孕期心理健康状态与睡眠质量的纵向研究

季文佳; 饶琳; 周璇; 刘志伟; 李红

doi:10.16766/j.cnki.issn.1674-4152.003168

孕期心理健康状态与睡眠质量的纵向研究

doi: 10.16766/j.cnki.issn.1674-4152.003168

季文佳^{1, 2},
饶琳³,
周璇³,
刘志伟³,
李红^{2, 3, ,}

1.
上海交通大学医学院附属瑞金医院护理部，上海 200025
2.
上海交通大学护理学院，上海 200025
3.
上海交通大学医学院附属国际和平妇幼保健院护理部，上海 200030

基金项目:

科技部国家重点研发计划项目 2022YFC2702903

科技部国家重点研发计划项目 2016YFC1000203

上海交通大学医学院护理学科建设项目沪交医[2021]21

上海市护理学会重点项目 2022SD-B02

详细信息

通讯作者:
李红，E-mail：2750074682@qq.com

中图分类号: R725.3
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- 文章访问数: 423
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- 被引次数: 0
出版历程
- 收稿日期: 2022-12-07
- 网络出版日期: 2023-10-19

Longitudinal study of gestational psychological health and sleep quality

JI Wenjia^{1, 2},
RAO Lin³,
ZHOU Xuan³,
LIU Zhiwei³,
LI Hong^{2, 3
, ,}

1.
Nursing Department, Ruijin Hospital Affiliated to Jiaotong University School of Medicine, Shanghai 200025, China

摘要

摘要: 目的探讨孕期女性心理健康状态、睡眠质量变化，分析孕期睡眠质量影响因素。方法选择2020年1月—2021年12月于上海交通大学医学院附属国际和平妇幼保健院产检的3 904例自然受孕女性为研究对象，使用焦虑自评量表(SAS)、抑郁自评量表(CES-D)、压力感知量表(PSS-10)、匹兹堡睡眠质量指数(PSQI)评估孕早期(10~14孕周)、孕中期(20~24孕周)、孕晚期(28~32孕周)女性的心理健康状态和睡眠质量，分析睡眠质量影响因素。结果孕早期女性的焦虑、抑郁、有压力占比分别为11.83%、42.32%、71.47%，较孕中、晚期高；孕早、中、晚期睡眠质量问题占比分别为14.81%、50.59%、16.14%；线性混合模型分析显示，焦虑(B=0.548，P<0.001)、抑郁(B=0.768，P<0.001)、压力(B=0.649，P=0.002)、年龄(B=0.646，P=0.023)、大专及以上学历(B=0.699，P=0.023)、无业(B=0.429，P=0.004)、家庭收入(B=0.452，P=0.039)、孕次(B=0.608，P=0.044)、产次(B=0.606，P=0.017)是孕期女性睡眠质量问题的影响因素(均P<0.05)，随机截距模型显示随着孕期时间增加，孕期不同女性睡眠质量变化趋势相同(B=9.621，P<0.001)。结论孕期女性易出现焦虑、抑郁、压力等心理问题，且孕期心理健康与睡眠质量息息相关，妇幼专科技术人员应及时关注孕早期心理状况及孕期睡眠质量。
- 孕期女性 /
- 孕期 /
- 焦虑 /
- 压力 /
- 抑郁 /
- 睡眠质量 /
- 相关性
Abstract: Objective To explore changes of gestational psychological health and sleep quality in women, and to analyze influencing factors of sleep quality. Methods A total of 3 904 natural conception women undergoing antenatal examinations in the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine were enrolled as the research objects from January 2020 to December 2021. The psychological health and sleep quality of women in early (10-14 gestational weeks), middle (20-24 gestational weeks) and late pregnancy (28-32 gestational weeks) were evaluated by self-rating anxiety scale (SAS), the center for epidemiological studies depression scale (CES-D), the perceived stress scale (PSS-10) and Pittsburgh sleep quality index (PSQI), and influencing factors of sleep quality were analyzed. Results In early pregnancy, proportions of anxiety, depression and stress were 11.83%, 42.32% and 71.47%, which were higher than those in middle and late pregnancy. The proportions of sleep disorders in early, middle and late pregnancy were 14.81%, 50.59% and 16.14%, respectively. Linear mixed model analysis showed that anxiety (B=0.548, P<0.001), depression (B=0.768, P<0.001), stress (B=0.649, P=0.002), age (B=0.646, P=0.023), education level of college degree or above (B=0.699, P=0.023), unemployment (B=0.429, P=0.004), family income (B=0.452, P=0.039), gravidity (B=0.608, P=0.044) and parity (B=0.606, P=0.017) were influencing factors of sleep disorders (all P<0.05). The random intercept model showed that with the increase of pregnant time, the change trend of sleep quality was the same in women with different gestational periods (B=9.621, P<0.001). Conclusion The incidence of psychological problems (anxiety, depression, stress) is high in women during pregnancy. Gestational psychological health is closely related to sleep quality. Professional staffs for women and children should pay attentions to psychological status in early pregnancy and sleep quality during pregnancy.
- Woman during pregnancy /
- Gestational period /
- Anxiety /
- Stress /
- Depression /
- Sleep quality /
- Correlation

