目的 调查妊娠晚期孕妇的心理健康状况及与分娩方式的关系,为促进妊娠期孕妇心理健康状况,优化分娩结局提供科学依据. 方法 选择2013年1月至2013年6月在海口市妇幼保健院进行产前检查并分娩的28~37周的孕妇作为研究对象,采用《症状自评量表( SCL-90 )》对孕妇的心理健康状况进行问卷调查;通过查阅分娩记录及电话随访等方式获取孕妇的分娩结局资料. 采用独立样本的t检验比较不同分组孕妇SCL-90因子得分及总分的差异;采用多因素Logistic回归模型分析影响妊娠晚期孕妇心理健康的危险因素. 结果 妊娠晚期孕妇心理状况SCL-90总评分显著高于国内常模组(t=4.152,P<0.001),且躯体化症状、人际关系敏感、强迫症状、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子评分均显著高于国内常模组(t值分别为3.989、5.128、4.012、18.556、21.025、8.836、3.852、4.193、3.512,均P<0.001). 妊娠晚期孕妇检出例数最多的前5位健康症状因子依次为:躯体化症状(11.56%)、精神病性(10.22%)、人际关系敏感(7.80%)、焦虑(7.53%)和抑郁(7.26%). 剖宫产孕妇心理状况SCL-90总评分显著高于自然分娩的孕妇(t=3.499,P<0.001),且躯体化症状、强迫症状、抑郁、焦虑、偏执、精神病性6个症状因子评分均显著高于自然分娩的孕妇(t值分别为4.215、3.315、2.283、2.621、2.452、3.884,均P<0.05). 而剖宫产孕妇的人际关系敏感、敌对、恐怖和其他4个症状因子评分在两组不同分娩方式孕妇之间的差异无统计学意义(均P>0.05). 经多因素Logistic回归分析显示,影响妊娠晚期孕妇心理健康的主要因素有:家族遗传病史( OR=3.893,P<0.001)、流产经历( OR=2.597,P=0.019)、孕期用药史(OR=2.042,P=0.015)、本科及以上文化程度(OR=1.196,P=0.023). 结论 妊娠晚期孕妇的心理健康状况较差,容易出现各种心理问题,有家族遗传病史、流产经历、孕期用药史、文化程度是影响妊娠晚期孕妇心理健康的主要因素,做好妊娠期孕妇心理健康教育工作尤为重要.%Objective To study the relationship between mental health of pregnant women in late pregnancy and delivery mode, so as to provide scientific evidence for promoting mental health of pregnant women in late pregnancy and improving birth outcomes.Methods Study subjects were pregnant women taking antenatal care and giving childbirth during the period of January 2013 to June 2013 in Haikou Women and Children Hospital, and self-designed questionnaire ( SCL-90 ) was used to survey pregnant women ' s mental health status.Birth outcomes of them were obtained by checking birth records or telephone follow-up.The differences in SCL-90 scores and total score between different groups were analyzed with t test, and the risk factors influencing mental health status of pregnant women were analyzed with multivariate Logistic regression analysis.Results The SCL-90 total score of mental status of pregnant women in late pregnancy was significantly higher than that of domestic norms (t =4.152, P <0.001), and the scores of somatization symptoms, interpersonal sensitivity, obsessive-compulsive symptoms, depression, anxiety, hostility, phobia, paranoid and psychosis were significantly higher than those of the domestic norms (t value was 3.989, 5.128, 4.012, 18.556, 21.025, 8.836, 3.852, 4.193 and 3.512, respectively, all P<0.001).The top 5 health symptoms detected among pregnant women in late pregnancy were as follows: somatization symptoms (11.56%), psychosis (10.22%), interpersonal relationship sensitivity (7.80%), anxiety (7.53%) and depression (7.26%).The SCL-90 total score of psychological status of pregnant women with cesarean section was significantly higher than that of natural childbirth pregnant women (t=3.499,P<0.001), and the scores of somatization symptoms, obsessive-compulsive symptoms, depression, anxiety, paranoid, psychosis symptoms were significantly higher than those of natural childbirth pregnant women ( t value was 4.215, 3.315, 2.283, 2.621, 2.452 and 3.884, respectively, all P<0.05).Scores of interpersonal relationship sensitivity, hostility, phobia and other symptom were significantly different between two groups (all P>0.05).Multivariate Logistic regression analysis showed that the major influencing factors of mental health of pregnant women in late pregnancy were family history (OR=3.893,P<0.001), history of abortion (OR=2.597,P=0.019), history of drug use during pregnancy (OR=2.042, P=0.015), and bachelor degree or above culture (OR=1.196, P=0.023).Conclusion Pregnant women in late pregnancy have poor mental health, and they are likely to suffer all kinds of psychological problems.Family genetic history, miscarriage experience, medication history during pregnancy and educational level are main factors influencing mental health of pregnant women in late pregnancy.It is very important to carry out mental health education for pregnant women during pregnancy.
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