妊娠期糖尿病孕妇妊娠相关焦虑的潜在类别分析

doi:10.3761/j.issn.0254-1769.2020.10.010

摘要/Abstract

摘要：

目的探索妊娠期糖尿病孕妇妊娠相关焦虑的潜在类别,分析不同类别孕妇的特征差异。方法于2018年12月—2019年5月便利选取郑州市某三级甲等医院门诊的172例妊娠期糖尿病孕妇为研究对象,采用一般资料调查表、妊娠相关焦虑量表、易感性人格类型问卷和心理弹性量表进行调查。结果妊娠期糖尿病孕妇妊娠相关焦虑分为2个潜在类别：焦虑高发组（59.0%）和低焦虑-担心胎儿组（41%）;Logistic回归分析结果显示,大专及以上学历（OR=6.799）、既往有不良妊娠史（OR=4.276）、易感性人格（OR=5.999）是妊娠相关焦虑高发的危险因素（均P<0.05）,心理弹性得分是妊娠相关焦虑高发的保护因素（OR=0.940,P<0.05）。结论妊娠期糖尿病孕妇妊娠相关焦虑有明显的分类特征,高学历、不良妊娠史及易感性人格的孕妇焦虑高发,应多关注该类别孕妇;高心理弹性是妊娠相关焦虑的保护因素,应注重挖掘孕妇的心理弹性,减轻其心理应激,缓解孕妇妊娠相关焦虑。

关键词: 妊娠期糖尿病, 焦虑, 潜在类别分析, 心理弹性, 易感性人格, 护理

Abstract:

Objective To explore the potential categories of pregnancy-related anxiety in patients with gestational diabetes mellitus（GDM）,and the different characteristics of each potential categories. Methods From December 2018 to May 2019,172 gestational diabetes mellitus patients were investigated by general information questionnaire,Pregnancy-related Anxiety Questionnaire（PAQ）,Vulnerable Personality Style Questionnaire（VPSQ） and Connor-Davidson Resilience Scale（CD-RISC）. Results Pregnancy-related anxiety in patients with GDM has 2 potential categories,namely high incidence of anxiety group（59.0%） and low anxiety-worry fetus group（41%）. Logistic regression analysis showed that college degree or above（OR=6.799）,adverse pregnancy history（OR=4.276） and susceptibility personality（OR=5.999） were risk factors for high incidence of anxiety（P<0.05）. Psychological resilience was protective factor for high incidence of anxiety（OR=0.940,P<0.05）. Conclusion GDM patients have obvious classification characteristics of pregnancy-related anxiety. Patients with high education,adverse pregnancy history and susceptibility personality have high incidence of anxiety,therefore,this population should be given more attention for caring. The low psychological resilience is related to the pregnancy-related anxiety,so it is necessary to develop the psychological resilience of patients,relieve their psychological stress,and alleviate their pregnancy-related anxiety.

Key words: Gestational Diabetes Mellitus, Anxiety, Latent Class Analysis, Psychological Resilience, Susceptible Personality, Nursing Care

张贤贤,张利霞,贾智慧,张博雅. 妊娠期糖尿病孕妇妊娠相关焦虑的潜在类别分析[J]. 中华护理杂志, 2020, 55(10): 1503-1508.

ZHANG Xianxian,ZHANG Lixia,JIA Zhihui,ZHANG Boya. Analysis of potential categories of pregnancy-related anxiety in patients with gestational diabetes mellitus[J]. Chinese Journal of Nursing, 2020, 55(10): 1503-1508.

图/表 4

表1 妊娠相关焦虑的潜在类别模型适配指标

Table 1 Latent class model fit indicators for pregnancy-related anxiety

图1 2个潜在类别在妊娠相关焦虑量表各条目上的条件概率分布图

Figure 1. Conditional probability distribution of 2 latent classes on each item of Pregnancy-related Anxiety Questionnaire

表2 2个潜在妊娠相关焦虑类别妊娠期糖尿病孕妇的不同特征分析[例（百分比,%）]

Table 2 Analysis of different characteristics of pregnant women with gestational diabetes mellitus in 2 latent classes of pregnancy-related anxiety [case（percentage,%）]

