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中国高龄产妇产后抑郁检出率的Meta分析

The Detection Rate of Postpartum Depression in Advanced Maternal Age in China:a Meta-analysis

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背景 随着我国经济的高速发展和现代人生育观念的转变,高龄产妇的数量正在逐年增加.相较于适龄产妇,高龄产妇更可能因自身、家庭、工作等原因产生抑郁症状.目的 系统评价我国高龄产妇(分娩时年龄≥35岁)产后抑郁检出率,为早期预防和干预提供相关依据.方法 在中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库和PubMed、Cochrane Library、Embase、Web of Science数据库中以主题词和自由词相结合的方式检索与中国高龄产妇产后抑郁检出率相关的文献,检索时限为数据库建库至 2023 年 7 月.文献筛选、资料提取和质量评价过程由 2 名研究员独立进行.使用Stata 16.0 软件进行数据分析.结果 共纳入 21 篇文献,样本量合计 5 163例.Meta分析结果显示,我国高龄产妇产后抑郁总检出率为 20.0%(95%CI=17.4%~22.6%).亚组分析结果显示,年龄<40 岁高龄产妇产后抑郁检出率为 19.5%(95%CI=13.8%~25.3%),≥40 岁为 40.3%(95%CI=11.4%~69.3%);文化程度高中以上为 19.7%(95%CI=11.7%~27.7%),高中及以下为 30.7%(95%CI=19.1%~42.3%);初产妇为 21.1%(95%CI=14.4%~27.9%),经产妇为 16.2%(95%CI=12.9%~19.6%);自然分娩为 16.4%(95%CI=12.2%~20.6%),剖宫产为 27.8%(95%CI=20.9%~34.8%);新生儿性别男性为 20.7%(95%CI=15.6%~25.8%),女性为 27.3%(95%CI=20.5%~34.0%);有妊娠并发症为 38.7%(95%CI=22.6%~54.8%),无妊娠并发症为 11.7%(95%CI=7.6%~15.8%);有不良孕产史为 29.5%(95%CI=17.9%~41.1%),无不良孕产史为 27.7%(95%CI=16.6%~38.8%);发表年份为 2020 年以前为 18.0%(95%CI=16.5%~19.4%),发表年份为 2020 年及以后为 19.5%(95%CI=18.0%~21.0%);调查地区北方为20.4%(95%CI=18.2%~22.6%),南方为18.2%(95%CI=17.0%~19.4%);爱丁堡产后抑郁量表(EPDS)评分≥13 分为 20.0%(95%CI=18.5%~21.5%),≥10 分为 16.9%(95%CI=15.2%~18.5%).Egger's检验(t=1.76,P=0.095)和Begg's检验(Z=1.48,P=0.147)提示不存在明显发表偏倚.结论 我国高龄产妇产后抑郁检出率较高(20.0%),其中年龄≥40 岁、文化程度高中及以下、初产妇、剖宫产、新生儿性别为女性、有妊娠并发症、有不良孕产史、发表年份为 2020 年及以后、调查地区为北方、EPDS评分≥13 分的高龄产妇产后抑郁检出率较高,应重视以上高龄产妇的心理状况,并制定相应的预防和干预措施.
Background With the rapid development of economy and the change of fertility concept in modern population,the number of advanced maternal age is increasing year by year.Compared with appropriate maternal age,advanced maternal age is more likely to suffer from depressive symptoms due to personal,family,work,and other reasons.Objective To systematically evaluate the detection rate of postpartum depression in advanced maternal age(≥35 years at delivery)in China to provide relevant evidence for early prevention and intervention.Methods CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,and Web of Science were searched for articles on the detection rate of postpartum depression in advanced maternal age in China by combining subject terms and free terms from inception to July 2023.The process of literature screening,data extraction and quality assessment were carried out by two researchers independently.Stata 16.0 software was used for data analysis.Results A total of 21 studies were included,with a total sample size of 5 163.The results of Meta-analysis showed that the overall detection rate of postpartum depression in advanced maternal age in China was 20.0%(95%CI=17.4%-22.6%).The subgroup analysis revealed that the detection rate of postpartum depression was 19.5%(95%CI=13.8%-25.3%)in women<40 years old,40.3%(95%CI=11.4%-69.3%)in women≥40 years old,19.7%(95%CI=11.7%-27.7%)in women with high school education level or higher,30.7%(95%CI=19.1%-42.3%)in women with high school education level or lower,21.1%(95%CI=14.4%-27.9%)in primipara,16.2%(95%CI=12.9%-19.6%)in multipara,16.4%(95%CI=12.2%-20.6%)in natural childbirth,27.8%(95%CI=20.9%-34.8%)in cesarean section,20.7%(95%CI=15.6%-25.8%)in women with male newborn and 27.3%(95%CI=20.5%-34.0%)in women with female newborn;there were 38.7%(95%CI=22.6%-54.8%)women with pregnancy complications,11.7%(95%CI=7.6%-15.8%)women without pregnancy complications,29.5%(95%CI=17.9%-41.1%)women with adverse pregnancy and childbirth history,27.7%(95%CI=16.6%-38.8%)women without adverse pregnancy and childbirth history,18.0%(95%CI=16.5%-19.4%)published the year before 2020,19.5%(95%CI=18.0%-21.0%)published the year after 2020,20.4%(95%CI=18.2%-22.6%)in the north and 18.2%(95%CI=17.0%-19.4%)in the south,20.0%(95%CI=18.5%-21.5%)in the Edinburgh Postnatal Depression Scale(EPDS)score≥13 and 16.9%(95%CI=15.2%-18.5%)in the EPDS score≥10.The Egger's test(t=1.76,P=0.095)and the Begg's test(Z=1.48,P=0.147)indicated no significant publication bias.Conclusion The detection rate of postpartum depression is higher for advanced maternal age in China,including women≥40 years old,with high school education level or lower,primipara,cesarean section,female newborn,pregnancy complications and adverse pregnancy and childbirth history,publish year after 2020,areas of the north,EPDS score≥13,attention should be paid to the psychological status of advanced maternal age,and corresponding prevention and intervention measures should be formulated.

Depression,postpartumMaternalAdvanced ageDetection rateMeta-analysisChina

李龙、安雪梅、张杰、黄琳瑜、张兴玲

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610075 四川省成都市,成都中医药大学护理学院

610032 四川省成都市,成都中医药大学附属医院护理部

抑郁症,产后 产妇 高龄 检出率 Meta分析 中国

四川省科技厅科研项目

2023JDKP0092

2024

中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
年,卷(期):2024.27(11)
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