3390/ijerph19031553.
[15]	Zheng J, Gao L, Li H, et al. Postpartum depression and social support: A longitudinal study of the first six months as parents[J]. J Clin Nurs, 2023, 32(11/12):2652-2662. doi: 10.1111/jocn.16351.
[16]	汤丹丹, 温忠麟. 共同方法偏差检验:问题与建议[J]. 心理科学, 2020, 43(1):215-223. doi: 10.16719/j.cnki.1671-6981.20200130.
[17]	Meng J, Du J, Diao X, et al. Effects of an evidence-based nursing intervention on prevention of anxiety and depression in the postpartum period[J]. Stress Health, 2022, 38(3):435-442. doi: 10.1002/smi.3104.
[18]	Çankaya S, Buran G. The effects of dyadic coping strategies and dyadic conflict resolution styles on postpartum depression of mothers in heterosexual marriages in Turkey[J]. Bull Menninger Clin, 2023, 87(1):63-82. doi: 10.1521/bumc.2023.87.1.63. pmid: 36856475
[19]	Meier F, Milek A, Rauch-Anderegg V, et al. Fair enough? Decreased equity of dyadic coping across the transition to parenthood associated with depression of first-time parents[J]. PLoS One, 2020, 15(2):e0227342. doi: 10.1371/journal.pone.0227342.
[20]	Finnbogadóttir HR, Persson EK. Risk for partners′ depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study[J]. Eur J Midwifery, 2022,6:40. doi: 10.18332/ejm/148162.
[21]	Quin N, Lee JJ, Pinnington DM, et al. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum[J]. Sleep, 2022, 45(2):zsab293. doi: 10.1093/sleep/zsab293.
[22]	Alves S, Fonseca A, Canavarro MC, et al. Does Dyadic Coping Predict Couples′ Postpartum Psychosocial Adjustment? A Dyadic Longitudinal Study[J]. Front Psychol, 2020,11:561091. doi: 10.3389/fpsyg.2020.561091.
[23]	Liu Y, Zhang L, Guo N, et al. Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors[J]. BMC Psychiatry, 2021, 21(1):487. doi: 10.1186/s12888-021-03432-7. pmid: 34610797
[24]	Muanido A, Cumbe V, Manaca N, et al. Prevalence and associated factors of common mental disorders in primary care settings in Sofala Province, Mozambique[J]. BJPsych Open, 2023, 9(1):e12. doi: 10.1192/bjo.2022.613. pmid: 36632814

项目	分类	例数	百分比（%）
年龄（岁）	<30	85	52.47
年龄（岁）	≥30	77	47.53
居住地	农村	35	21.60
	乡镇	52	32.10
	城市	75	46.30
人均月收入（元）	≤3 000	26	16.05
	3 000~6 000	56	34.57
	6 000~10 000	58	35.80
	>10 000	22	13.58
职业	企事业单位	51	31.48
	农民	26	16.05
	职工/职员	54	33.33
	无固定职业	31	19.14
文化程度	初中及以下	47	29.01
	高中	66	40.74
	专科及以上	49	30.25
分娩方式	剖宫产	34	20.99
分娩方式	经阴道	128	79.01
产次（次）	1	127	78.40
	2	28	17.28
	≥3	7	4.32
喂养方式	母乳	79	48.77
	人工	35	21.60
	混合	48	29.63
喂养压力	有	92	56.79
喂养压力	无	70	43.21

项目	分类	例数	百分比（%）
年龄（岁）	<30	85	52.47
年龄（岁）	≥30	77	47.53
居住地	农村	35	21.60
	乡镇	52	32.10
	城市	75	46.30
人均月收入（元）	≤3 000	26	16.05
	3 000~6 000	56	34.57
	6 000~10 000	58	35.80
	>10 000	22	13.58
职业	企事业单位	51	31.48
	农民	26	16.05
	职工/职员	54	33.33
	无固定职业	31	19.14
文化程度	初中及以下	47	29.01
	高中	66	40.74
	专科及以上	49	30.25
分娩方式	剖宫产	34	20.99
分娩方式	经阴道	128	79.01
产次（次）	1	127	78.40
	2	28	17.28
	≥3	7	4.32
喂养方式	母乳	79	48.77
	人工	35	21.60
	混合	48	29.63
喂养压力	有	92	56.79
喂养压力	无	70	43.21

