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TRAi'J THO NHI NGUYE~J THI THUY HAi\IH i"GO VAi'J TOAN. i'JGUYEN Due HI0JH
TRAM CAM 0 PHl) NO MANG THAIvA MOT SO YEU TO LIEN QUAN
TA-IHUYEN DONG ANH, THANH PHO HA NOI
TlI khec: Tram cam a phu numang thai, yeu to lien quan, yeuto nguy co, ty Ie.Keywords: Depression duringpregnancy, related factors, riskfactors, prevalence.
Tiic gia lien M(Cormsponding author).TranTho Nhi.email: [email protected] liJi(ff£eived).' 15/03/2016Ngay phin bien danhgia liJiruo (revised).'10/04/2016Ngay liJiruo duoc eM{! nhan dang(accepted). 20/04/2016
Tran Tho Nhj, Nguyen Thj Thtiy HQnh, Ngo Von Toan, Nguyen OU(HinhTruong 8(1i h« YHiJNpi
T6rn tatTram cam trang thai ky la mot roi 10t;1.ntam than phd bien anh huang
den sue kh6e cue me va thai nhl. Muc lieu cue nonien cuu te xec djnhty 1$tram cam trang mang thai va mot so yeu to lien quan den tram camtrang mang thai.
Phlfong phap: Nghien cuu sa dl,lng thiet ke nghien cuu thuen tep voi1274 phu no mang thai tel huyen Dong Anh, thenn ph6 Ha NOi. NhOngphu nO nay duoc ph6ng van hai Ian: Ian dau khi thai duoi 24 tuen va Iantiu)hai khi thai auoc 30 den 34 tuen. . :
Ket qua: Ty 1$ tram cam trong mang thai te 5% (95%C!: 3,77-6,16).Cec yeu t6 lien quan voi tram cam trang mang thai baa gam beo tuc giadinh, tien su thai iuu, 10au trang mang thai va h6 tro gia dinh irong khimang thai.
Ket lusn: NhOng pMt hi$n nay nhan mt;1.nhsl) can thi£3tpMi sang loctram cam va cac yeu t6 nguy co trang khi mang thai 6 nhOng noi chamsoc san co de cai thi$n sUc kh6e ba m€? va thai nhi.
Til kh6a: Tram cam 6 phl,l nOmang thai, yeu t6 lien quanr yeu t6 nguyco, ty 1$.
AbstractDEPRESSION AMONG PREGNANT WOMEN
AND SOME RELATED FACTORS IN DONG ANHDISTRICT, HANOI CITY
Background: Depression during pregnancy is a common psychiatricdisorder affecting health of both the mother and the unborn child. Theobjectives of this study were to estimate the prevalence of depressionduring pregnancy among pregnant women and to examine theassociated risk factors.
Methods: The study was designed as a cohort study which includeda total of 1274 pregnant women in Dong Anh district, Hanoi city. Thewomen were interviewed in two surveys. The first one was conducted
when participants were at least 24 weeks gestation and the second whenparticipants were from 30to 34 weeks gestation.
Results:The prevalence of depression during pregnancy was 14.2% (95%CI: 10.7-18.5) andassociated factors included: domestic violence, history of stillbirth, anxiety during pregnancy andfamily support during pregnancy.
Conclusions:The findings suggest the need of screening for depression and its risk factors duringpregnancy settings where care is needed to improve the health of mothers and unborn child.
Keywords:Depression during pregnancy, related factors, risk factors, prevalence.
I. D()t van d~Tram cam 10m¢t r6i loon tam than thuang g9P,
d9c trung boi noi buon, mat hung thu h09C niemvui, ngu khong yen giac h09C chan an, cam giacm$t moi, vo kern t9P trung [1]. Tram cam 0 phu nO'mang thai 10 kho pho bien. Theo dl,J"boo cuo Tochu Y te the gioi (WHO), voo nom 2020, roi loontam than se 10 nguyen nhan dung hang thu haiganh n9ng cho y te tocn cou [2]. Ty 1$tram camtrong mang thai dao d¢ng tv 9.1%den 14.2%[3],[4]. Cac nghien cuu gan day cho thay tram camtrong mang thai co lien quan den sinh non va nhE?can [5],[6]. M9t khac, tram cam trong mang thaikhong duc;lcphat hi$n va dieu tri, co the lam tangnguy co bi b$nh tam than n9ng, tram cam sau sinhva anh huong den SI,J" phat trien tinh than va tfnhcach cua tre trong tuong lai [2], [7].