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表 1 自然受孕女性人口学特征分布情况

Table 1. Distribution of demographic characteristics of naturally conceived women

人口学特征	例数(%)	人口学特征	例数(%)
年龄(岁)		家庭收入(元/年)
≥30	2 031(52.02)	≥10万	2 221(56.89)
<30	1 873(47.98)	<10万	1 683(43.11)
BMI		孕次(次)
≥24	1 030(26.38)	≥3	2 600(66.60)
<24	2 874(73.62)	<3	1 304(33.40)
居住地		产次(次)
城市	1 406(36.01)	≥3	1 332(34.12)
城郊	1 727(44.24)	<3	2 572(65.88)
农村	771(19.75)	饮食不佳	922(23.62)
学历		饮酒	665(17.03)
初中及以下	913(23.39)	被动烟草暴露	734(18.80)
高中或中专	1 728(44.26)	经前紧张综合征	993(25.44)
大专及以上	1 263(32.35)
职业
职员	2 270(58.15)
个体户	1 018(26.08)
无业	616(15.78)

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表 2 不同孕期女性的心理健康状态和睡眠质量情况[例(%)]

Table 2. Mental health status and sleep quality of women during different pregnancies[cases (%)]

孕期	例数	焦虑	抑郁	有压力	睡眠质量问题
孕早期	3 904	462(11.83)	1 652(42.32)	2 790(71.47)	578(14.81)
孕中期	3 904	184(4.71)^a	796(20.39)^a	1 950(49.95)^a	1 975(50.59)^a
孕晚期	3 904	248(6.35)^ab	848(21.72)^a	1 772(45.39)^ab	630(16.14)^b
Wald χ²值		114.361	468.047	569.430	1 349.441
P值		<0.001	<0.001	<0.001	<0.001
注：与孕早期比较，^aP<0.05；与孕中期比较，^bP<0.05。

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表 3 不同孕期女性不良睡眠质量发生相关因素分析

Table 3. Analysis of related factors of poor sleep quality in women during different pregnancies

