剖宫产围产期抑郁现状及其影响因素的研究进展
Research Progress on the Current Status and Influencing Factors of Perinatal Depression in Cesarean Section
DOI: 10.12677/acm.2025.15113068, PDF,   
作者: 陈 洁, 何陈玉, 周卫华：吉首大学医学院，湖南 吉首；唐妍妍*：永州市中心医院神经内科，湖南 永州
关键词: 剖宫产；围产期抑郁；妊娠；影响因素；Cesarean Section； Perinatal Depression； Pregnancy； Influencing Factors
摘要: 围产期抑郁(perinatal depression, PND)是孕产妇妊娠及产褥期一种常见的精神障碍性疾病，影响高达全球1/5的女性，包括产前抑郁及产后抑郁。PND的发生与社会人口、心理、产科等因素有关，其可能会影响母婴身心健康甚至出现不良结局。剖宫产作为常见的外科手术，手术本身的疼痛，术后恢复时间长和术后并发症风险，这会增加孕产妇的心理负担而诱发或加重抑郁情况。本文综述了围产期抑郁影响因素的研究进展，对未来的研究和临床干预方向进行了展望，旨在为临床一线的医护人员对围产期抑郁的早期预防、诊断和干预提供参考。
Abstract: Perinatal depression (PND) is a common mental disorder affecting up to one-fifth of women globally during pregnancy and the postpartum period, encompassing both prenatal and postpartum depression. The occurrence of PND is associated with sociodemographic, psychological, and obstetric factors, and it may impact the physical and mental health of both mother and child, potentially leading to adverse outcomes. Cesarean section, as a common surgical procedure, involves the pain of the surgery itself, a prolonged recovery period, and the risk of postoperative complications, which can increase the psychological burden on pregnant women and induce or exacerbate depressive conditions. This article reviews the research progress on influencing factors of perinatal depression, and provides an outlook on future research and clinical intervention directions, aiming to offer a reference for frontline healthcare professionals in the early prevention, diagnosis, and intervention of perinatal depression.
文章引用：陈洁, 何陈玉, 周卫华, 唐妍妍. 剖宫产围产期抑郁现状及其影响因素的研究进展[J]. 临床医学进展, 2025, 15(11): 75-82. https://doi.org/10.12677/acm.2025.15113068

参考文献

[1] Akkineni, R., Rao, A. and Ganjekar, S. (2023) Guide for Integration of Perinatal Mental Health in Maternal and Child Health Services: A Review. Indian Journal of Social Psychiatry, 39, 227-229.
[2] 陈静, 邹涛, 赵丹青, 等. 围产期精神障碍筛查与诊治专家共识[J]. 中国全科医学, 2023, 26(28): 3463-3470.
[3] Turner, M.J. (2023) Delivery after a Previous Cesarean Section Reviewed. International Journal of Gynecology & Obstetrics, 163, 757-762. [Google Scholar] [CrossRef] [PubMed]
[4] Vogel, J.P., Pujar, Y., Vernekar, S.S., Armari, E., Pingray, V., Althabe, F., et al. (2024) Effects of the WHO Labour Care Guide on Cesarean Section in India: A Pragmatic, Stepped-Wedge, Cluster-Randomized Pilot Trial. Nature Medicine, 30, 463-469. [Google Scholar] [CrossRef] [PubMed]
[5] Voelker, R. (2024) What Is Perinatal Depression? JAMA, 331, 1254. [Google Scholar] [CrossRef] [PubMed]
[6] Low, S.R., Bono, S.A. and Azmi, Z. (2023) Prevalence and Factors of Postpartum Depression during the COVID-19 Pandemic: A Review. Current Psychology, 43, 12084-12101.
[7] Bränn, E., Shen, Q. and Lu, D. (2024) Perinatal Depression and Its Health Impact. BMJ, 384, p2777. [Google Scholar] [CrossRef] [PubMed]
[8] 国家产科专业医疗质量控制中心, 中华医学会围产医学分会, 赵扬玉, 漆洪波, 魏瑗. 剖宫产手术专家共识(2023) [J]. 中华妇产科杂志, 2024, 59(1): 14-21.