Hi$n t9i, cac nghien cuu chu yeu t9P trung vaotram cam sau sinh. Co m¢t 56 nghien cuu ve tramcam 0 phy nO'mang thai, tuy nhien nghien cuuve tram cam va m¢t 56 yeu t6 lien quan con h9nche, chu yeu 10t9P trung do luang m¢t yeu t6 nhub90 Il,J"cb9n tlnh trong'mang thai [8], h09Cyeu t6san khoa [9] h09Cm¢t 56 yeu t6 lien quon nhungthl,J"chi$n tren cac d6i tUc;lngkhac nhau nhu phynO'mang thai 0 vung d¢ng dot [10] hay thl,J"chi$no phy nO"mang thai bi HIV [11 ], hay 0 vung dant¢c thieu 56 [12], va thl,J"Chi$n 0 b$nh vi$n [13].a Vi$t Nam, co nhieu nghien cuu ve tram camsou sinh, cac nghien cuu ve tram c6m 0 phy mangthai va m¢t 56 yeu t6 lien quan con h9n che. VIV9Y, chung toi tien hanh nghien cuu nay nh&mxac dinh ty 1$tram cam 0 phy nO"mang thai vam¢t 56 yeu t6 lien quan, tV do de xuat cac khuyennghi thfch hc;lPnh&m cai thi$n suc khoe sinh sanphu nO"va tre em.
2. DOi nrong va plurongphap nghlen ciru2.1. Dia diem, doi tu~ng, co m6u va
thiet ke nghien cooNghien cuu duc;lc tien hanh t9i hUY$n Dong
Anh, thanh ph6 Ho Noi, Day 10m¢t hUY$nnqooithanh, n&m trong vung quy hO<;lchphat trien congnghi$p, do th], dich vu vo du lich vo 10dau m6igiao thong quan tronq n6i Thu do voi coc tinh phiaSac. Huy$n co 23 XCI, 1 thi tran va hai b$nh vi$nSac Thang Long va b$nh vi$n da khoa Dong Anh.Da 56 phy nO'den hai b$nh vi$n nay de kham thaiva sinh con. Theo th6ng ke tV hai b$nh vi$n nam2012, co 11.600 phy nO'mang thai den char:nsoctien san va sinh con t9i day. - ,
Nghien cuu nay 10m¢t phan cua nghien cuuthu9n t9P, voi tong 56 1.337 phy nO'mang thai dCl-duc;lcmai tham gia nghien cuu, va co 1.274 phy nO'hoan thanh cac cu¢c phong van. Co mau nay duc;lcdung de phan tfch 56 li$u.
2.2. Quy tr'inh chf?nm6uTat co phy nO'mang thai tv 23 XCI va 1 thi ~ran
thu¢c hUY$nDong Anh duc;lcmai tham gia nghiencuu tv thang 5/2014 den thang 5/2015. NhO'ngnguai tham gia nghien cuu nay duc;lcphong vanhai Ian: oj T9i thai diem mai tham gia nghien cuukhi thai duc;lcduoi 24 tuan; bJ Khi thai nhi duc;lc30den 34 tuan.
Lan phong van 1: Danh sach phy nO'mang thaiduoi 24 tuan duc;lccac c¢ng tac vien dan 56 19Phang thong va g(li cho 6 dieu tra vien cua nghiencuu. H9 10cac c¢ng cac vien dan 56 thu¢c Trungtam Dan 56 hUY$nDong Anh va co kinh nghi$mlam nghien cuu truOc do va co ky nang phongvan va khai thac thong tin t6t. H9 se lien h$ vamai nhO"ngphy nO"len hai b$nh vi$n de kh6m thai
II-;-J>-0
n:;;::,uI·c:cz
•
fRAN THO i'JHi fIiGUYEi'J THI THUY HMJH. fliGO VMJ TOAN. NGUYtr, DLiG HINH
vo phonq van. Neu thai phu nco khong the denhai b$nh vien hocc nho qua xa hai benh vien thlnhorn nghien cuu se den tvng trorn y te xa de tienhcnh thu th¢p 56 lieu. TQi Ian phong van nay, thuth¢p coc thong tin ve tuoi, trinh d¢ h9Cvan, nghenghi$p, dan toe, ton qioo, noi sinh, vo lich SU sinhsan vo 10 au trong mang thai vo coc hanh vi booII/c do chong. Ket thuc cuoc phonq van, coc dieutra vien hen coc thai phu cho Ian phong van thu 2.
