盆腔脏器脱垂患者围手术期焦虑抑郁变化及 术后6个月相关因素分析

Perioperative Anxiety and Depression in Pelvic Organ Prolapse Patients and Factors Associated with Six-Month Postoperative Psychological Distress

摘要: 目的：探讨盆腔脏器脱垂(Pelvic Organ Prolapse, POP)患者围手术期焦虑、抑郁的动态变化及术后6个月心理困扰的相关因素。方法：前瞻性纳入2024年3月至2025年5月于安徽医科大学附属第二医院接受手术治疗的287例POP患者，于术前1天及术后1、3、6个月分别采用广泛性焦虑量表(GAD-7)和患者健康问卷(PHQ-9)评估焦虑、抑郁状况。采用广义估计方程(GEE)分析不同时间点焦虑、抑郁阳性率变化趋势。以术后6个月GAD-7 ≥ 10分和/或PHQ-9 ≥ 10分定义心理困扰，采用多因素Logistic回归分析相关因素。结果：POP患者术前焦虑、抑郁阳性率分别为38.7%和34.5%，术后1个月降至25.1%和22.3%，术后3个月焦虑阳性率略回升至28.2%，抑郁阳性率保持稳定为21.6%，术后6个月分别进一步降至19.5%和16.7%，时间效应均有统计学意义(P < 0.001)。多因素Logistic回归分析显示，独居、术前PFDI-20评分较高(按本研究样本中位数分层)、慢性疼痛史、低社会支持及术后3个月盆底功能自评不满意与术后6个月心理困扰相关(均P < 0.05)。结论：POP患者围手术期焦虑、抑郁总体呈下降趋势，但术后3个月仍可能出现心理波动。独居、低社会支持、慢性疼痛、较高症状负担水平及主观功能恢复不佳者应作为围手术期重点筛查和干预对象。

Abstract: Objective: To investigate the dynamic changes of anxiety and depression during the perioperative period in patients with pelvic organ prolapse (POP) and to identify factors associated with psychological distress six months postoperatively. Methods: A prospective study was conducted including 287 POP patients who underwent surgical treatment at the Second Affiliated Hospital of Anhui Medical University from March 2024 to May 2025. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) at one day preoperatively and one, three, and six months postoperatively. Generalized estimating equations (GEE) were applied to evaluate temporal trends in the prevalence of anxiety and depression. Psychological distress at six months was defined as GAD-7 ≥ 10 and/or PHQ-9 ≥ 10, and multivariate logistic regression was performed to identify associated factors. Results: Preoperative anxiety and depression rates were 38.7% and 34.5%, respectively. These decreased to 25.1% and 22.3% at one month postoperatively. At three months, anxiety slightly rebounded to 28.2%, while depression remained at 21.6%. By six months, anxiety and depression further declined to 19.5% and 16.7%, with significant time effects (all P < 0.001). Multivariate analysis identified living alone, higher preoperative PFDI-20 scores, chronic pain history, low social support, and poor subjective pelvic floor function at three months as factors associated with psychological distress at six months (all P < 0.05). Conclusion: Anxiety and depression in POP patients generally decrease during the perioperative period, though transient fluctuations may occur at three months postoperatively. Patients who live alone, have low social support, chronic pain, higher symptom burden, or poor subjective functional recovery should be prioritized for perioperative screening and interventions.