İsteyerek düşük yapan ve spontan düşük yapan kadınlarda depresyon, anksiyete ve yaşam kalitesi ölçekleri ile karşılaştırmalı prospektif bir çalışma

Yıl 2022, , 364 - 368, 15.03.2022

Mehmet Ufuk Ceran , Umit Tasdemir

https://doi.org/10.16899/jcm.1024203

Öz

Amaç: İsteyerek düşük ve spontan düşük nedeniyle gebeliği sonlandırılacak kadınların yaşam kalitesi (YK), depresyon ve anksiyete belirtileri açısından karşılaştırılması.
Yöntem: Bu prospektif vaka-kontrol çalışmasına, gebelik terminasyonu için hastaneye yatırılan kadınlar dahil edildi. İsteyerek düşük grubundaki 35 kadına ve spontan düşük grubundaki 35 kadına, kronik sistemik hastalıklar, önceden bilinen psikolojik rahatsızlıklar ve uyuşturucu madde kullanımı dışlandıktan sonra öz değerlendirme anketleri sunuldu. Bunun için terminasyon öncesi psikolojik stres düzeylerini belirlemek için WHOQOL-BREF kısa form yaşam kalitesi anketi, Beck Depresyon ve Beck Anksiyete envanteri kullanıldı.
Bulgular: İsteyerek düşük grubunda orta-ağır depresyon istatistiksel olarak spontan düşük grubuna göre daha yüksek bulundu (sırasıyla %31,4, %5,7, p<0,05). Benzer şekilde, isteyerek düşük grubunda orta-şiddetli anksiyete %34.3, spontan düşük grubunda %8.6 idi ve istatistiksel olarak fark gözlendi (p<0.05). Yaşam kalitesi ölçeğinin fiziksel ve psikolojik alanı açısından, isteyerek düşük grubunda spontan düşük grubuna göre istatistiksel olarak anlamlı derecede daha düşük sonuçlar elde ettik (p<0.05).
Sonuç: İsteyerek düşük yapan kadınların, gebeliği sonlandırmadan önce, spontan düşük yapanlara göre depresyon ve anksiyeteye daha yatkın oldukları gözlendi. İsteyerek düşük grubundaki düşük psikolojik YK skorları ve her iki gruptaki düşük çevresel YK skorları, üreme çağındaki kadınların öz yeterliklerini ve psikolojik dayanıklılıklarını artıracak stratejilerle desteklemenin, ileride yaşanacak erken gebelik sorunlarının yönetiminde onlara fayda sağlayacağını düşündürmektedir.

Anahtar Kelimeler

isteyerek düşük, spontan düşük, depresyon, anksiyete, yaşam kalitesi

A comparative prospective study with depression, anxiety and quality of life scales in women with induced abortion and miscarriage before pregnancy termination

Öz

Objective: Comparison of women whose pregnancy will be terminated due to induced abortion and spontaneous miscarriage in terms of quality of life (QoL), depression and anxiety symptoms.
Method: This prospective case-control study included women hospitalized for pregnancy termination. Self-evaluation questionnaires were presented to 35 women in induced abortion group and 35 women in miscarriage group after exclusion of chronic systemic disease, previously known psychological disorders and drug users, women recommended abortion by the decision of the health board. For this, WHOQOL-BREF short-form quality of life questionnaire, Beck Depression and Anxiety Inventory were used to determine psychological stress levels before termination.
Results: Moderate-severe depression was found to be statistically higher in induced abortion group than miscarriage group (31.4 %, 5.7%, respectively, p<0.05). Similarly moderate-severe anxiety was 34.3% in induced abortion group and 8.6% in miscarriage group, and a statistical difference was observed (p<0.05). In terms of the physical and psychological domain of QoL, we obtained statistically significantly lower results in induced abortion group compared to miscarriage group (p<0.05).
Conclusion: It was observed that women who had induced abortion were more prone to depression and anxiety before pregnancy termination than those who had spontaneous miscarriage . The low psychological QoL in induced abortion group as well as the low environmental QoL in both groups suggest that supporting women of reproductive age with strategies to enhance their self-efficacy and increasing their psychological resilience will benefit them in the management of early pregnancy problems that they may encounter in the future.

