高度生殖補助医療および一般不妊治療後妊産褥婦の抑うつ傾向とストレス対処能力の関連

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1 J. Jpn. Acad. Midwif., Vol. 28, No. 2, , 2014 資 料 高度生殖補助医療および一般不妊治療後妊産褥婦の抑うつ傾向とストレス対処能力の関連 妊娠末期から産後 1 ヶ月までの縦断的調査 Association between depressive tendency and stress-coping ability of pregnant and postpartum women following assisted reproductive technology and conventional infertility treatment: A longitudinal survey from late pregnancy to 1 month postpartum Chiharu FUKAO 1 Kiyoko KABEYAMA 2 抄 録 目的 ART 対象と方法 ART EPDS SOC 3 結果 3 EPDSSOC EPDS SOC ART 3r= p.01 r= p.05 r=.466 p.01 r=.592 p.011 r=.623 p.01 EPDS SOC 1 EPDSp= SOC p=.057 p=.052 結論 ART 1 Kyoto University Graduate School of Medicine Program for Nursing and Health Science Master's Course 2 Kyoto University Graduate School of Medicine Program for Nursing and Health Science

2 EPDS SOCEPDS キーワード : Abstract Objective The aim of the study was to characterize the depressive tendency and stress-coping ability of pregnant and postpartum women who conceived through assisted reproductive technology (ART) and conventional infertility treatment, in terms of their serial changes, association, and influencing factors, to explore an effective approach to support these women. Subjects and Methods The survey was conducted from March to October 2011 at a hospital in Kyoto Prefecture, Japan. A total of 95 pregnant women (36 conceived spontaneously, 13 with conventional infertility treatment, and 46 with ART; valid response rate, 95%) who provided consent for participation were assessed longitudinally at 3 time-points (late pregnancy, early postpartum period [2-7 days postpartum], and 1 month postpartum) regarding their past history, depressive tendency (Edinburgh Postnatal Depression Scale, EPDS), and stress-coping ability (Sense of Coherence Scale, SOC). Data were compared among the three conception groups. Results The conventional infertility treatment group tended to have higher EPDS and lower SOC scores at the 3 timepoints, with no significant differences among the groups. With respect to the relationship between EPDS and SOC scores, a significant negative correlation was observed in the ART group at all 3 time-points (r= to 0.592, p<0.01) and in the conventional infertility treatment group at 2 time-points other than late pregnancy (r= 0.563, 0.640, p <0.05), and a relatively strong negative correlation was noted in the participants at late pregnancy (r= 0.466, p<0.01), early postpartum (r= 0.592, p<0.01), and 1 month postpartum (r= 0.623, p<0.01), demonstrating that the higher the EPDS total score, the lower the SOC total score. Regarding the influencing factors, the EPDS score at 1 month postpartum tended to be higher in older primipara (p=0.056), and SOC scores at late pregnancy and 1 month postpartum tended to be lower in older pregnant/postpartum women (p=0.057 and 0.052, respectively). Conclusion Depression in pregnant and postpartum women who conceive after ART is currently attracting increasing attention. However, the present finding that pregnant and postpartum women who conceived through conventional infertility treatment had the highest score on the scale for a depressive tendency suggests the need to support pregnant and postpartum women who conceive after infertility treatment, regardless of the type of treatment, from the early stages of pregnancy. Furthermore, the results showed that the depressive tendency and stress-coping ability changed over the peripartum period, and that the EPDS and SOC scores were closely correlated, highlighting the need to provide support for pregnant/postpartum women with high EPDS scores, namely "those who conceive after conventional infertility treatment" and "older primipara", so that they can improve their stress-coping skills. Keywords: peripartum women, depressive tendency, stress-coping ability, infertility background Ⅰ. はじめに, 2010, p. 57, 2011, p. 260, 2010, p. 54 Csatordai, Kozinszky, Devosa et al., 2007, p.88 ART Cox, Holden, & Sagovsky 1987 EPDS Cox & Holden, 1987/2006 J. Jpn. Acad. Midwif., Vol. 28, No. 2,

3 EPDS EPDS EPDS 17.0 EPDS, 2013, pp SOC, 2007, pp SOC Sjostrom, Langius, & Hjeretberg, 2004, p EPDS SOC ART Ⅱ. 研究方法 1. 調査期間および対象者 D D データ収集方法 EPDS SOC 3. 調査内容 1 2 EPDS EPDS Cox, Holden, & Sagovsky, EPDS EPDS EPDS EPDS Cox & Holden, 1987/2006, pp EPDS EPDS r=.532epds 9 17, 2013, p. 448 EPDS, 2013, p /9 3 SOC SOCWHO Antonovsky, 1983/ χ 2 EPDS SOC Bonferroni Pearson Mann-Whitney U IBM SPSS Statistics ver.20 for Windows