[9] Betran, A.P., Ye, J., Moller, A., Souza, J.P. and Zhang, J. (2021) Trends and Projections of Caesarean Section Rates: Global and Regional Estimates. BMJ Global Health, 6, e005671. [Google Scholar] [CrossRef] [PubMed]
[10] Yang, Y., Zhang, X., Fan, Y., Zhang, J., Chen, B., Sun, X., et al. (2023) Correlation Analysis of Hysterectomy and Ovarian Preservation with Depression. Scientific Reports, 13, Article No. 9744. [Google Scholar] [CrossRef] [PubMed]
[11] Huang, X., Wang, Y., Wang, Y., Guo, X., Zhang, L., Wang, W., et al. (2023) Prevalence and Factors Associated with Trajectories of Antenatal Depression: A Prospective Multi-Center Cohort Study in Chengdu, China. BMC Pregnancy and Childbirth, 23, Article No. 358. [Google Scholar] [CrossRef] [PubMed]
[12] Froeliger, A., Deneux‐Tharaux, C., Loussert, L., et al. (2024) Prevalence and Risk Factors for Postpartum Depression 2 Months after Cesarean Delivery: A Prospective Multicenter Study. American Journal of Obstetrics and Gynecology, 230, S1128-S1137.e6.
[13] Sun, L., Wang, S. and Li, X. (2020) Association between Mode of Delivery and Postpartum Depression: A Systematic Review and Network Meta-Analysis. Australian & New Zealand Journal of Psychiatry, 55, 588-601. [Google Scholar] [CrossRef] [PubMed]
[14] 中华医学会妇产科学分会产科学组, 范玲, 杨慧霞, 伍绍文, 程蔚蔚, 陈叙. 围产期抑郁症筛查与诊治专家共识[J]. 中华妇产科杂志, 2021, 56(8): 521-527.
[15] 周莉莉. 围产期抑郁症早期识别与干预的研究进展[J]. 中国城乡企业卫生, 2025, 40(7): 37-40.
[16] Roddy Mitchell, A., Gordon, H., Lindquist, A., Walker, S.P., Homer, C.S.E., Middleton, A., et al. (2023) Prevalence of Perinatal Depression in Low-and Middle-Income Countries: A Systematic Review and Meta-Analysis. JAMA Psychiatry, 80, 425-431. [Google Scholar] [CrossRef] [PubMed]
[17] Nisar, A., Yin, J., Waqas, A., Bai, X., Wang, D., Rahman, A., et al. (2020) Prevalence of Perinatal Depression and Its Determinants in Mainland China: A Systematic Review and Meta-Analysis. Journal of Affective Disorders, 277, 1022-1037. [Google Scholar] [CrossRef] [PubMed]
[18] 吴秋露. COVID-19流行前后初产妇产后抑郁人群分布特征和影响因素[D]: [硕士学位论文]. 广州: 广州医科大学, 2022.
[19] 李淑艳. 产后抑郁症的发生率及其影响因素的探讨[J]. 实用妇科内分泌电子杂志, 2020, 7(5): 38-39.
[20] 王建蕾. 产科因素与围产期抑郁的关系研究进展[J]. 心理月刊, 2024, 19(10): 212-214+223.
[21] Kovacheva, K., de la Fe Rodríguez-Muñoz, M., Gómez-Baya, D., Domínguez-Salas, S. and Motrico, E. (2023) Relationship between Social Support and Perinatal Depression during the COVID-19 Pandemic. Journal of Reproductive and Infant Psychology, 43, 167-180. [Google Scholar] [CrossRef] [PubMed]
[22] 王晨, 李安宁, 侯金芹, 等. 围产期抑郁发展轨迹的异质性及其相关因素[J]. 中国心理卫生杂志, 2025, 39(8): 720-726.
[23] Dimcea, D.A.‐M., Petca, R., Dumitrașcu, M.C., et al. (2024) Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care. Diagnostics (Basel, Switzerland), 14, Article No. 865.
[24] Chen, Q., Li, W., Xiong, J. and Zheng, X. (2022) Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 19, Article No. 2219. [Google Scholar] [CrossRef] [PubMed]
[25] 李敏. 孕产妇围产期抑郁、焦虑情绪发展轨迹特点及其影响因素研究[D]: [硕士学位论文]. 广州: 南方医科大学, 2024.
[26] Mohamed Radzi, C.W.J.W., Jenatabadi, H.S. and Samsudin, N. (2021) Postpartum Depression Symptoms in Survey-Based Research: A Structural Equation Analysis. BMC Public Health, 21, Article No. 27.
[27] Zhu, J., Ye, Y., Liu, X., Chen, Y., Chen, L., Lin, Y., et al. (2024) The Incidence and Risk Factors of Depression across Six Time Points in the Perinatal Period: A Prospective Study in China. Frontiers in Medicine, 11, Article ID: 1407034. [Google Scholar] [CrossRef] [PubMed]
[28] Ashley, J., Harper, B.D., Arms‐Chavez, C.J., et al. (2015) Estimated Prevalence of Antenatal Depression in the US Population. Archives of Women’s Mental Health, 19, 395-400.
