摘要
目的 梳理产后抑郁影响因素与干预措施的研究进展，为临床早期识别与分层干预提供依据。方法 以产后抑郁、围产期抑郁、危险因素、筛查、干预为检索词，检索Web of Science等数据库2019-2025年发表的系统评价、Meta分析等，结合研究类型与证据层级按主题归纳。结果 产后抑郁是生物学、心理与社会因素共同作用的结果，其中产前抑郁状态、产前焦虑、社会支持不足、夫妻关系不良、产妇贫血及部分分娩与婴儿因素为主要相关因素；上述因素中，贫血等部分具有干预可及性，而剖宫产、早产等围产结局更多作为风险标记或潜在中介变量，并非均可直接作为预防干预靶点；筛查以爱丁堡产后抑郁量表为主，但中文版界值尚未统一，且量表筛查阳性不等同于临床诊断；干预以认知行为疗法、正念疗法、运动疗法等非药物措施及选择性5-羟色胺再摄取抑制剂为主，祖拉诺龙等神经活性类固醇类药物为产后抑郁（尤其重度）提供了快速起效的治疗新路径，但其适用需综合诊断、症状严重程度、哺乳情况及当地可及性等因素决策。结论 应建立覆盖孕产全程的动态筛查与分级干预体系，并加强以我国人群为对象、随访时间更长的高质量干预性研究，同时重视生物学标志物与临床危险因素结合的预测模型研究。
关键词： 产后抑郁；围产期抑郁；影响因素；爱丁堡产后抑郁量表；认知行为疗法；正念干预；神经活性类固醇
Abstract
Objective To review research progress regarding the influencing factors and interventions for postpartum depression, thereby providing a basis for early clinical identification and stratified intervention. Methods Databases such as Web of Science were searched for systematic reviews and meta-analyses published between 2019 and 2025, using keywords including “postpartum depression,” “perinatal depression,” “risk factors,” “screening,” and “intervention”; findings were summarized by theme based on study type and level of evidence. Results Postpartum depression results from the interplay of biological, psychological, and social factors; key associated factors include prenatal depressive states, prenatal anxiety, insufficient social support, poor marital relationships, maternal anemia, and certain delivery- or infant-related factors. Among these, factors such as anemia are amenable to intervention, whereas perinatal outcomes like cesarean section and preterm birth serve primarily as risk markers or potential mediators rather than direct targets for preventive intervention. Screening relies predominantly on the Edinburgh Postnatal Depression Scale (EPDS), though the cutoff value for the Chinese version remains unstandardized, and a positive screening result is not equivalent to a clinical diagnosis. Interventions primarily involve non-pharmacological approaches—such as cognitive behavioral therapy, mindfulness-based therapy, and exercise—and selective serotonin reuptake inhibitors (SSRIs); neuroactive steroids like zuranolone offer a new, rapid-acting treatment pathway for postpartum depression (particularly severe cases), though decisions regarding their use require consideration of diagnosis, symptom severity, breastfeeding status, and local availability. Conclusion A dynamic screening and stratified intervention system covering the entire pregnancy and postpartum period should be established. Furthermore, high-quality intervention studies focusing on Chinese populations with extended follow-up periods should be prioritized, alongside research into predictive models that integrate biological markers with clinical risk factors.
Key words： Postpartum depression; Perinatal depression; Influencing factors; Edinburgh postnatal depression scale; Cognitive behavioral therapy; Mindfulness-based interventions; Neuroactive steroids
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