TQi Ian phong van thu 2: Thu th¢p coc thong tinve tram cam, sue khoe cua thai phI,)va he tn;i xah¢i va gia dlnh.
2.3. Thang do tram camThong do tram cam (EPDS)bao gam 10 cau
hoi, mei cau hoi gom 4 II/a Ch9n tra loi, tinh theothang diem tV 0 den 3, trong do: cau 1, 2 va 4:cach tfnh diem cho cac dap an tang dan tV 0 chodap an dau tien den 3 cho dap an cu6i cung; cau3, 5 -10 duc;lccho diem ngu9c IQi, diem 56 chocau tra loi giam dan tv 3 diem cho dap an dautien den 0 diem cho dap an cuoi. Tong diem tV 0den 30 diem, diem cang cao thl muc d¢ tram tr9ngcua tram cam cang tang. Thang do EPDSIan dautien dUc;lcdich sang tieng Vi$t va dUc;lcdanh giatren c¢ng dong nguoi Vi$t di ClJ 6 Uc va cho diemcat 9/10 v6i d¢ nhQY10 100%va d¢ d¢c hi$u 1068,5%[14].Gan day, thang do EPDSm¢t Ian nvadUc;lcthl/c hi$n 6 Vi$t Nam do Trung tam nghiencuu va daD tQophat trien c¢ng dong (RTCCD)thl/chi$n va dua ra diem cat thap hon rat nhieu 10 3/4v6i d¢ nhQY,d¢ d¢c hi$u tuong ung 10 69,7% va72,9% [15]. 0 nghien cuu nay, chung toi SU dl,)ngdiem cat 9/10 10 diem cat da duc;lCkhuyen nghi tt;lim¢t so quoc gia c6 nhvng net tuong dong ve vanh6a Vi$t Nam [16], [17], va c(jng 10 diem cat dodUc;lckhuyen nghi cho c¢ng dong nguoi Vi$t Namsong 6 Uc [14].
2.4. D90 duc nghiEm CUuNghien cuu do dUc;lcthong qua H¢i dong dt;lO
duc nghien cuu khoo h9Ccua Truong DQi hQ( Y HaN¢i (So 137, ngay 29 Thang 11 nom 2013). £)Oituc;lngtham gio nghiemcuu 10 hoan toan tv nguy$nsou khi do dUc;lcthong bao ve ml,)cdfch nghien cuuva ky veo ban chap thu¢n thom gia nghien cuu.NhO'ngphI,)nO'c6 dau hi$u tram cam do dU9c cungcap dia chi phong kham, lien h$ voi cac bac 51tamthan de gioi thi$u h9 den tu van, kham va dieu trio
3. K6t qua nghlen coo3.1. D(lc diem chung clla d6i tU'«;)ng
tham gia nghiEm euuBong 1. floc lliem cua dOlWongnghien CUll
! CIiedocai6mrua dOihiOnQ nahienalu SOjygrJg (n) Tvl~(%)! TuOi(n-l 274)i 16-24 573 450, 25-34 620 487I ~35 81 64: Noisinh (n-l 272), CiJ.ng_xiithuiic~tliinQAnh 610 479i KhOc xiithuOch~n flOng Anh 350 275: Khoch_~nLtinh/thilnh oh6 312 246, Nghengh~ (n-l 273)I ~ dMAiYilln chcKLnhon vien ciJng IV IIImoo 408 32,0!~nhon !
349 274i Nangdim 166 130: BuonbonnhO 181 142Th6tngh~/ngi frQ/~nhYiiln 169 133
; TrinhdohQCvanjn-1274): Mil chu/ti¬ uuhoc 24 19, PTCS 228 179: P1lH 465 365Tf!l!