4 E1348 Ⅲ. 結果 1. 対象の属性 背景 ART ART ART p=.006 ART 7 p=.013 ART 7 4 p= ART p= ART 5p= ml ART p=.000 ART p= 妊娠方法別の各時期のEPDSとSOCの経時的変化 EPDS ART EPDS SOC 表 1 対象の属性 Mean SD or ART 群一般不妊治療群自然妊娠群 χ 2 値 or 項目 (n=46: 48.4%) (n=13: 13.7%) (n=36: 37.9%) F 値 ** * * * *** n= n= * χ 2 *: p<0.05 **: p<0.01 ***: p< J. Jpn. Acad. Midwif., Vol. 28, No. 2,

5 図 1 3 群のEPDSの比較および経時的変化 3 Bonferronin.s.: not significant 3. 妊娠方法別の各時期のEPDSとSOCの関連 2 ART3r= , p.01 r= , p.053 r= , p.01 r=.466, p.01 r=.592, p.011 r=.623, p.01 EPDS SOC 4.EPDSとSOCに影響する要因の関連 EPDS 1 p=.056 SOC 1 p=.057,.052 EPDS 1 p=.071soc 図 2 3 群のSOCの比較および経時的変化 3 Bonferroni*: p< ART p.05 Ⅳ. 考察 1. 対象者の属性 ART 表 2 対象者全体および妊娠方法別の各時期 EPDSと SOCの相関全対象者自然妊娠群一般不妊治療群 ART 群 1.466**.592**.623**.476**.698**.714** Person*: p<.05 **: p< *.640*.592**.500**.562** 表 3 年齢別のEPDS,SOCの比較 EPDS 1 35 歳未満 (n=48) 歳以上 (n=47) 歳未満 (n=48) Mann-Whitney Uns: not significant SOC 35 歳以上 (n=47)

6 表 4 初経産別のEPDS,SOCの比較 EPDS 1 初産婦 (n=47) 経産婦 (n=48) 初産婦 (n=47) Mann-Whitney Uns: not significant SOC 経産婦 (n=48) ART 9 ART 2. 妊娠方法別の各時期の EPDSと SOCの経時的変化 3 EPDS 5 SOC 60 Csatordai, Kozinszky, Devosa et al., 2007, p. 88 ART, 2012, p. 72EPDS ART =ARTART 2011, p. 261 ART Antonovsky 1983/2001, pp SOC 3. 妊娠方法別の各時期の EPDSと SOCの関連 3 EPDS SOC EPDS SOC 8 Hospital Anxiety and Depression HADSOCr=.50,.56 Sjostrom, Langius, & Hjeretberg, 2004, p Zung SOC, 2007, p. 109 EPDS EPDSr=.532, 2013, p. 448 EPDS EPDS SOC EPDS EPDS SOC EPDS SOC EPDS1 EPDS SOC 1 SOC EPDS ART Csatordai, Kozinszky, Devosa et al., 2007, p. 88 J. Jpn. Acad. Midwif., Vol. 28, No. 2,

7 SOC Sjostrom, Langius, & Hjeretberg, 2004, p Antonovsky 1983/2001, pp SOC Feldt, Kokko, Kinnumen et al. 2005, pp SOC SOC EPDS SOC EPDS 1 SOC EPDS 謝辞 B Ⅴ. 助産実践への示唆と本研究の限界, 今後の課題 ART ART ART EPDS SOC EPDS SOCEPDS 13 EPDS SOC SOCEPDS Ⅶ. 結論 ART 文献 Antonovsky, A Cox, J.L., Holden, J.M. & Sagovsky, R. (1987). Detection of postnatal depression. Development of the Edinburgh Postnatal Depression Scale. Brit J Psychiatry, 150, Cox, J.L. & Holden, J.M EPDS Csatordai, S., Kozinszky, Z., Devosa, I., Toth, E., Krajcsi, A. & Sefcsik, T. (2007). Obstetric and sociodemographic risk of vulnerability to postnatal depression. Patient Education and Counseling, 67, Feldt, T., Kokko, K., Kinnumen, U., & Pulkkinen, L. (2005). The role of family background, school success, and career orientation in the development of sense of coherence. European Psychologist, 10, (2)

8 (1) jinkou/geppo/nengai11/dl/gaikyou23.pdf [ ] 1996 EPDS (1) Sjostrom, H., Langius, E. & Hjeretberg, R. (2004). Wellbeing and sense of coherence during pregnancy. Acta Obstet Gynecol Scand, 83(12), (4) Sence of coherence1 SOC 44(10) 243 J. Jpn. Acad. Midwif., Vol. 28, No. 2,