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中国循证儿科杂志

中国循证儿科杂志 ›› 2024, Vol. 19 ›› Issue (5): 392-399.DOI: 10.3969/j.issn.1673-5501.2024.05.013

• 论著 • 上一篇    下一篇

母亲产后分离焦虑对学龄前儿童社会情绪影响的前瞻性队列研究

苏茹昕1,潘昊2,3,林青敏2,王广海2,4,5,孙莞绮1,姜艳蕊2,朱绮2,张云婷2,江帆1,2,4,5   

  1.  1 上海交通大学医学院附属精神卫生中心 上海，200030；2 国家儿童医学中心，上海交通大学医学院附属上海儿童医学中心 发育行为儿科 上海，200127，3 国家儿童医学中心，上海交通大学医学院附属上海儿童医学中心 儿童健康管理研究所 上海， 200127，4 上海交通大学医学院附属新华医院，教育部和上海环境与儿童健康重点实验室 上海，200092；5 上海脑科学与类脑研究中心 上海， 201602
  • 收稿日期:2024-03-18 修回日期:2024-06-23 出版日期:2024-10-25 发布日期:2024-10-25
  • 通讯作者: 张云婷;江帆

Association between maternal postpartum separation anxiety and socialemotional problems in preschool children: A prospective cohort study

SU Ruxin1, PAN Hao2,3, LIN Qingmin2, WANG Guanghai2,4,5, SUN Wanqi1, JIANG Yanrui2, ZHU Qi2, ZHANG Yunting3, JIANG Fan1,2,4,5   

  1. 1 Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; 2 Department of Developmental and Behavioral Pediatrics, National Children's Medical Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 3 Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 4 MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; 5 Shanghai Center for Brain Science and Brain-Inspired Technology，Shanghai 201602, China
  • Received:2024-03-18 Revised:2024-06-23 Online:2024-10-25 Published:2024-10-25
  • Contact: ZHANG Yunting; JIANG Fan

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摘要： 背景：母亲产后分离焦虑是影响儿童社会情绪发展的重要因素，但母亲产后分离焦虑对儿童早期的影响和产生影响的关键节点尚不明确。 目的：探讨母亲在产后2年内4个时点的分离焦虑对学龄前期儿童社会情绪的影响。 设计：前瞻性队列研究。 方法：在上海睡眠出生队列中纳入年龄18~45岁、孕周≥28周、胎儿无已知畸形、长期定居在上海并在上海交通大学医学院附属仁济医院东区分院分娩、单胎妊娠的孕晚期产妇作为本文队列人群，子代纳入出生胎龄≥37周且出生体重2 500~4 000 g的健康新生儿，排除曾入住NICU或出生1、5 min Apgar评分中有1次≤7分者。采集孕晚期母亲受教育程度，家庭年收入，母亲生产年龄，抑郁、焦虑和整体应激水平，采集子代6月龄时婴儿气质类型。母亲于产后6、12、18和24个月行母亲分离焦虑量表（MSAS)评估，子代6岁时以长处和困难问卷（SDQ）评估儿童社会情绪发展情况。 主要结局指标：SDQ困难总分、内化问题和外化问题。 结果：2012年5月至2013年7月纳入符合本文孕晚期产妇和新生儿纳排标准的孕晚期产妇和子代新生儿均为262名，退出样本（n=80）和纳入样本(n=182)基线数据敏感性分析差异均无统计学意义。孕产妇生产时年龄（29.7±3.3)岁，最高学历以本科或大专学历占比最高（73.1%），基于抑郁量表评估抑郁，状态特质焦虑问卷评估焦虑，孕妇生活事件量表评估应激水平，结果显示母亲孕晚期整体心理健康情况良好，家庭年收入14~29万元人民币者占48.6%，＜14万元人民币者占38.1%；子代6月龄气质类型：易养型44.3%，中间偏易养型39.2%，中间型或难养型16.5%。母亲在子代6、12、18和24月龄的分离焦虑水平呈逐渐下降趋势，18和24月龄时母亲分离焦虑水平显著低于6月龄，差异有统计学意义。家庭年收入更高的母亲在儿童18月龄时分离焦虑水平更低，受教育程度更高的母亲在6月龄和18月龄时分离焦虑水平更低。母亲生产时年龄与儿童18月龄时母亲分离焦虑呈显著负相关，孕晚期母亲抑郁水平与儿童18月龄和24月龄时母亲分离焦虑呈显著正相关，孕晚期母亲特质焦虑水平与儿童24月龄时母亲分离焦虑呈显著正相关，未发现儿童性别和气质与母亲分离焦虑水平的显著关联。调整了基本人口学变量和母亲孕晚期情绪状态等因素后，产后12和18个月时母亲分离焦虑水平与儿童内化问题存在显著关联。未发现产后6个月时母亲分离焦虑与儿童6岁时内化问题的显著相关，未观察到母亲分离焦虑水平与儿童6岁时外化问题和困难总分的显著相关。 结论：生命早期的母亲分离焦虑水平是儿童社会情绪发展的独特风险因素，与儿童学龄前期内化问题存在显著关联。

