山东部分地区农村已婚育龄妇女生殖相关因素与心理健康状况的关联性研究-林少倩.docx

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1、硕士学位论文 山东部分地区农村已婚育龄妇女生殖相关因素与心理健康状况 的关联性研究 姓名：林少倩 申请学位级别：硕士 专业：流行病与卫生统计学 指导教师：王志萍 20120525 中文摘要 山东部分地区农村已婚育龄妇女生殖相关因素与心理健康状况 的关联性研究 硕士研究生林少倩 导师 王 志 萍 背景：妇女的心理健康是妇女精神卫生的重要方面。多项研究表明，目前农村女 性的心理健康状况不容乐观，烦恼、焦虑、抑郁等不良情绪在农村妇女中显得较 为突出。据报道农村妇女的心理健康问题也是导致中国农村女性自杀率明显高于 男性的原因之一，中国精神卫生工作规划 （ 2002 2010)中指出， 要加强对妇 女特

2、有心理行为问题和精神障碍的研究，积极制定对策，进行综合干预。 育龄 妇女作为特殊人群有其自身的特点，育龄期时间跨度大，在此期间妇女要经历婚 姻、妊娠、生育、育儿直至绝经等过裎。女性本身的生理特点以及各种家庭和社 会环境因素等均会对其心理健康状况产生影响，其中与女性生殖相关的月经和生 育等因素对妇女的心理健康状况变化起到不可忽视的作用，如围绝经期综合征 、 产后抑郁症等。与城市妇女相比，农村妇女的文化程度低，生殖保健知识相对缺 乏并且农村卫生条件相对落后，致使农村妇女的生殖健康状况相对较差，农村已 婚育龄妇女的生殖相关因素可能对其心理健康产生一定影响。 目的：探讨农村已婚育龄妇女月经和生育等生殖

3、相关因素与心理健康状况的关 系，寻找影响农村已婚育龄妇女心理健康状况的危险因素，从三级预防角度为提 高农村已婚育龄妇女的心理健康水平提供合理建议，为制定有效的针对农村已婚 育龄妇女的心理健康干预措施提供科学依据。 方法：在山东大学卫生研究基地的平阴县、梁山县和莒南县 三个县内随机选取 5 个乡镇 17个自然村作为研究现场。以被选中的自然村内的常住人口中所有 15 49 岁已婚育龄妇女作为本次调査的研究对象。采用入户个人问卷调査的方法，于 2009年 10月至 12月由统一培训的调査员对研究对象进行面对面问卷调査并填 写调查表。 SCL-90量表的填写由研究对象独立完成。采用 Access软件进

4、行数据 双录入，数据分析采用 SPSS16.0软件完成。研究对象 SCL90量表得分与相关 影响因素的单因素分析采用两个或多个样本的秩和检验 (Kruskal-Wallis检验 ) 进行分析。根据本研究人群 SCL*90量表总得分的 75分位数将研究对象心理健 康状况分为两组，大于等于 75分位数的赋值为 1，表示心理健康状况较差，小 于 75分位数的赋值为 0,表示心理健康状况相对较好。采用 Binary Logistic回归 模型分析研究对象月经和生育等生殖相关因素对心理健康状况的影响。 结果 1. 研究对象一般情况。研究现场中符合本次研究对象条件并且提供有效数 据的农村已婚育龄妇女共 3

5、397人，平均 38.387.43岁（ 19.33岁 49.75岁）。研 究对象不同年龄、不同文 化程度、不同职业和不同婚姻状况的人群其 SCL-90量 表总得分的分布有统计学差异， 41 50岁年龄组、高中及以上文化程度、经商和 离婚或丧偶的研究对象 SCL-90量表总得分的中位数较高。研究对象两周内伤病 情况、半年内是否患有慢性疾病、是否患有妇科疾病与 SCL-90量表总得分和各 维度得分均有统计学关联，两周内有伤病、半年内患有慢性疾病和患有妇科疾病 的研究对象 SCL-90量表总得分的中位数较高。研究对象社会支持状况、近一年 是否经历负性生活事件与 SCL-90量表总得分也有统计学关联。

6、 目前有月经的研究对象中月经不规律的比例为 10.31%,痛经的比例为 46.57%; 50岁之前停经的发生率为 10.30% (其中自然停经和因手术原因停经的 比例分别占 44.00%和 12.00%),自然停经者平均停经年龄为 46.58土 2.73岁 (42.28 岁 -49.31岁 )。另外，研究对象或配偶不育症占研究对象的 0.44%。 2. 研究对象月经机能和心理健康状况的关系。单因素分析结果显示，研究 对象月经规律性、痛经情况和停经原因与 SCL-90量表总得分有统计学关联。 月经规律性与研究对象心理健康状况：多因素分析 结果显示，调整了研究对象一 般人口学状况、痛经情况、躯体健