[29] 王成伟, 王清峰, 蔡田晓. 高龄剖宫产产妇发生产后抑郁的影响因素及相关护理对策分析[J]. 心理月刊, 2025, 20(15): 81-83.
[30] Kapoor, B., Malik, N., Gupta, G. and Khan, I.A. (2024) A Cross-Sectional Study Exploring Postpartum Depression at a Tertiary Care Center in Eastern Uttar Pradesh, India. Cureus, 16, e58653. [Google Scholar] [CrossRef] [PubMed]
[31] 杜兴梅, 邓淦元, 杨中婷, 等. 不同年龄组女性围产期抑郁发生风险及影响因素分析[J]. 中国预防医学杂志, 2024, 25(3): 300-306.
[32] Hymas, R. and Girard, L. (2019) Predicting Postpartum Depression among Adolescent Mothers: A Systematic Review of Risk. Journal of Affective Disorders, 246, 873-885. [Google Scholar] [CrossRef] [PubMed]
[33] Lodha, P. and De Sousa, A. (2024) Neurobiology of Postpartum Depression: Critical Aspects. Annals of Indian Psychiatry, 8, 173-176.
[34] Chrzan-Dętkoś, M., Murawska, N. and Łockiewicz, M. (2024) Who Decides to Follow the Referral Advice after a Positive Postpartum Depression Screening Result? Reflections about the Role of Sociodemographic, Health, and Psychological Factors from Psychological Consultations—A Cross-Sectional Study. Journal of Affective Disorders, 369, 1122-1130.
[35] Hutchens, B.F. and Kearney, J.A. (2020) Risk Factors for Postpartum Depression: An Umbrella Review. Journal of Midwifery & Women’s Health, 65, 96-108.
[36] Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., et al. (2018) Examining the Relationship between Mothers’ Prenatal Mental Health and Demographic Factors with Postpartum Depression. Journal of Education and Health Promotion, 7, 146.
[37] Pillai, L., Srivastava, S.K., Ajin, A., et al. (2023) Etiology and Incidence of Postpartum Depression among Birthing Women in the Scenario of Pandemics, Geopolitical Conflicts and Natural Disasters: A Systematic Review. Journal of Psychosomatic Obstetrics and Gynaecology, 44, Article ID: 2278016.
[38] Kovacheva, K., de la Fe Rodríguez Muñoz, M., Gómez‐Baya, D., et al. (2022) The Relationship between Healthcare Experience and Perinatal Depression during COVID-19 Pandemic. Clinica y Salud, 33, 117-125.
[39] 韩书勤, 张庆悦. 社会心理因素影响喀什地区孕妇产前抑郁、焦虑的分析[J]. 临床医药文献电子杂志, 2017, 4(41): 8097+8100.
[40] Zhang, R., Liu, Y., Zhang, Z., Luo, R. and Lv, B. (2025) Interpretable Machine Learning Model for Predicting Postpartum Depression: Retrospective Study. JMIR Medical Informatics, 13, e58649. [Google Scholar] [CrossRef] [PubMed]
[41] Xie, H., Jiang, Y., Zhang, X., Min, X., Zeng, J., Chen, L., et al. (2025) Corticosterone-Induced Postpartum Depression Induces Depression-Like Behavior and Impairs Hippocampal Neurogenesis in Adolescent Offspring via HPA Axis and BDNF-mTOR Pathway. Neurobiology of Stress, 34, Article ID: 100708. [Google Scholar] [CrossRef] [PubMed]
[42] Leff, P., Flores‐Ramos, M., López‐Martínez, M., et al. (2015) Hypothalamic-Pituitary-Adrenal Axis Function during Perinatal Depression. Neuroscience Bulletin, 31, 338-350.
[43] Chai, Y., Li, Q., Wang, Y., Tao, E. and Asakawa, T. (2022) The Value of HPA Axis Hormones as Biomarkers for Screening and Early Diagnosis of Postpartum Depression: Updated Information about Methodology. Frontiers in Endocrinology, 13, Article ID: 916611. [Google Scholar] [CrossRef] [PubMed]
[44] Kashkouli, M., Jahanian Sadatmahalleh, S., Ziaei, S., Kazemnejad, A., Saber, A., Darvishnia, H., et al. (2023) Relationship between Postpartum Depression and Plasma Vasopressin Level at 6-8 Weeks Postpartum: A Cross-Sectional Study. Scientific Reports, 13, Article No. 3518. [Google Scholar] [CrossRef] [PubMed]
[45] 马曙铮, 孟宝丽, 王宏锋. 产后抑郁症患者HPA轴激素、甲状腺功能及性激素的水平分析[J]. 国际精神病学杂志, 2020, 47(3): 504-506+513.