- - - - - -- ----- ----
(99,5%); hon mot nuo da hocn thcnh qico dueco ban (56,3%) va 73,2% phu nO'co viec lam.Ve lich su sinh san: tuoi mang thai Ian dau tv20 den 29 tuoi chiern ty 1$cao nheit 76,4%. Ty1$thai Ivu 10 17,3% vo ty 1$ nco thai va mangthai nqooi y muon chiern ty 1$Ian IVQt 1026,1%vo 27%.
3.2. Ty I~ tram cam trang mang thaiTy 1$tram cam trong mang thai 105%. Coc deiu
hi$u chu yeu cue tram cam trong mang thai duocphu nO'boo coo 10:10au vo 10SQm(lt coch v6 co:h!d616i cho ban than khi S\,lvi$c xay ra kh6ng nhvmong muon; cam giac buan rau den muc kho ngu;cam theiy c6ng vi$c ng(lp dau.
Bong 2. M\if sO yeu folien quan den fram com !rong mang fhoi
Tram Khimg Phlin tim don bien Phon tim do bien(ocy€ufo com frOm
OR(95%0) AORcOm p (95%(1) p
BQo it.rcaioomh (11'"1.274)(6 34{S4,o) 416 (34,5) 22(1.343)1) D.OO2 1,5(1,19-5,34) 0.016KOOna 29(46D) 790(65,5) 1 1TIll cOOiB! riI(riml(n-1269)<24 25(39.71 4~(34,8) 1,3(0,67-2,41) 0469 1,2(0,433,31) 01'JI25-29 22{34,9) 44S{36,9) 1,1(0,54-2,04) 0877 1,2(0,51-2.78) 0,684 .~o.34 16(25,4) 341(28,3) 1 1Ngoo nN (n-1268)
[ COng chU;IWindulnOO nOOc 7{l1,1) 19S{l6,2) 1 1Nhan vien rona tv IU nhim 131m) 19l(]5,9) 1,9(0)44,86) 0182 1,5(0,40-5,82)~,(iing nhlin 16(25,4) 33l{27,4) 1,4(0,55-3,34) 0,515 1,1(0,294,46) 0,844 .Niinadiin 11{l7,S) 155{lZ9) 2,0(0)5-5,22) 0169 1,5(0,35-6,69) 0,567 ;Boon bon nhil 7(11.1) 174(14.4) 1.1(0,393,26) 1Q834 0,8(0,164,19) 0,818 ;
I lliftrdieo/niiifnl/siOOWin 9(14,3) lro{l~4) 1,6(0,574,30) 0,l13 1,2(0,25-5,89) 0,812 :Trinh do hoc viln (n-l 269)
I
Milmil/fieu hoc 1{1,6) Zl{l,9) 1.0(0,67·2,15) 0.%7 1,1(0,46-2,69) 0,811PrCS 14(22,2) 214{l7l) 1,4(0)32,84) Om 0,9(0,32-2,74) 0912 ,
. PT1H 24(381) 4«J(3651 1,2(0,67-2,15) 0,533 0,6{0f.66,23) 0664 •TrunQafp/ma dim/00ihoc 24(381) 529(43.9) 1 1Uih sir sinh sOnThoiluu I
,(6 14{3'l,6) 110{lM) 1,5(1,26479) 000} 3,3(1,47·7,60) O,IDI IKOOna 29(674) 5SlJ{83,6) 1 1
, Noo thai (n-726)(6 9(214) 181 (26,S) 0,8~,36-1,61) 0.473 0,6(0,25-1,61) ()JlS_'
, Khiinq 3317&6) mnsl 1 1 ,I SOythci (n-743)(6 6(14,6) 158122.S) 0,6~,2~1,43' 0142 O,8(O,3'l1,l1) 0,682Khong 35(85,4) S44(77,5) 1 1
. Iowto'gllDQhi(n-I269)I
])(47,6) 215(17.8) 4,2~Df) 1D,002! ;::8 0.000 3,3(1,57-6,95)<8 33(52.4) 991(82,2) 1 1HOtvcOO~dm(n-1,266)[ Khiing 14(22,2) 46{3,8) 7.19(371)1195) 0.000 51(Z2'l-1~42) 0,000(6 49(77,8) 1157j%,2} 1 1-- ---
3.3. Mc?tso yeu to lien quan den tramcam trang mang thai