表3 妊娠相关焦虑潜在类别的多因素分析

Table 3 Multi-factor analysis of latent classes of pregnancy-related anxiety

参考文献 20

[1]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会妊娠合并糖尿病协作组. 妊娠合并糖尿病诊治指南(2014)[J]. 中国实用乡村医生杂志, 2017,24(8):45-52.
	Obstetrics Group,Chinese Society of Obstetrics and Gynecology,Chinese Medical Association;; Cooperation Group of Pregnancy and Diabetes Mellitus,Chinese Society of Perinatal Medicine,Chinese Medical Association. Guidelines for the Diagnosis and Treatment of Gestational Diabetes Mellitus（GDM）（2014）[J]. Chin J Pract Rur Doct, 2017,24(8):45-52.
[2]	勾宝华, 关惠敏, 高立研, 等. 综合护理干预在妊娠期糖尿病高危人群中的应用[J]. 中华护理杂志, 2019,54(4):511-515.
	Gou BH, Guan HM, Gao LY, et al. The effects of comprehensive nursing intervention on gestational diabetes mellitus in high-risk pregnant women[J]. Chin J Nurs, 2019,54(4):511-515.
[3]	Gao CH, Sun X, Lu L, et al. Prevalence of gestational diabetes mellitus in mainland China:a systematic review and meta-analysis[J]. J Diabetes Investig, 2019,10(1):154-162. DOI URL PMID
[4]	Blackmore ER, Gustafsson H, Gilchrist M, et al. Pregnancy-related anxiety:evidence of distinct clinical significance from a prospective longitudinal study[J]. J Affect Disord, 2016,197:251-258. DOI URL PMID
[5]	祁梦君, 朱淑青, 张利霞, 等. 妊娠糖尿病患者妊娠相关焦虑及影响因素分析[J]. 现代预防医学, 2018,45(1):183-187.
	Qi MJ, Zhu SQ, Zhang LX, et al. Pregnancy related anxiety and its influencing factors in pregnant women with gestational diabetes mellitus[J]. Mod Preve Med, 2018,45(1):183-187.
[6]	苏斌原, 张洁婷, 喻承甫, 等. 大学生心理行为问题的识别:基于潜在剖面分析[J]. 心理发展与教育, 2015,31(3):350-359.
	Su BY, Zhang JT, Yu CF, et al. Identifying psychological or behavioral problems of college students:based on Latent profile analysis[J]. Psychol Develop Edu, 2015,31(3):350-359.
[7]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中国实用内科杂志, 2018,38(4):292-344.
	Chinese Society of Diabetes,Chinese Medical Association. Guidelines for the prevention and control of type 2 diabetes in China(2017 Edition)[J]. Chin J Practical Internal Med, 2018,38(4):292-344.
[8]	肖利敏, 陶芳标, 章景丽, 等. 妊娠相关焦虑量表编制及信度评价[J]. 中国公共卫生, 2012,28(3):275-277. DOI URL
	Xiao LM, Tao FB, Zhang JL, et al. Development and reliability evaluation of a Pregnancy-Related Anxiety Questionnaire[J]. Chin J Public Health, 2012,28(3):275-277. DOI URL
[9]	Boyce P, Hickey A, Gilchrist J, et al. The development of a brief personality scale to measure vulnerability to postnatal depression[J]. Arch Women#s Ment Heal, 2001,3(4):147-153.
[10]	金三丽, 李明子. 易感性人格类型量表预测产后抑郁症的效果研究[J]. 中华护理杂志, 2006,41(9):781-784.
	Jin SL, Li MZ. A study of the effectiveness of Vulnerable Personality Style Questionnaire to predict postpartum depression[J]. Chin J Nurs, 2006,41(9):781-784.
[11]	Yu XN, Zhang JX. Factor analysis and psychometric evaluation of the connor-Davidson resilience scale(cd-risc) with Chinese people[J]. Soc Behav Pers, 2007,35(1):19-30. DOI URL
[12]	Collins LM, Lanza ST. Latent class and latent transition analysis[M]. Hoboken USA, 2009.
[13]	章景丽, 郝加虎, 陶芳标, 等. 孕早期妊娠相关焦虑影响因素分析[J]. 中国公共卫生, 2011,27(08):969-71.
	Zhang JL, Hao JH, Tao FB, et al. Influencing factors of pregnancy-related anxiety in first trimester of pregnancy[J]. Chin J Public Health, 2011,27(08):969-71.
[14]	李君琴, 曹淑殷, 余晓燕. 孕中晚期妇女妊娠相关焦虑及其影响因素分析[J]. 中华护理杂志, 2016,51(7):798-803.
	Li JQ, Cao SY, Yu XY. The level and influencing factors of pregnancy-related anxiety among pregnant women during mid-late pregnancy[J]. Chin J Nurs, 2016,51(7):798-803.
[15]	徐秀菊. 高龄经产妇产后抑郁与人格特征、社会支持的相关性研究[D]. 济南:山东大学, 2017.
	Xu XJ. A study on the correlation between postpartum depression and personality and social support in elderly postpartum women[D]. Jinan:Shandong University, 2017.
[16]	李瑶, 秦春香, 孙玫, 等. 因胎儿异常引产孕妇产后抑郁的发生情况及其影响因素[J]. 解放军护理杂志, 2017,34(19):1-6.
	Li Y, Qin CX, Sun M, et al. Survey of postpartum depression and its influencing factors among women with termination of pregnancy for fetal abnormality[J]. Nurs J Chinese People#s Liberation Army, 2017,34(19):1-6.
[17]	芦沁蕊, 丁琳, 王艳丽, 等. 心理弹性调节围产期妇女产前感知压力与产后抑郁的关系[J]. 护理研究, 2019,33(11):1906-1910.
	Lu QR, Ding L, Wang YL, et al. Moderating effect of psychological resilience between prenatal perceived stress and postnatal depression among perinatal women[J]. Chin Nurs Res, 2019,33(11):1906-1910.
[18]	章新琼, 吴小婷, 韩世钰, 等. 化疗期胃癌患者心理弹性预测因素的纵向研究[J]. 中国心理卫生杂志, 2019,33(9):695-700.
	Zhang XQ, Wu XT, Han SY, et al. Longitudinal study on predictors of resilience in patients with gastric cancer during chemotherapy[J]. Chin Mental Health J, 2019,33(9):695-700.
[19]	钟婕, 周英凤, 李丽, 等. 妊娠期糖尿病孕妇心理弹性现况及影响因素研究[J]. 护理学杂志, 2019,34(4):74-78.
	Zhong J, Zhou YF, Li L, et al. The level and factors associated with resilience among women with gestational diabetes mellitus[J]. J Nurs Sci, 2019,34(4):74-78.
[20]	宋丽青, 李金莲, 陶敏. 孕妇妊娠压力状况及其影响因素调查[J]. 中华护理杂志, 2013,48(9):808-811.
	Song LQ, LI JL, Tao M. The level and influence factors of maternal stress among pregnant women[J]. Chin J Nurs, 2013,48(9):808-811.