[46] World Health Organization (2012) WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage. WHO Guidelines Approved by the Guidelines Review Committee.
[47] Bernasconi, M., Eggel-Hort, B., Horsch, A., Vial, Y., Denys, A., Quibel, T., et al. (2021) Paternal and Maternal Long-Term Psychological Outcomes after Uterine Artery Embolization for Severe Post-Partum Hemorrhage. Scientific Reports, 11, Article No. 13990. [Google Scholar] [CrossRef] [PubMed]
[48] Al-Abri, K., Edge, D. and Armitage, C.J. (2024) Prospective Analysis of Factors Associated with Perinatal Depression. Midwifery, 128, Article ID: 103871. [Google Scholar] [CrossRef] [PubMed]
[49] Eckerdal, P., Georgakis, M.K., Kollia, N., et al. (2017) Delineating the Association between Mode of Delivery and Postpartum Depression Symptoms: A Longitudinal Study. Acta Obstetricia et Gynecologica Scandinavica, 97, 301-311.
[50] 胡燕, 方莉, 叶姗, 等. 系统性红斑狼疮、抗磷脂抗体综合征与围产期抑郁症[J]. 中国妇幼健康研究, 2022, 33(2): 121-125.
[51] Abeysekera, M.V., Ni, D., Gilbert, L., et al. (2024) Linking the Reversal of Gestational Insulin Resistance to Postpartum Depression. BMC Medicine, 22, Article No. 433.
[52] Chen, L. and Shi, Y. (2023) Analysis of Influencing Factors and the Construction of Predictive Models for Postpartum Depression in Older Pregnant Women. World Journal of Psychiatry, 13, 1079-1086. [Google Scholar] [CrossRef] [PubMed]
[53] Zhou, Z., Deng, C. and Xiang, X. (2021) Blood Glucose Related to Pregnancy Induced Hypertension Syndrome. American Journal of Translational Research, 13, 5301-5307.
[54] Pan, J. and Zhao, G. (2023) Analysis of Factors Related to Postpartum Depression in Pregnancy-Induced Hypertension Syndrome Patients and Construction and Evaluation of Nomograms. World Journal of Psychiatry, 13, 654-664. [Google Scholar] [CrossRef] [PubMed]
[55] 胡敏慧, 刘瑞霞, 赵蓉, 等. 妊娠期亚临床甲状腺功能减退症与妊娠期高血压疾病关系的研究进展[J]. 国际妇产科学杂志, 2023, 50(6): 679-683.
[56] 杨淑娟, 罗岳西, 刘俐, 等. 孕晚期孕妇产前抑郁影响因素及抑郁程度与血清促甲状腺激素、甲状腺过氧化物酶抗体相关性研究[J]. 陕西医学杂志, 2023, 52(12): 1718-1722.
[57] Peng, C.C.‐H. and Pearce, E.N. (2022) An Update on Thyroid Disorders in the Postpartum Period. Journal of Endocrinological Investigation, 45, 1497-1506.
[58] 陆杰华, 伍绪青. 妇女剖宫产行为的主要影响因素分析——基于2017年全国生育状况抽样调查[J]. 中国计划生育学杂志, 2021, 29(5): 873-876.
[59] Moameri, H., Nematollahi, S., Yaseri, M., Ahmadi Gharaee, H., Karimi, R. and Holakouie-Naieni, K. (2019) The Relationship between Maternal Mental Health during Pregnancy and Type of Delivery in the Suburbs of Bandar Abbas during 2017-2018. Medical Journal of the Islamic Republic of Iran, 33, Article No. 108. [Google Scholar] [CrossRef] 
[60] 张明霞, 何敏芝, 许晓峰, 等. 瘢痕子宫再次妊娠孕产妇围生期心理状况的影响因素分析[J]. 中国妇幼健康研究, 2019, 30(12): 1520-1527.
[61] 沈娟. 优质护理干预在初产妇剖宫产术后母乳喂养中的应用价值[J]. 实用临床护理学电子杂志, 2020, 5(21): 144.

为你推荐