项目	孕早期 (n=578)	χ²值	P值	孕中期 (n=1 975)	χ²值	P值	孕晚期 (n=630)	χ²值	P值
年龄(岁)		29.588	<0.001		15.546	<0.001		19.919	<0.001
≥30	361			1 089			379
<30	217			886			251
孕前BMI		0.589	0.443		0.136	0.713		0.076	0.783
≥24	160			516			169
<24	418			1 459			461
居住地		20.308	<0.001		90.790	<0.001		66.629	<0.001
城市	181			671			198
城郊	244			796			233
农村	153			508			199
学历		28.717	<0.001		32.766	<0.001		11.037	0.004
初中及以下	156			491			165
高中或中专	197			786			241
大专及以上	225			698			224
职业		43.258	<0.001		19.216	<0.001		33.015	<0.001
职员	292			1 134			325
个体户	142			482			158
无业	144			359			147
家庭收入(元/年)		24.890	<0.001		27.133	<0.001		15.220	<0.001
≥10万	274			1 043			314
<10万	304			932			316
孕次(次)		11.872	0.001		12.785	<0.001		8.949	0.003
≥3	421			1 368			452
<3	157			607			178
产次(次)		17.327	<0.001		20.588	<0.001		5.715	0.017
≥3	241			741			241
<3	337			1 234			389
饮食不佳		0.812	0.367		0.760	0.383		1.005	0.316
是	145			478			139
否	433			1 497			491
饮酒		2.261	0.133		0.643	0.423		0.147	0.701
是	111			327			104
否	467			1 648			526
被动烟草暴露		1.419	0.234		0.395	0.529		0.081	0.776
是	119			379			121
否	459			1 596			509
经前紧张综合征		0.522	0.470		0.733	0.392		1.624	0.203
是	154			514			173
否	424			1 461			457
焦虑		166.895	<0.001		66.329	<0.001		257.596	<0.001
是	154			147			130
否	424			1 828			500
抑郁		118.639	<0.001		191.815	<0.001		326.095	<0.001
是	364			577			308
否	214			1 398			322
压力		51.026	<0.001		486.496	<0.001		190.736	<0.001
是	485			1 331			444
否	93			644			186

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表 4 变量名称及赋值情况

Table 4. Variable name and assignment

变量类型	变量名称	赋值方法
因变量	睡眠质量	PSQI≤6分=0，PSQI＞7分=1
自变量
X1	年龄	<30岁=0，≥30岁=1
X2	孕前BMI	<24=0，≥24=1
X3	居住地	城市=(0, 0)，城郊=(0，1)，农村=, (1，0)
X4	学历	初中及以下=0，高中或中专=1，大专及以上=2
X5	职业	职业=(0, 0, 0)，职员=(1，0，0)，个体户=(0，1，0)，无业=(0，0，1)
X6	家庭年收入	≥10万/年=0，<10万/年=1
X7	孕次	<3次=0，≥3=1
X8	产次	<3次=0，≥3=1
X9	饮食不佳	否=0，是=1
X10	饮酒	否=0，是=1
X11	被动烟草暴露	否=0，是=1
X12	经前紧张综合征	否=0，是=1
X13	焦虑	SAS<49分=0，SAS≥50分=1
X14	抑郁	CES-D<15分=0，CES-D≥16分=1
X15	压力	PSS-10≤9分=0，PSS-10>10分=1

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表 5 孕期女性睡眠质量变化固定效应分析结果

Table 5. Fixed effect analysis of sleep quality change in pregnant women

变量	B	SE	t值	P值	95% CI
焦虑	0.548	0.114	5.242	<0.001	0.334~0.762
抑郁	0.768	0.103	6.128	<0.001	0.423~1.113
压力	0.649	0.204	3.214	0.002	0.389~0.909
年龄	0.646	0.283	2.987	0.023	0.355~0.937
BMI	0.356	0.222	1.667	0.109	0.157~0.556
居住地
城郊	0.686	0.514	1.113	0.183	0.397~0.975
农村	0.482	0.339	1.146	0.156	0.236~0.728
学历
高中或中专	0.427	0.267	1.583	0.110	0.197~0.658
大专及以上	0.699	0.307	3.018	0.023	0.364~1.034
职业
个体户	0.478	0.280	3.034	0.088	0.193~0.763
无业	0.429	0.149	3.360	0.004	0.244~0.614
家庭收入(元/年)
<10万	0.452	0.219	3.258	0.039	0.278~0.626
孕次(次)
≥3	0.608	0.301	3.309	0.044	0.415~0.801
产次(次)
≥3	0.606	0.254	3.429	0.017	0.433~0.778
饮食不佳	0.424	0.285	1.607	0.137	0.239~0.610
饮酒	0.564	0.387	1.425	0.145	0.374~0.754
被动烟草暴露	0.634	0.465	1.204	0.173	0.398~0.871
经前紧张综合征	0.680	0.549	1.033	0.216	0.433~0.927

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