Bang 2 chi ra moi lien quan giO'a mot so yeuto nguy co vo tram cam trong mang thai. Ket quaphon tfch do bien cho thay nhO'ngthai phu b] booluc trong mang thai thl nguy co bi tram cam trongmang thai cao gap gan 3 Ian khi so sanh voi nhO'ngthai phu kh6ng b] boo l\,Ic(OR: 2,5; 95%CI: 1,19-5,34), Nghien ceu con cho thay, nhO'ngthai phuco tien su bi thai Ivu thl nguy co b] tram cam trongmang thai cao gap hon 3 Ian khi so sonh voi nhO'ngthai phy kh6ng bi tien su thai Ivu (OR: 3,3; 95%CI:1,47-7,60), M¢t khac, nhO'ng thai phy co 10 autrong mang thai thl nguy cd bi tram cam cao gaphdn 3 Ian so v6i nhO'ngthai phy kh6ng 10au trongmang thai (OR: 3,3; 95%CI: 1,57-6,95). NhO'ngthai phy kh6ng dl1Qcgia dlnh h6 trQ trong mangthai thl nguy Cdbi tram cam cao gap gan 6 Ian sov6i nhO'ngthai phy dV9c gia dlnh h6 trQ (OR: 5,7;95%CI: 2,22-14,42).
4. Banlu(inKet qua nghien cuu cho thay ty 1$ tram cam
trong mang thai 105%.Ty 1$nay n6m trong khoang4% den 23,1% phy nO' mang thai bi tram cam [18],[19]. Ty 1$nay thap hdn so v6i nghien cuudV9ctien hanh 6 Malaysia va Brazil cho ty 1$tram camtrong mang thai Ian IV9t Ia 9,1%va 14% [13], [20],S6 dTco 5\,1 khac nhau ve ty 1$tram cam 10do khacnhau ve phl1dng phap nghien cuu, khac nhau vel\,Ia ch9n doi tuc;lngnghien cuu 6 c(lng dang hayb$nh vi$n va khac nhau ve thai gian do Ivang tramcam trong mang thai, M¢t khac, cac nghien coo sOdyng cung m(lt thang do tram cam (EPDS)nhvngsOdyng diem cat khac nhau.
M(lt phat hi$n thu hai trong nghien cuu cuachung t6i ve m(lt so yeu lien quan den tram camtrong mang thai bao gam: yeu to b<;lol\,Icgia dlnh,tien su thai Ivu, 10au trong mang thai va h6 trQgiacI1nhtrong khi mang thai, Ket qua phon tich dabien chi ra r6ng cac yeu to nay ket hQPm<;lnhmev6i tram cam trong mang thai, phat hi$n nay phuhQPv6i cae nghien cuu phan tich va tong hQPvecac yeu to nguy cd lien quan den tram cam trongmang thai [18], [19], [21].
Theo m(lt so nghien cOu cho thay, b<;lol\,Icgiadlnh/b<;lo l\,Icb<;lntlnh trong mang thai anh hv6ng
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TRAN THO I\JHI NGUYEf'J THI THUY Hi\~jH ~jGO vArJ TOAf~ ~jGUYE~JDue HINH
rncnh me den tram cam (> thai phu, Neu phu nO'mang thai bi b90 Illc ben tlnh thl nguy co bi tramcam coo hon nhO'ngphu nO'kh6ng b] b90 h,c trongmang thai [22], [23], [24].
M¢t khcc, coc nghi€m cuu cOng chi ra mot yeut6 quan tronq khoc la thieu su he fro xo h¢i, he frocuo gia dlnh onh hu(>ngden tram cam trong mangthai. Neu thai phu kh6ng due;>che tro trong khimang thai thl nguy co b] tram cam coo hon nhO'ngphv nO'due;>che tre;>tV xCih¢i, gia dlnh [19], [25],[26]. D¢c bi$t trong b6i canh van hoa Vi$t Nom,mang thai la giai d09n nh9Y cam va phv nO'candue;>che tre;>nhieu tV xCih¢i va cac thanh vi€mtronggia cIlnh d¢c bi$t la cheng ho¢c b9n tlnh.