7、康状况、社会支持和负性生活事件等因素，月 经不规律的研究对象心理健康状况较差，其出现不良心理健康状况的危险性是月 经规律的研究对象的 1.571倍 （ C=1.571， 1.209-2.043)。 痛经与研 究对象心理健康状况：调整了研究对象一般人口学状况、月经规律性、躯体健康 状况、社会支持和负性生活事件等因素，有痛经症状的研究对象出现不良心理健 康状况的风险明显升高 ,经常痛经的研究对象出现不良心理健康状况的危险性是 没有痛经症状研究对象的 1.705倍 （ Oi?=1.705, 1.361 2.136)，偶尔痛 经的研究对象出现不良心理健康状况的危险性是没有痛经症状研究对象的 1.438

8、 倍（ 0及 =1.438, 95%C/: 1.181 1.752),研究对象出现不良心理健康状况的风险 随着痛经症状的严重程度而加强。 停经情况与研究对象心理健康状况的关系： 单因素分析结果显示，不同停经原因的研究对象 SCL90量表总得分差异有统计 学意义。调整了研究对象一 般人口学状况、躯体健康状况、社会支持和负性生活 事件等因素，与未停经且月经规律的研究对象相比，目前因妊娠而停经的研究对 象出现不良心理健康状况的风险降低 （ 0/H).877, 0.788 0.974)。目前 已自然停经的研究对象出现不良心理健康状况的风险是未停经且月经规律者的 1.918倍（ 0及 =1.918, 1

9、.324-2.777)。因子宫或卵巢切除而停经的研究对 象心理健康状况与未停经且月经规律的研究对象相比无统计学差异。 3. 研究对象生育情况和心理健康状况的关系。 流产或引产次数、分娩次 数与研究对象心理健 康状况的关系：单因素分析结果显示，研究对象流产或引产 次数与 SCL-90量表总得分有统计学关联，流产或引产 2次及以上的研究对象 SCL-90量表总得分较高；研究对象分娩次数和 SCL-90量表总得分无统计学关 联。多因素分析结果显示，调整了研究对象一般人口学状况、躯体健康状况、社 会支持和负性生活事件等因素，研究对象流产或引产经历与心理健康状况有统计 学关联。流产或引产 2次及以上的研

10、究对象出现不良心理健康状况的风险是没有 流产或引产经历的研究对象的 1.612倍（ 0/?=1.612,1.253 2.074)。 研究对象或配偶不育症和研究对象心理健康状况的关系：单因素分析结果显示， 研究对象或配偶不育症和 SCL-90量表总得分无统计学关联。调整了研究对象一 般人口学状况、躯体健康状况、社会支持和负性生活事件等因素，研究对象或其 配偶是否患有不育症和研究对象心理健康状况也无统计学关联 * 结论 1. 农村已婚育龄妇女月经规律性和痛经情况与心理健康状况相关联，月经 不规律和痛经都会增加农村已婚育龄妇女发生不良心理健康状况的风险性，并且 发生不良心理健康状况的危险性随着痛经症

11、状的严重程度而增加。 2. 流产或引产经历与农村已婚育龄妇女心理健康状况有关联，流产或引产 2 次及以上是影响农村已婚育龄妇女心理健康状况的危险因素。 3. 自然停经对农村己婚育龄妇女心理健康状况有负面影响，使农村己婚育 龄妇女出现不良心理健康状况的风险增加。 4. 处于妊娠期的农村已婚育龄妇女心理健康水平相对较高。 建议 :农村已婚育龄妇女的心理健康状况受到月经和生育等生殖健康因素的 影响，应加强对农村育龄妇女月经和生育相关心理卫生问题的宣传、教育和研究 , 提高农村已婚育龄妇女生殖相关心理健康知识的知晓率，对月经不规律、痛经、 处于围绝经期以及流产或引产等重点人群采取有效心理干预措施 ,从

12、而增强农村 已婚育龄妇女的心理健康状况。 关键词：心理健康；月经；生育；生殖健康； SCL-90量表 The Association between Psychological Health Status and Reproduction for Rural Women of Child-bearing Age in Some Regions of Shandong Province Postgraduate: Lin Shao-qian Supervisor: Wang Zhi-ping ABSTRACT Background： Women* psychological health is

13、an important part of women* mental health, nowadays many researches show that the psychological health status of rural women is not optimistic, and some bad psychological status such as worry, anxiety and depression appear relatively prominent among rural women. Rural women, psychological symptoms a

14、re one of the reasons that lead to the unique phenomenon that the suicide prevalence of rural women is higher than that of men in China. Chinas Mental Health Plan (2002 2010) pointed out researches on women particular psychological behavior problems and mental disorders should be strengthened, and e

15、ffective strategies and interventions should be carried out actively. Women of child-bearing age as a special population have the characteristics of their own. The time span of reproductive age is long, and during this period women will experience marriage, pregnancy, childbirth, parenting and menop

16、ause and so on. Female physical factors and various family and social environmental factors will have an effect on their psychological health. Of these factors，related factors could make certain effect on psychological health in rural women of child-bearing age. Objectives： To investigate the relati