关键词: 母亲分离焦虑, 学龄前儿童, 情绪与行为问题

Abstract: Background: Maternal separation anxiety is important for children's socialemotional development. However, the influence of postpartum separation anxiety on early childhood and the critical time points of its effect are still unclear. Objective: To explore the impact of maternal separation anxiety at different time points within 2 years at 4 time points after delivery on socialemotional behavior problems of preschool children. Design: Prospective cohort study. Methods: In the Shanghai Sleep Birth Cohort, women during the third trimester, aged 18 to 45, gestational age ≥28 weeks, without any known deformity, longterm resident in Shanghai, delivery in the eastern division of the Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and single pregnancy were included as the cohort population. The offsprings were included if they were born at term and weighed 2500 to 4000g at birth, and excluded if they were admitted to the NICU after birth, or their Apgar score was ≤7 at 1 or 5 minutes with asphyxia at birth. Maternal education level, family annual income, maternal age at delivery, maternal depression, anxiety, and overall stress level were assessed during late pregnancy, and the offspring were evaluated for temperament type when they were 6 months old. Maternal separation anxiety was assessed by the Maternal Separation Anxiety Scale (MSAS) at 6, 12, 18, and 24 months postpartum, and the offspring's socialemotional development was assessed with the Strengths and Difficulties Questionnaire (SDQ) at age 6. Main outcome measures: Total difficulties score, internalizing problems, and externalizing problems. Results: From May 2012 to July 2013, 262 dyads of pregnant women and their offspring newborns were included according to the criteria for mothers and neonates. There was no statistical significance in the sensitivity analysis of baseline data between the withdrawn samples (n=80) and the final included samples in the current study (n=182). Maternal age at delivery was 29.7±3.3. Most of the mothers attained the highest education level of bachelor or college degree (73.1%). Maternal depression assessed by the Center for Epidemiological Studies Depression Scale, anxiety assessed by State-Trait Anxiety Inventory scale and stress level assessed by Life Events Scale for Pregnant Women represented good overall mental health. Family annual income of 140,000 to 290,000 RMB accounted for 48.6%, <140,000 RMB accounted for 38.1%. Among the temperament types of children aged 6 months, 44.3% were "easy", 39.2% were "intermediate low", and 16.5% were "intermediate high" or "difficult". Maternal separation anxiety gradually decreases at 6, 12, 18, 24 months postpartum. Specifically, maternal separation anxiety at 18 and 24 months postpartum was lower than that at 6 months postpartum, which was statistically significant. Higher family annual income predicted lower separation anxiety at 18 months postpartum, and mothers with higher education had lower levels of separation anxiety at 6 and 18 months postpartum. Maternal age at delivery was significantly negatively correlated with maternal separation anxiety at 18 months postpartum, maternal depression in late pregnancy was significantly positively correlated with maternal separation anxiety at 18 months and 24 months postpartum, and maternal trait anxiety in late pregnancy was significantly positively correlated with maternal separation anxiety at 24 months postpartum. Neither child gender nor temperament was significantly associated with maternal separation anxiety. After controlling for basic demographic information and maternal emotional state during late pregnancy, maternal separation anxiety at 12 and 18 months postpartum was significantly and positively associated with children's internalizing problems at 6 years of age. There was no significant association between maternal separation anxiety at 6 months postpartum and children's internalization problems at 6 years of age, and no significant association between maternal separation anxiety and children's externalization problems and difficulty scores at 6 years of age. Conclusion: Maternal separation anxiety early in life is a unique risk factor for children's socioemotional development and is significantly associated with internalization problems in children at preschool age.

Key words: Maternal separation anxiety, Preschool children, emotional and behavioral problems