概要
目 的
孕产妇的心理健康风险较为突出, 但尚未有文献说明何种心理干预方式对患有新冠肺炎的围产期孕妇有效. 本文报告了一例确诊新冠肺炎的 35 周 2 天孕妇在入住隔离病房后, 使用辩证行为治疗 (DBT) 相关技术对其存在的抑郁和焦虑症状在围产期进行持续心理干预的案例, 旨在探究以 DBT 为基础的短程心理治疗对围产期新冠肺炎患者的抑郁和焦虑症状的改善作用.
创新点
首例对确诊新冠肺炎的孕产妇进行产前及产后心理评估及干预的案例. 也是首次报道在公共卫生危机事件的个体干预中使用了 DBT 相关技术.
方 法
患者, 女, 30 岁, 孕 35 周 +2 天, 干咳两天就诊, 在当地医院进行新型冠状病毒核酸测验提示阳性后转入浙江大学医学院附属第一医院住院治疗. 2020 年 2 月 8 日行剖腹产, 产后继续在隔离病房治疗. 入院后精神科访谈及心理测量均提示存在抑郁和焦虑症状, 于 2 月 7 日、 10 日、 16 日进行三次心理干预, 主要使用 DBT 相关干预技术, 包括放松训练、 正念练习、 情绪控制技巧训练、 人际支持等. 期间根据患者的需要及时调整干预策略. 通过三次心理干预, 患者的抑郁、 焦虑症状得到改善, 抑郁和焦虑量表评分与基线比显著下降.
结 论
本报告显示了对确诊新冠肺炎的隔离病房患者及时进行心理干预的必要性. 心理干预能有效改善患者的抑郁、 焦虑症状, 减少或避免了精神类药物的使用, 为新冠肺炎的临床治疗提供了支持. 此报告也为以 DBT 为基础的心理治疗在危机干预中的应用提供了临床证据.
Article PDF
Avoid common mistakes on your manuscript.
References
Abad C, Fearday A, Safdar N, 2010. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect, 76(2):97–102. https://doi.org/10.1016/j.jhin.2010.04.027
Eisner L, Eddie D, Harley R, et al., 2017. Dialectical behavior therapy group skills training for bipolar disorder. Behav Ther, 48(4):557–566. https://doi.org/10.1016/j.beth.2016.12.006
Fassbinder E, Schweiger U, Martius D, et al., 2016. Emotion regulation in schema therapy and dialectical behavior therapy. Front Psychol, 7:1373. https://doi.org/10.3389/fpsyg.2016.01373
Forman EM, Herbert JD, Moitra E, et al., 2007. A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behav Modif, 31(6):772–799. https://doi.org/10.1177/0145445507302202
Gambina I, Soldera G, Benevento B, et al., 2011. Postpartum psychosocial distress and late preterm delivery. J Reprod Infant Psychol, 29(5):472–479. https://doi.org/10.1080/02646838.2011.653962
Gress-Smith JL, Luecken LJ, Lemery-Chalfant K, et al., 2012. Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Matern Child Health J, 16(4):887–893. https://doi.org/10.1007/s10995-011-0812-y
Harley R, Sprich S, Safren S, et al., 2008. Adaptation of dialectical behavior therapy skills training group for treatmentresistant depression. J Nerv Ment Dis, 196(2):136–143. https://doi.org/10.1097/NMD.0b013e318162aa3f
Holditch-Davis D, Santos H, Levy J, et al., 2015. Patterns of psychological distress in mothers of preterm infants. Infant Behav Dev, 41:154–163. https://doi.org/10.1016/j.infbeh.2015.10.004
Jung SM, Akhmetzhanov AR, Hayashi K, et al., 2020. Realtime estimation of the risk of death from novel coronavirus (COVID-19) infection: inference using exported cases. J Clin Med, 9(2):523. https://doi.org/10.3390/JCM9020523
Kang LJ, Li Y, Hu SH, et al., 2020. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry, 7(3):e14. https://doi.org/10.1016/s2215-0366(20)30047-x
Kingston D, Tough S, Whitfield H, 2012. Prenatal and postpartum maternal psychological distress and infant development: a systematic review. Child Psychiatry Hum Dev, 43(5):683–714. https://doi.org/10.1007/s10578-012-0291-4
Leentjens AFG, Dujardin K, Marsh L, et al., 2011. Anxiety rating scales in Parkinson’s disease: a validation study of the Hamilton anxiety rating scale, the Beck anxiety inventory, and the hospital anxiety and depression scale. Mov Disord, 26(3):407–415. https://doi.org/10.1002/mds.23184
Leontjevas R, van Hooren S, Mulders A, 2009. The Montgomery-Asberg Depression Rating Scale and the Cornell Scale for Depression in Dementia: a validation study with patients exhibiting early-onset dementia. Am J Geriatr Psychiatry, 17(1):56–64. https://doi.org/10.1097/JGP.0b013e31818b4111
Licht RW, Qvitzau S, Allerup P, et al., 2005. Validation of the Bech-Rafaelsen Melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity? Acta Psychiatr Scand, 111(2):144–149. https://doi.org/10.1111/j.1600-0447.2004.00440.x
Linehan MM, 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford, New York, USA.