M¢t yeu to quan tr9ng khac ket he;>pm~mh mevoi tram cam trong mang thai la 10au trong mangthai. Ket qua cua chung t6i chi ra nhO'ngthai phvco 10au trong mang thai thl nguy co bi tram camcoo gap hon 3 Ian so voi nhOng thai phv kh6ng 10au trong mang thai. Phat hi$n nay phu he;>pvoi ketqua cua m¢t nghi€m cvu phan tfch tong he;>pchothay 10au trong mang thai ket he;>pm9nh me voitram cam truoc sinh ke co phan tich don bien vado bien [25].
Ngoai cac phat hi$n trim, nghi€m cvu cuachung t6i con chi ra yeu to tiemsu thai luu ket he;>pm9nh me voi tram cam trong mang thai. Ket quanay gi6ng nhu trong nghi€m cvu cua Abiodun trenphv nO'mang thai (>Nigerian [26]. Phv nO'co tien
Tai lieu tham khao1. World Health Organization. ICD-10, international statisticalclassification of diseases and related health problems, tenth revision.World Health Organization; 1992.2. World Health Organisation Staff. World Health Report, 2001: MentalHealth: New Understanding, New Hope. Albany, NY, USA: World HealthOrganization; 01.3. Ajinkya S, Jadhav P, Srivastava N. Depression during pregnancy:Prevalence and obstetric risk factors among pregnant women attendinga tertiary care hospital in Navi Mumbai. Ind. Psychiatry J. 2013;22:37-40.4. Pereira PK, Lovisi GM, Pilowsky DL, Lima LA, Legay LF. Depressionduring pregnancy: prevalence and risk factors among women attending apublic health clinic in Rio de Janeiro, Brazil. Cad. Saude Publica [Internet].2009 [cited 2016 Mar 30];25:2725-2736. Available from: http://www.scielo.br/scielo.php?pid=SOI 02-311X2009001200019&script=sci_arttext5. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ.A meta-analysis of depression during pregnancy and the risk of pretermbirth, low birth weight, and intrauterine growth restriction. Arch. Gen.Psychiatry. 2010;67:1012-24.6. Vigod S, Villegas L, Dennis Col, Ross L. Prevalence and risk factors for
su thai luu thl nguy co b] tram cam coo gap 8 Iankhi so sanh voi phu nO'kh6ng b] thai luu (OR: 8,0,95%CI:1,70-37,57).
Nghiem cuu cuo chung toi cho thay kh6ng comoi lien quan giO'a coc yeu to nhu trlnh d¢ h9cvan thap, that nghi$p vo tuai cue thai phu vo tramcam trong mang thai. Phot hien nay cOng tuong tvnhu mot nghien cuu h$ thong chi ra kh6ng co moituonq quan nay khi phan tich do bien [25]. Trongm¢t nghien CLIU phan tich tang he;>pkhac 19i choket qua nhO'ng thai phv tre tuai thl nguy co bi tramcam truoc sinh coo hon khi so voi nhO'ngthai phvIon tuai hon [19].
H9n che cua nghi€m CLlU: Tram cam 10 chu denh9Y cam rna co kha nang se lam cho m¢t s6 phynO'kh6ng tiet I¢ kinh nghi$m cua h9 dan den cothe anh huong den vi$c uoc lue;>ngty 1$.M¢t khac,vi$c danh gia tram cam (>phv nO'mang thai la dl/avao phv nO'tll bao cao chv kh6ng phai 10danh gialam sang.
5. Ket lu~nNghien CLIU cua chung t6i chi ra r&ng tram
cam 10 kha pha bien (> phv nO'mang thai, voim¢t ty 1$ tuong duong voi cac .nUOctrong khuVI/C. M¢t so yeu t6 lien quan cK¢t che voi tramcam (>thai ky boo gem b90 Illc gia dlnh, tiemsuthai luu, 10au trong mang thai va he tre;>gia dlnhtrong khi mang thai.
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