目的 分析孕晚期综合性医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HAD)评分对产后抑郁症的预测效果,为孕晚期识别产后抑郁症高危孕妇提供依据.方法 采用一般情况调查表及自编相关因素调查表和HAD,在孕晚期对1 230例孕妇进行测评,并于产后4周内采用HAD、爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)再次对其进行测评,经受试者工作特征曲线法分析孕晚期HAD分值对产后抑郁症的预测效果.结果 (1)孕晚期焦虑、抑郁症状发生率为5.20％ (64/1 230)、4.07％ (50/1 230);产后抑郁症发生率为9.98％ (121/1 213).(2)根据两步筛查法确诊产后抑郁症患者121例(患者组)和健康对照者1 092名(对照组),2组在年龄、夫妻感情、工作学习压力、分娩育儿及产后抑郁知识的了解程度、产妇对胎儿的性别歧视及入组时HAD评分(A和D评分)以及产后EPDS评分上差异均有统计学意义(x2=6.54、6.92、8.07、23.82、21.88、10.24、9.26、6.63、5.66,均P＜0.05),而婚姻状况、性格、文化程度、职业、不良产史、孕期并发症、丈夫及家人对胎儿性别的歧视方面差异均无统计学意义.(3)经受试者工作特征曲线法分析,孕晚期HAD最佳临界值为9分,预测产后抑郁症的敏感度、特异度分别为86.21％和87.64％、95.43％和94.72％.(4)受试者工作特征曲线下面积分别为0.941和0.914.(5)孕晚期HAD最佳临界值和产后EPDS分值相关(r=0.852、0.846,均P＜0.01).(6)孕晚期HAD≥9分孕妇发生产后抑郁症的相对危险度分别增加15.891、18.264倍.结论 孕晚期可将HAD作为产后抑郁症高危孕妇的常规筛查工具,对HAD分值≥9分的孕妇应同时进行产后抑郁危险因素的综合评估.%Objective To explore the possibility of predicting postnatal depression based on Hospital Anxiety and Depression (HAD) scale for women during the third trimester of pregnancy.Methods 1 230 pregnant women were evaluated during their third trimester of pregnancy using HAD scale deriving from common questionnaire and self-related questionnaire,and again 4 weeks postnatal using Edinburgh Postnatal Depression Scale (EPDS).Results (1) The incidences for depression and anxiety during the third trimester of pregnancy were 5.20％ (64 /1 230) and 4.07％ (50 /1 230),respectively.The incidence of postnatal depression was 9.98％ (121 /1 213).(2) According to the two step screening diagnosis for severe postnatal depression,the 1 230 cases were categorized into patient group (121 cases) and normal group (1 092 cases).There were statistically significant differences between the two groups in age,the relationship of the couple,work and study pressure,knowledge of childbirth,parenting and postnatal depression,maternal gender discrimination,group HAD score and EPDS score (x2 =6.54,6.92,8.07,23.82,21.88,10.24,9.26,6.63,5.66,P ＜ 0.05 for all).There were no significant differences between the two groups in marital status,personality,level of education,occupation,history of abnormal delivery,complications of pregnancy,gender discrimination from the husband and/or family.(3) In ROC curve the optimal critical value of the HAD during postnatal depression was 9 symptoms.For the cases who got an A or D in the HAD scale,the sensitivity and specificity of predicting postnatal depression were 86.21％/87.64％,95.43％/94.72％,respectively.(4) For the cases who got an A or D in the HAD scale,the area under the ROC curve were 0.941 and 0.914,respectively.(5) The optimal critical value of HAD was related to the scores of EPDS after delivery (r =0.852,0.846,both P ＜ 0.01).(6) For the cases with HAD ≥ 9 points,the probability for the risk of postnatal depression will be increased by 15.891 and 18.264 times,respectively.Conclusion HAD scale can be used as a routine screening method for women in late stage pregnancy.Women with HAD ≥ 9 points should be comprehensively evaluated for the risk of postnatal depression.
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