產婦特性和憂鬱症相關性研究

研究背景依據過去文獻研究指出憂鬱症發生在女性的機會較高，可能和女性體內荷爾蒙的改變有關。有一些研究分析產婦和憂鬱症的關聯性，但多數為問卷調查(憂鬱量表)的資料，故本研究想藉由全民健保資料庫(National Health Insurance Research Database , NHIRD)，進行產婦特性(Maternal Characteristics)和憂鬱症(depression)相關性研究。研究目的分析台灣不同特性的產婦(不同年齡層、居住地區、投保金額的差異、生產方式)及相關疾病史，於妊娠前三年及產後一年內發生憂鬱症的相關性，希望能找出憂鬱症高危險群的產婦；並探討可能影響生產後憂鬱症之相關因素。研究方法利用全民健保資料庫(NHIRD)百萬歸人檔中的門診處方及治療明細檔 (CD 檔)、住院檔(DD檔)和承保資料檔(ID檔)（適用1999∼2008年資料），選取15-46歲的產婦作為研究對象。本研究分為產婦於產後有憂鬱症及產後無憂鬱症兩組，依變項為產後憂鬱症，自變項為產婦年齡（15-22歲產婦、23-28歲產婦、29-35歲產婦、36-46歲產婦）、居住地區、投保金額、生產方式的差異，控制變項為產婦疾病史(憂鬱症疾病史、妊娠合併症、產後併發症)，以Logistic regression分析產婦特性和憂鬱症之相關性。研究結果 23-28歲產婦組發生產後憂鬱症的風險為36-46歲以上高齡產婦組的1.38 倍，且年齡組別間達統計上差異(P=0.02)；產婦居住地、投保金額在產後憂鬱症的發生風險上皆達統計差異；居住在都會區的產婦比非都會區的產婦得到憂鬱症的風險是1.15倍；剖腹產比自然產發生產後憂鬱症的風險是1.26倍，在羅吉斯回歸模型中達統計顯著差異；在控制變項中有有憂鬱症疾病史的產婦發生產後憂鬱症的風險為11.94倍(P<0.001)；妊娠合併症有氣喘的產婦發生產後憂鬱症的風險為1.51倍(P<0.01)；產後併發症有產後出血的產婦發生產後憂鬱症的風險為2.25倍(P=0.018)具顯著差異；產後併發症有泌尿道感染的產婦發生產後憂鬱症的風險為1.52倍(P<0.001)具顯著差異。結論與建議 23-28歲產婦為次要生育人口，經羅吉斯回歸檢定雖統計結果未達顯著差異，但產後憂鬱症發生在此年齡族群上的風險較高；居住在都會區及自然產的產婦得到產後憂鬱症的風險也較高，且有憂鬱症疾病史的婦女也會增加得到產後憂鬱症的風險；若妊娠有氣喘、產後出血、產後有泌尿道感染的產婦都會增加發生憂鬱症的風險。建議衛生主管機關應將產後憂鬱症納入預防保健衛生政策內，可於產前早期篩檢預防且配合產後輔導及治療。

關鍵字

產婦特性，產婦年齡，憂鬱症

並列摘要

Background According to the findings of previous studies, Higher chance of depression occurred in women throughout the life. Some studies supported the association between women and depression was caused by the change of hormone level throughout the life. But most by investigated the relations among Primiparas Age and depression by questionnaire. Therefore, we intend to evaluate the relationship by applying the Taiwan National Health Insurance Research Database (NHIRD) for a long-term follow-up study. Objectives: Analysis of Taiwanese Maternal different characteristics (different ages, area of residence, Insurance amount, differences in the mode of production) and related diseases, in the three years before pregnancy, occurring within 1 year after production related depression, hoping to find a high-risk group of maternal depression; and to explore factors related to depression after production. Methods Use NHIRD a CD file, DD file and ID file (for 1999 to 2008 data), select maternal aged 15-46 years research object. The study is divided into a maternal in postpartum depression and postpartum depression without groups, the dependent variable is the initial occurrence of maternal depression, independent variables were maternal age, area of residence, Insurance amount, differences in production methods, the control variables were maternal history of disease (history of depressive illness, pregnancy complications, postpartum complications) to Logistic regression analysis of maternal characteristics and the correlation between depression. Results Maternal-age group of 23-28 years the risk of postpartum depression was 36-46 of age mothers group 1.38 times, and the age difference between groups was statistically significant (P = 0.02); Maternal residence, Insurance amount at the risk of postpartum depression was significant difference; Living in metropolitan areas than non-metropolitan areas of maternal get 1.15 times the risk of depression , Caesarean section than vaginal birth postpartum depression risk is 1.26 times. In a logistic regression model was statistically significant difference. In the control variable has a history of maternal depression disease risk for postpartum depression occurs 11.94 times (P <0.001). Pregnancy complications include asthma risk of maternal postpartum depression was 1.51 times (P <0.01);Postpartum complications of Postpartum Hemorrhage risk of maternal postpartum depression was 2.25 times (P=0.018) was statistically significant. Postpartum complications of urinary tract infection risk of maternal postpartum depression was 1.52 times (P <0.001) was statistically significant. Conclusion 23-28 year-old Maternal is secondary childbearing population. But in this age group at highest risk of postpartum depression. And there is a history of depressive disease women get postpartum depression of the risk also increases. Have asthma during pregnancy and delivery after urinary tract infection, Postpartum Hemorrhage will increase the risk of depression. Postpartum depression is a major issue which impacts maternal health. Competent health authorities shall include preventive care postpartum depression within health policy. Early screening for prevention of pre-production and with postpartum psychological counseling and therapy.