Health-related Quality Of Life Among Pregnant Women And Related Factors In Chinese Mainland

ObjectivesHealth is the most significant part of quality of life. Generally, public health professionals use health-related quality of life (HRQoL) to measure a person or group's perceived physical and mental health status over time. Up to now, limited information exists, about Chinese mainland pregnant women, regarding the HRQoL and related factors. Prenatal depression, sleep quality, stress and social support were identified as the significant perdictors of worse health status of pregnant women in western countries. However, in Chinese population, less is known about the extent to which HRQoL is affected by the pregnancy and related factors.Therefore, the purpose of the present paper was to (a) describe the prevalence of depression mood, sleep quality, perceived stress, perceived social support and HRQoL among pregnant women; (b) compare HRQoL, sleep quality, perceived stress and perceived social support between women with and without prenatal depression; (c) compare HRQoL, perceived stress and perceived social support between pregnant women with and without sleep disorder; (d) compare HRQoL and related factors among pregnant women in different trimesters; (e) compare HRQoL between pregnant women and American female normative data; (f) compare HRQoL between women with prenatal depression and American depressive population; (g) examine the relationships among demographic characteristics, depression, perceived stress, perceived social support, sleep quality and physical and mental HRQoL; (h) explore the risk factors of prenatal depression; (i) identify the predictors of severity of depressive symptoms and sleep quality of pregnant women; and (j) find the best predictors of each domain of HRQoL and, physical and mental HRQoL,MethodsThis study was designed as a cross-sectional and exploratory survey. Participants were recruited at the outpatient department of obstetrics and gynecology of two general hospitals in central China. Women were eligible if they were:(1) at least 18 years of age, (2) able to read and understand Chinese, and (3) willing to provide written consent. A convenience sample of 454 pregnant women participated in the study between February 2010 and July 2010 in central China.Six self-report questionnaires were administered to collect data, measuring sample characteristics (Sociodemographic characteristic questionnaire), prenatal depression (The Edinburgh Postnatal Depression Scale, EPDS), perceived stress (Perceived Stress Scale, PSS), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and HRQoL (Medical Outcomes Study short-form-36v2, SF-36v2).ResultsThe mean EPDS score was 8.49 (SD=4.44),39.86% women experience prenatal depression. The proportion of women with prenatal depression in the first, second and third trimester was 36.4%,40.2% and 39.8% respectively. The mean EPDS scores in the first, second and third trimester was 8.45 (SD=5.15),8.71(SD=4.55) and 8.19 (SD=4.20) respectively. No significant differences were found in EPDS scores and the percentage of depressive disorder across three trimesters.87% pregnant women experience sleep disorder (PSQI score>5). No significant differences were found in the proportion of women with sleep disorder across three trimesters. Poorer global sleep quality, subjective sleep quality, lower sleep efficiency and sleep disturbances were most prevalent during third trimester. Women with prenatal depression reported more score of each subscale of PSQI than nondepressed women.The mean score of MSPSS and PSS was 63.30 and 13.23 respectively. Women with prenatal depression perceived less social support and more stress than nondepressed women. No significant differences were found in MSPSS scores between women with and without sleep disorder. Women with sleep disorder suggested more score of PSS than good sleepers. No significant differences were found in MSPSS and PSS scores across three trimesters.Mean score of HRQoL were significantly less for women with sleep disorder compared with women without sleep disorder on each domain scales and the physical and mental component summary (PCS and MCS) measures. Mean score of HRQoL were significantly higher for women without prenatal depression compared with women with prenatal depression on all eight health domain scales, PCS and MCS measures. Body pain score during third trimester was less than second trimester. PCS score in third trimester was less than second trimester. While MCS score in third trimester was higher than second trimester. Compared to American female normative data, women experiencing prenatal depression scored significantly lower on all SF-36 domains, as well as on the PCS and MCS score, with the exception of vitality. Moreover, compared to American depressive population, women with prenatal depression reported more score of each domain scales and two component summary measures, with the exception of role limitation due to physical problems.Prenatal depression score was found to have significant positive correlations with perceived stress score and sleep quality score. Perceived stress score and sleep quality score were found to have a significant positive correlation. Higher perceived social support score was significantly associated with higher score of general health, vitality, role limitation due to emotional health, mental health and mental component summary.Significant negative correlations were found between perceived social support score and perceived stress score. Higher prenatal depression score, perceived stress score and sleep quality score was significantly correlated with lower score across all the SF-36 subscales and two component summary measures respectively. Furthermore, prenatal depression score and perceived social support score were found to have a significant negative correlation.General linear regression analyses showed that perceived stress and sleep quality were significant contributors of severity of prenatal depression. In comparison to women with master degree, the risk for prenatal depression of women with doctoral degree was 5.68 times higher. The risk of prenatal depression in women with total family income below 2000 CNY was 2.38 times higher than women with total family income over 6000 CNY. The significant contributors of sleep quality for pregnant women were prenatal depression, age and gestational age. Sleep quality emerged as a significant determinant of worse HRQoL in eight domains. Perceived stress was a significant independent determinant of 6 of the 8 HRQoL dimensions. Sleep quality, age, perceived stress, employment status and gestational age were significant determinants of physical HRQoL. Prenatal depression, perceived stress, gestational age and unplanned pregnancy were significant predictors of mental HRQoL.ConclusionsPrenatal depression is common in Chinese mainland women. The presence of depressive symptoms within this population is a major public health problem. It is recommended that antenatal services integrate screening for depression in routine antenatal care. Women with doctoral degree and low level of family income are more likely to experience prenatal depression. Poorer sleep quality, increased stress and lack of social support may increase the severity of depressive symptom.Women experience more body pain in third trimester. Worse mental health status was found in second trimester, while worse physical health status was demonstrate in third trimester. Impaired health status of pregnant women were correlated with depressed mood, sleep disorder, high level of perceived stress and low level of perceived social support. Especially, prenatal depression and sleep disorder had a negatively impact on Chinese women's physical and mental HRQoL. These findings will help increase the awareness of health care professions assess the mental health status and sleep quality of pregnant women, and promote the conduct of more effective interventions directed toward the prevention of prenatal depression and sleep disorder. Consequently, the HRQoL of pregnant women will be improved.InnovationThe current study identify the best predictors of HRQoL, sleep quality and severity of depression of pregnant women; explore the risk factors of prenatal depression; demonstrate the relationships among demographic characteristics, depression, perceived stress, perceived social support, sleep quality and physical and mental HRQoL; use the validated instruments to assess variables, the data collected was indispensable for transcultural research; propose that pregnant women with sleep disorder is the high risk group with prenatal depression. They should be screened in routine antenatal care. The overall conclusions are important for clinical practice and research in future.