Relationship Between Depression And Rumination In Pregnant Women And The Attentional Bias

BACKGROUNDPregnant women may have complex psychological changes at the same time and prone to depression during pregnancy[1].At present,the detection rate of depression in pregnant women at home and abroad is about 5.00%～52.00%[2,3],and it is increasing year by year[4].Depression in pregnant women will not only endanger the health of mother and child,affect their social and family relationships[5],but it may also increase the risk of postpartum depression[6].In September 2020,the National Health Commission issued the Work Plan of Exploring the Special Services for the Prevention and Treatment of Depression,which mentioned that depression screening during pregnancy should be included in the routine pregnancy examination process,to strengthen the prevention and treatment of depression in pregnant women,it is very important to carry out early screening and health services for depression during pregnancy before delivery.Rumination is a kind of maladaptive cognitive style,which means that individuals continuously and passively pay attention to and repeatedly think about negative events that cannot be removed,the attentional bias to negative emotions may be a risk factor for depression[7].At present,the domestic research on rumination and depression has been few carried out in pregnant women.The existing research results abroad are still inconsistent and most of them are assessed by scales.This study focused on pregnant women,carried out investigations of pregnant women’s depression and its risk factors.Taking rumination of pregnant women as the breakthrough point,combined with subjective scales and objective experiments,to studies the relationship between depression and rumination of pregnant women as well as the characteristics of attention bias,so as to provide theoretical support and practical reference for early screening and intervention of depression of pregnant women in the clinical.OBJECTIVEl.To understand the status quo of pregnant women’s depression and rumination,to analyze its characteristics and influencing factors,and to explore the relationship between depression and rumination and its mediating effect through questionnaire survey.2.To understand the characteristics of attention bias of pregnant women with depression,to explore the relationship between rumination and attention bias of pregnant women,and to provide a new research perspective for the identification and intervention of prenatal depression through emotional Stroop test.METHODSResearch content 1:The status quo of depression and rumination in pregnant women and its influencing factorsUsing questionnaire survey method,applying Edinburgh Postpartum Depression Scale,Ruminative Response Scale,Perceived Stress Scale,Dysexecutive Questionnaire and general information questionnaire,2059 pregnant women from 5 third class A hospitals in Guangdong were selected to carry out questionnaire survey.The status quo investigation of depression and rumination in pregnant women were analyzed,and to understand its characteristics and influencing factors.Research content 2:The mediating effect of depression and rumination in pregnant womenThe mediating effect analysis method was used to analyze the chain mediating effects of dysexecutive function and perceived stress on rumination and depression in 2059 pregnant women,to understand its relationship and characteristics,and to analyze the predictive effect of rumination on depression in pregnant women.Research content 3:Attentional bias between depression and rumination in pregnant womenUsing emotional Stroop test,105 pregnant women who participated in the questionnaire survey were screened for experiments.According to the Edinburgh Postpartum Depression Scale score was ≥9 and excluded depression,pregnant women were divided into high score group of depression and low score group.Pregnant women were asked to name emotional words and recorded reaction time and accuracy,to analyze the relationship between rumination and attentional bias in pregnant women with depression.STATISTICS AND ANALYSISThe questionnaire data was input and check with Epidata 3.1 software,SPSS 22.0 software was used for statistical analysis.The general data of pregnant women were described as frequency,percentage,mean and standard deviation.The detection rate of depression among pregnant women with different characteristics was compared by two independent sample t test,Chi-square test or Fisher exact test.Pearson correlation analysis and Binary Logistic regression analysis was used to explore the influencing factors of pregnant women’s depression.Harman single factor method was used to test the common method deviation between the scale items by unrotated factor analysis.Process 3.2 plugin was used for path analysis,the multiple mediation effect was tested by the Boopstrap program,and the sampling was repeated 5000 times.The reaction time and accuracy of different types of words were tested by repeated measures analysis of variance for inter-group effect,intra-group effect and interaction effect.Pearson correlation analysis was used to evaluate the correlation between reaction and attentional bias in pregnant women with depression.α=0.05 and P<0.05 was considered statistically significant.RESULTS1.The detection rate of depression in pregnant women and its influencing factorsThe detection rate of depression in pregnant women was 36.72%.Binary logistic regression analysis showed that high relationship satisfaction with husband was a protective factor of depression in pregnant women（OR=0.587,95%CI=0.421-0.81.7）.Worrying about delivery safety（OR=1.712,95%CI=1.455～2.014）,symptom-focused rumination（OR=1.060,95%CI=1.015～1.108）,brooding（OR=1.105,95%CI=1.013～1.206）,crisis perception（OR=1.369,95%CI=1.307～1.434）,coping ability perception（OR=1.110,95%CI=1.069～1.153）,inhibition（OR=1.110，95%CI=1.069～1.153）were risk factors for depression in pregnant women.Hosmer-Lemeshow test showed that the value was 7.036（P=0.533>0.05）,indicating good equation fitting degree.2.The mediating effect of dysexecutive function and perceived stress on rumination and depression in pregnant womenRegression analysis showed that pregnant women’s rumination had a positive predictive effect on dysexecutive function,perceived stress and depression（β=0.653,0.232,0.190）.Dysexecutive function in pregnant women positively predicted perceived stress and depression（β=0.110,0.054）.Perceived stress in pregnant women had a positive predictive effect on depression（β=0.319）,all P<0.001.Rumination had an indirect effect on pregnant women’s depression through dysexecutive function and perceived stress,the chain mediating effect was significant.There are three mediating pathways for mediating effect:indirect effect 1 was "rumination→dysexecutive function→depression"（effect=0.036,95%CI=0.024～0.048）;Indirect effect 2 was"rumination→perceived stress→depression"（effect0.074,95%CI=0.062～0.086）;Indirect effect 3 was "rumination→dysexecutive function perceived stressg→depression"（effect=0.023,95%CI=0.018～0.028）.3.Characteristics of attentional bias between depression and rumination in pregnant womenThere was no significant difference in the accuracy and reaction time between two groups（P>0.05）.The reaction time of high-score group was longer,the reaction time of negative words was slightly longer than positive words in high-score group,the reaction time of negative words was slightly lower than positive words in low-score group,however,the difference between two groups under the stimulus of different types of words didn’t reach the level of statistical significance（P>0.05）.Pearson correlation analysis showed that there was a negative correlation between reflective pondering and total reaction time,neutral word and negative word reaction time（r=-0.312,-0.327,-0.307,P<0.05）.CONCLUSION1.The detection rate of depression in pregnant women was 36.72%in this study.The high degree of worry delivery safety,symptom-focused rumination,brooding the crisis perception,coping ability perception and inhibition were the risk factors of depression in pregnant women.The high satisfaction of relationship with husband was the protective factor.Rumination can indirectly influence the depression in pregnant women through the mediating path of dysexecutive function and perceived stress.2.Pregnant women occupy a certain amount of attention resources during cognitive processing of emotional stimuli,especially those with high depression,but the difference of attentional bias in pregnant women with different levels of depression didn’t reach a statistically significant level.Reflective pondering can reduce the attentional bias to emotional stimuli in pregnant women with depression to some extent.The characteristics of attentional bias between pregnant women’s depression and rumination need further research.