时间节点	二元应对							精神心理症状群
时间节点	DCI得分	压力沟通	积极应对	消极应对	代办应对	共同应对	应对评价	MFL得分	PSQI得分	HADS得分
T1	99.74±11.46	27.33±6.27	25.53±5.69	18.20±5.04	13.22±3.86	15.46±5.19	6.63±2.02	45.07±9.85	6.32±1.49	21.15±6.51
T2	104.79±11.97^a	28.42±5.39^a	26.62±5.37^a	19.29±5.11^a	13.91±3.74	16.55±5.02	7.12±2.11^a	43.26±8.57^a	5.60±1.34^a	19.76±6.35^a
T3	98.59±10.58^b	26.84±5.50^ab	24.74±5.18^b	18.11±5.31^b	12.83±3.67	15.07±5.04	6.24±2.14^b	40.15±8.64^ab	5.54±1.40^a	16.90±6.42^ab
F	8.338	4.336	4.114	4.425	3.725	3.199	4.682	8.126	4.110	9.317
P	<0.001	0.027	0.032	0.025	0.052	0.084	0.015	<0.001	0.032	<0.001

时间节点	二元应对							精神心理症状群
时间节点	DCI得分	压力沟通	积极应对	消极应对	代办应对	共同应对	应对评价	MFL得分	PSQI得分	HADS得分
T1	99.74±11.46	27.33±6.27	25.53±5.69	18.20±5.04	13.22±3.86	15.46±5.19	6.63±2.02	45.07±9.85	6.32±1.49	21.15±6.51
T2	104.79±11.97^a	28.42±5.39^a	26.62±5.37^a	19.29±5.11^a	13.91±3.74	16.55±5.02	7.12±2.11^a	43.26±8.57^a	5.60±1.34^a	19.76±6.35^a
T3	98.59±10.58^b	26.84±5.50^ab	24.74±5.18^b	18.11±5.31^b	12.83±3.67	15.07±5.04	6.24±2.14^b	40.15±8.64^ab	5.54±1.40^a	16.90±6.42^ab
F	8.338	4.336	4.114	4.425	3.725	3.199	4.682	8.126	4.110	9.317
P	<0.001	0.027	0.032	0.025	0.052	0.084	0.015	<0.001	0.032	<0.001

项目	DCI T1	MFL T1	PSQI T1	HADS T1	DCI T2	MFL T2	PSQI T2	HADS T2	DCI T3	MFL T3	PSQI T3	HADS T3
DCI T1	1
MFL T1	-0.415**	1
PSQI T1	-0.392**	0.560**	1
HADS T1	-0.456**	0.491**	0.482**	1
DCI T2	0.562**	-0.302*	-0.379**	-0.462**	1
MFL T2	-0.395**	0.488**	0.461**	0.356*	-0.398**	1
PSQI T2	-0.303*	0.446**	0.470**	0.477**	-0.374**	0.451**	1
HADS T2	-0.356**	0.410**	0.439**	0.459**	-0.411**	0.467**	0.492**	1
DCI T3	0.456**	-0.279*	-0.504**	-0.306*	0.450**	-0.455**	-0.393**	-0.461**	1
MFL T3	-0.283*	0.360**	0.310**	0.381**	-0.374**	0.416**	0.410**	0.477**	-0.372**	1
PSQI T3	-0.267*	0.322**	0.405**	0.390**	-0.361**	0.422**	0.450**	0.450**	-0.391**	0.410**	1
HADS T3	-0.310*	0.358**	0.399**	0.403**	-0.399**	0.437**	0.402**	0.416**	-0.388**	0.443**	0.424**	1