许真

[摘要] 目的 收集与评估不同医保类型住院待产孕妇心理健康状况，分析不同醫疗费用支付方式对孕妇心理健康状况的影响。 方法 选取福建省妇幼保健院2014年2月～2016年2月收治的506例单胎妊娠孕妇，按不同医疗费用支付方式分为医保组（202例）、新农合组（195例）、自费组（109例），采用抑郁自评量表（SDS）、焦虑自评量表（SAS）和一般心理健康问卷（GHQ-12）对住院孕妇进行调查，对结果进行统计处理分析。 结果 支付方式为新农合组的待产孕妇高危倾向阳性率最高（25.6%），医保组（14.4%）的待产孕妇高危倾向阳性率高于自费组（7.3%）；不同医疗费用支付方式的待产孕妇间焦虑倾向、抑郁倾向阳性率差异均无统计学意义（P>0.05）。 结论 医疗费用支付方式是影响住院待产孕妇心理健康状况的重要因素，应重视农村妇幼保健工作，对高危孕产妇应制定详细的保健计划，加大心理健康宣教力度，普及优生优育知识，以利于孕妇顺利分娩和产后康复。

[关键词] 医疗费用支付方式；孕妇；心理健康；抑郁；焦虑

[中图分类号] R197.1 [文献标识码] B [文章编号] 1673-9701（2017）04-0128-04

Investigation on mental health status of hospitalized expectant pregnant women with different types of medical insurance

XU Zhen

Department of Medical Insurance， Fujian Women and Childrens Hospital， Fuzhou 350001， China

[Abstract] Objective To collect and evaluate the mental health status of hospitalized expectant pregnant women with different types of medical insurance and to analyze the effect of different payment method of medical expenses on the mental health status of pregnant women. Methods 506 cases of pregnant women with single pregnancy who were admitted to Fujian Women and Children's Hospital from February 2014 to February 2016 were selected. According to different payment methods of medical expenses， the pregnant women were divided into the medical insurance group（202 cases）， the new rural cooperative medical system（NCMS） group（195 cases） and the self-paying group（109 cases）. The pregnant women were investigated by self-rating depression scale（SDS）， self-rating anxiety scale（SAS） and general mental health questionnaire（GHQ-12）. The results were analyzed statistically. Results The positive rate of high risk tendency of expectant pregnant women was the highest in the NCMS group（25.6%）， and the positive rate of high risk tendency of pregnant women in the medical insurance group（14.4%） was higher than that in the self-paying group（7.3%）； there was no statistically significant difference in the positive rate of anxiety tendency and depression tendency among the pregnant women with different payment methods of medical expenses（P>0.05）. Conclusion The payment method of medical expenses is an important factor influencing the mental health of hospitalized expectant pregnant women. Attention should be paid to rural maternal and children's healthcare. A detailed health plan should be developed for the high-risk pregnant women， the mental health education should be enhanced， and the prenatal and postnatal care knowledge should be popularized， in order to facilitate the smooth delivery of pregnant women and postpartum rehabilitation.

[Key words] Payment methods of medical expenses； Pregnant women； Mental health； Depression； Anxiety

妊娠和分娩是女性一生中重要的生理时期，同时也是心理和情感的多变期，容易产生不同程度的不安、焦虑和恐惧心理。以往研究表明，孕妇普遍存在焦虑和抑郁情绪，这些心理健康问题不但会损害母儿健康，还可能严重影响其分娩质量和妊娠结局[1]。关于孕妇产前心理问题影响因素的研究已在国内外广泛开展，根据既往的研究报道，主要影响因素有孕妇的年龄、学历、职业、社会经济状况、家庭支持情况、孕周、妊娠合并症和并发症、既往有不良妊娠结局史等，其他因素如睡眠质量、居住环境、对胎儿性别的期盼等也在相关学者的研究范围内[2]。本……