Lothes JE, Mochrie KD, St John J, 2014. The effects of a DBT informed partial hospital program on: depression, anxiety, hopelessness, and degree of suffering. J Psychol Psychother, 4(3):144. https://doi.org/10.4172/2161-0487.1000144
Song Y, Lindquist R, 2015. Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students. Nurse Educ Today, 35(1):86–90. https://doi.org/10.1016/j.nedt.2014.06.010
Steil R, Dyer A, Priebe K, et al., 2011. Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential treatment program. J Trauma Stress, 24(1):102–106. https://doi.org/10.1002/jts.20617
WHO, 2020. Coronavirus disease 2019 (COVID-19). Situation Report-67. World Health Organization. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200327-sitrep-67-covid-19.pdf?sfvrsn=b65f68eb [Accessed on Mar. 27, 2020].
Xiang YT, Yang Y, Li W, et al., 2020. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry, 7(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8
Zar M, Wijma K, Wijma B, 2002. Relations between anxiety disorders and fear of childbirth during late pregnancy. Clin Psychol Psychother, 9(2):122–130. https://doi.org/10.1002/cpp.305
Author information
Authors and Affiliations
Contributions
Jin-wen HUANG and Xiao-yi ZHOU performed the psychological intervention plan, medical data analysis, and writing the manuscript. Shao-jia LU designed the figures. Yi XU, Jian-bo HU, Man-li HUANG, Hua-fen WANG, and Shao-hua HU designed the psychological intervention plan. Chan-chan HU, Shu-guang LI, Jing-kai CHEN, and Zhong WANG collected psychological data and edited the manuscript. Shao-hua HU and Ning WEI wrote and edited the manuscript. Ning WEI conducted the psychological assessment and intervention. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
Corresponding authors
Ethics declarations
Jin-wen HUANG, Xiao-yi ZHOU, Shao-jia LU, Yi XU, Jian-bo HU, Man-li HUANG, Hua-fen WANG, Chan-chan HU, Shu-guang LI, Jing-kai CHEN, Zhong WANG, Shao-hua HU, and Ning Wei declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from the patient for being included in the study.
Additional information
Project supported by the Science and Technology Department of Zhejiang Province (No. 2017C37037), the National Natural Science Foundation of China (No. 81801340), and the Zhejiang Provincial Natural Science Foundation of China (Nos. LQ18H090001 and LQ20 H090016)
Rights and permissions
About this article
Cite this article
Huang, Jw., Zhou, Xy., Lu, Sj. et al. Dialectical behavior therapy-based psychological intervention for woman in late pregnancy and early postpartum suffering from COVID-19: a case report. J. Zhejiang Univ. Sci. B 21, 394–399 (2020). https://doi.org/10.1631/jzus.B2010012
Published:
Issue Date:
DOI: https://doi.org/10.1631/jzus.B2010012