Anahtar Kelimeler

induced abortion, miscarriage, depression, anxiety, quality of life

Kaynakça

• 1. Sedgh, G., et al., Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. The Lancet, 2016. 388(10041): p. 258-267.
• 2. Luo, M., et al., Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study. BMC public health, 2018. 18(1): p. 1-11.
• 3. Gomez, A., Abortion and subsequent depressive symptoms: an analysis of the National Longitudinal Study of Adolescent Health. Psychological medicine, 2018. 48(2): p. 294.
• 4. Group, E.C.W., Induced abortion. Human reproduction (Oxford, England), 2017. 32(6): p. 1160-1169.
• 5. Blohm, F., B. Fridén, and I. Milsom, A prospective longitudinal population‐based study of clinical miscarriage in an urban Swedish population. BJOG: An International Journal of Obstetrics & Gynaecology, 2008. 115(2): p. 176-183.
• 6. Mutiso, S.K., A. Murage, and A.M. Mwaniki, Factors associated with a positive depression screen after a miscarriage. BMC psychiatry, 2019. 19(1): p. 1-6.
• 7. Farren, J., et al., The psychological impact of early pregnancy loss. Human Reproduction Update, 2018. 24(6): p. 731-749.
• 8. Hamilton Boyles, S., et al., Life event stress and the association with spontaneous abortion in gravid women at an urban emergency department. Health Psychology, 2000. 19(6): p. 510.
• 9. Neugebauer, R., et al., Association of stressful life events with chromosomally normal spontaneous abortion. American Journal of Epidemiology, 1996. 143(6): p. 588-596.
• 10. Qu, F., et al., The association between psychological stress and miscarriage: a systematic review and meta-analysis. Scientific reports, 2017. 7(1): p. 1-8.
• 11. Iwanowicz-Palus, G., M. Mróz, and A. Bień, Quality of life, social support and self-efficacy in women after a miscarriage. Health and Quality of Life Outcomes, 2021. 19(1): p. 1-8.
• 12. Faul, F., et al., Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behavior research methods, 2009. 41(4): p. 1149-1160.
• 13. Group, W., Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological medicine, 1998. 28(3): p. 551-558.
• 14. Eser, E., et al., WHOQOL-100 ve WHOQOL-BREF'in psikometrik özellikleri. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi, 1999. 7(Suppl 2): p. 23-40.
• 15. Beck, A.T., et al., Beck depression inventory (BDI). Arch Gen Psychiatry, 1961. 4(6): p. 561-571.
• 16. Kapci, E.G., et al., Beck Depression Inventory II: evaluation of the psychometric properties and cut‐off points in a Turkish adult population. Depression and anxiety, 2008. 25(10): p. E104-E110.
• 17. Beck, A.T., et al., An inventory for measuring clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 1988. 56(6): p. 893.
• 18. Ulusoy, M., N.H. Sahin, and H. Erkmen, The Beck anxiety inventory: psychometric properties. J. Cogn. Psychother, 1998. 12(2): p. 163-172.
• 19. Jacob, L., et al., Association between induced abortion, spontaneous abortion, and infertility respectively and the risk of psychiatric disorders in 57,770 women followed in gynecological practices in Germany. Journal of affective disorders, 2019. 251: p. 107-113.
• 20. Munk-Olsen, T., et al., Induced first-trimester abortion and risk of mental disorder. New England Journal of Medicine, 2011. 364(4): p. 332-339.
• 21. Steinberg, J.R., C.E. McCulloch, and N.E. Adler, Abortion and mental health: findings from the national comorbidity survey-replication. Obstetrics and gynecology, 2014. 123(2 0 1): p. 263.
• 22. Steinberg, J.R., et al., Psychosocial factors and pre-abortion psychological health: The significance of stigma. Social science & medicine, 2016. 150: p. 67-75.
• 23. Couto, E.R., et al., Quality of life, depression and anxiety among pregnant women with previous adverse pregnancy outcomes. Sao Paulo Medical Journal, 2009. 127(4): p. 185-189.
• 24. Tavoli, Z., et al., Quality of life and psychological distress in women with recurrent miscarriage: a comparative study. Health and quality of life outcomes, 2018. 16(1): p. 1-5.