17、onship between menstruation, reproduction and psychological health status in rural married women of child-bearing age, and to identify risk factors for psychological health, so as to make reasonable suggestions for the elevation of psychological health level of rural married women of child-bearing a

18、ge in terms of tertiary prevention perspective and to provide scientific basis for the draft of psychological health interventions. Methods： Randomly selected five towns seventeen villages as study fields from Shandong University Health Research Base, Pingyin county, Liangshan comty and Junan county

19、. The research population included all of the 15 to 49 years old married women of child-bearing age who lived in the village for more than half year. The investigation was conducted by the means of questionnaire survey from October 2009 to December 2009, and trained investigators gave face-to-face i

20、nterviews to research population and filled in the questionnaire. The SCL-90 scale was filled out by research population independently. The Access software was used to input survey data and data analysis was conducted by SPSS 16.0 software. Kruskal Wallis test was used to make univariate analysis fo

21、r SCL-90 total scores and related factors. According to the third quantile of the SCL-90 total scores, the research population was divided into two groups. One group was labeled r5, which meant worse psychological health, if the SCL-90 total scores were higher than the third quantile, and the other

22、group was labeled which meant better psychological health, if the SCL-90 total scores were lower than the third quantile. Bdistribution characteristics of the SCL-90 total scores in research populations The total scores of SCL-90 scale are statistically associated with ages, education levels, job oc

23、cupations and marriage status among research population. The medians of the SCL-90 total scores are higher in population of 4150 years old, population with high school education level, population with business occupation and divorced or widowed population. The SCL-90 total scores and every dimension

24、 scores are statistically associated with whether having injuries and sicknesses in two weeks, chronic diseases in half year and gynecological diseases. The medians of the SCL-90 total scores are higher in population with injuries and sicknesses in two weeks, population with chronic diseases in half

25、 year and population with gynecological diseases. Social support status and whether having an experience of negative life events in one year are statistically associated with the SCL-90 total scores. Among research population with menstruation the proportion of women who has irregular menstruation i

26、s 10.31%, while the proportion of women who has menstruation pain is 46.57%. The proportion of research population who has stopped menstraating is 10.30%, and among these people who have stopped menstruation the proportion of population who is in menopause is 44.00%, while the proportion of people w

27、ith uterine or ovarian removal is 12.00%. The average age of menopause is 46.582.73 (42.28-49.31) years old. The proportion of research people or their spouses who are infertile is 0.44% in research population. 2. The association between menstruation and psychological health status. The univariate a

28、nalysis resuand negative life events, compared with population without menstrual pain, the risk of having worse psychological status is significantly higher in population with frequent menstraal pain. 1.705 time the risk ( 0=1.705, 95%CI： 1.3612.136 ) of having worse psychological status is shown in

29、 population with frequent menstrual pain and 1.438 time the risk ( Oi?=1.438, 95%CI： 1.1811.752) is shown in population with occasional menstrual pain. The risk of having worse psychological status inaeases with the severity of menstrual pain symptoms. The association between menopause situation and

30、 psychological health status: The univariate analysis results show that the total scores of SCL-90 scale are statistically associated with the reason of menopause in research population. Adjusted for general demographic situation, physical health, social support and negative life events, compared wi

31、th population with regular menstruation, the psychological health status of population in pregnancy is better (Oi?=0.877,95%CI： 0.788-0.974), meanwhile the risk of having worse psychological status in postmenopausal population is 1.918 time(0/?=l .918,95%Ch 1.3242.777). There is no statistical diffe

32、rence between the psychological health status of population with regular menstruation and population with uterine or ovarian removal. 3. The association between reproduction situation and psychological health status. The relationship of psychological health and the times of abortion or induced labor

33、, the times of childbirth. The univariate analysis results show that the total scores of SCL-90 scale are statistically associated with the times of abortion or induced labor. While there is no statistical association between the total scores of SCL-90 scale abetween the total scores of SCL-90 scale

34、 and infertility (women or their spouses). Adjusted for general demographic situation, physical health, social support and negative life events, multivariate analysis results show that there is also no statistical association between the psychological health and infertility in research population or

35、 their spouses. Conclusions 1. There are statistical associations between psychological status and menstrual regularity, menstrual pain in rural married women of child-bearing age. Both irregular menstruation and menstrual pain will increase the risk of having worse psychological health status in ru

36、ral women of child-bearing age, and the risk of having worse psychological status increases with the severity of menstrual pain symptoms. 2. Miscarriage or induced abortion experiences are associated with the psychological health status of rural married women of child-bearing age. Miscarriage or ind

37、uced abortion two times or more are risk factors that jeopardize psychological health of rural married women of child-bearing age. 3. Menopause make negative effects on womens psychological health and will increase the risk of having worse psychological health status. 4. The level of psychological h

38、ealth status of rural married women of child-bearing age in pregnancy is higher in research population. Suggestion: The psychological health status of rural married women of child-bearing age is affected by menstrual and reproductive factors. We should strengthen propaganda, education and research on the psychological health problems related to menstruation a