产后抑郁症的筛选与干预措施

产后抑郁症是严重危害产妇健康的心理疾病，在产后6个月的发病率为10％～15％。该病对母婴均会产生不良影响，危害极大，早期识别具有高危因素的孕产妇并及时地实施干预措施是在临床工作中防治产后抑郁症的首要环节。该文综述了国外关于此方面的大量研究，包括高危孕产妇的筛选及妊娠期、分娩期和产后采取的干预措施等，对我国妇幼保健工作均有一定的参考价值。     

产后抑郁症的影响因素及干预措施研究

目的探讨产后抑郁症的影响因素,观察干预措施对产后抑郁症发病率的影响。方法选择在浙江永嘉人民医院行产前检查并在本院分娩的孕妇1100例,按单双号随机分为对照组（550例）和干预组（550例）。对两组孕妇于孕期行医院焦虑一抑郁情绪自评量表（HAD）测试,于产后3天至8周行艾迪产后抑郁量表（EPOS）测试。对干预组孕妇实施干预,对照组孕妇采取普通产科护理措施,观察两组产妇的产后抑郁症发生率变化情况。结果在98名焦虑一抑郁情绪者中,产后抑郁症的发生率为41．8％,高于正常人群的6．2％,二者差异存在统计学意义（P〈0．01）。对照组产妇产后抑郁症发生率为13．1％。干预组产妇产后抑郁症的发生率为5．6％,干预组的发生率低于对照组（P〈0．01）。在产前有焦虑一抑郁情绪的人群中,干预组的产后抑郁症发生率为25．0％,对照组的产后抑郁症发生率为58．0％,二者差异也具有统计学意义（P〈0．01）。结论产前焦虑一抑郁情绪是产后抑郁症的高危因素。采取综合干预措施能够显著降低产后抑郁症的发生率。     

产后抑郁症及社区干预

随着围产医学的发展,孕产妇的心理保健已成为围产保健中一个不可忽视的部分,妊娠虽然是发育年龄妇女一种正常、自然的生理现象,但对孕产妇来说,毕竟是一次巨大的生理变化和心理应激过程,她们在经历怀孕、分娩、产后恢复及哺乳等一系列生理过程中,会产生各种心理、生理变化,一旦某些改变的程度和性质超越了正常的变异界限,则成为病理性改变.     

产后抑郁症干预措施的探讨及有效性的评估

目的探讨针对孕产妇保护性和危险性因素制定的综合干预措施的有效性。方法选取产后42d复查的800位产妇进行问卷调查,通过分析找出与产后抑郁症有关的保护性和危险性因素,针对这些影响因素对300位孕妇进行孕期、产时、产后干预,产后42d进行调查,对两组的调查结果进行评估。结果孕期保健、分娩的准备、家人帮助等9项相关因素对产后抑郁症的发生有统计学意义。观察组中产后抑郁症的发生率为18．13％,对照组产后抑郁症的发生率比观察组下降了4．72％,但无统计学意义。结论产后抑郁症的发生原因是多因素的,针对其影响因素进行预防性干预,可以降低产后抑郁症发生。     

产后抑郁症的社区护理干预研究

目的：探讨产后抑郁症的社区护理干预。方法：定性与定量研究相结合，定性研究采用专题小组讨论和半结构性访谈，产妇9人参加专题讨论，半结构性访谈12人；定量研究随机抽取本市各社区产后42d左右的产妇200例问卷调查。结果：产妇“月子”期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难；半结构性访谈中有1产妇处于产后抑郁症的临界，EPDS量表测定为12分；173例“月子”里有身心健康问题的产妇中，求助者91．3％，其中需要社区护理人员帮助的64．2％，但实际寻求帮助的只有13．9％。结论：实施产后抑郁症的社区护理干预，应针对产妇“月子”期间的身心健康问题提供护理支持与指导，做到预防为主。与此同时，应加强社区护理人员培训、强化社区服务的规范化管理。     

综合性干预对产后抑郁症的效果及其发病影响因素调查

目的观察综合性干预对产后抑郁症(postpartum depression PPD)中的应用效果,并分析其发病的影响因素。方法随机选取2013年8月—2014年2月,妊娠12周左右的500名孕妇为研究组,进行一系列预防性干预措施,于产后42 d进行问卷调查,回收有效问卷490份。随机选取2013年1—7月,进行产后盆地功能筛查的500名产妇作为对照组,进行问卷调查,回收有效问卷495份。非条件Logistic回归单因素分析,得出8项有统计学意义的相关因素,将8项相关因素应用Logistic回归多因素分析。样本均数以(x珋±s)表示,P﹤0.05为差异有统计学意义。结果对照组PPD的发生率为22.63﹪,研究组为13.88﹪。Logistic回归多因素分析,再婚、不良孕产史、婆媳关系差为危险因素,分娩准备充分、PPD宣教、孕妇学校上课为保护性因素。结论实施综合性干预能有效降低PPD的发生率;再婚、不良孕产史、婆媳关系差为PPD发病的危险因素。     

产后抑郁症的社区护理干预研究

目的:探讨产后抑郁症的社区护理干预.方法:定性与定量研究相结合,定性研究采用专题小组讨论和半结构性访谈,产妇9人参加专题讨论,半结构性访谈12人;定量研究随机抽取本市各社区产后42d左右的产妇200例问卷调查.结果:产妇"月子"期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难;半结构性访谈中有1产妇处于产后抑郁症的临界,EPDS量表测定为12分;173例"月子"里有身心健康问题的产妇中,求助者91.3%,其中需要社区护理人员帮助的64.2%,但实际寻求帮助的只有13.9%.结论:实施产后抑郁症的社区护理干预,应针对产妇"月子"期间的身心健康问题提供护理支持与指导,做到预防为主.与此同时,应加强社区护理人员培训、强化社区服务的规范化管理.     

产后抑郁症的社区护理干预研究

目的:探讨产后抑郁症的社区护理干预。方法:定性与定量研究相结合,定性研究采用专题小组讨论和半结构性访谈,产妇9人参加专题讨论,半结构性访谈12人;定量研究随机抽取本市各社区产后42 d左右的产妇200例问卷调查。结果:产妇"月子"期间常发生头疼、恶心、焦虑、恐惧、失眠以及照顾新生儿困难;半结构性访谈中有1产妇处于产后抑郁症的临界,EPDS量表测定为12分;173例"月子"里有身心健康问题的产妇中,求助者91.3％,其中需要社区护理人员帮助的64.2％,但实际寻求帮助的只有13.9％。结论:实施产后抑郁症的社区护理干预,应针对产妇"月子"期间的身心健康问题提供护理支持与指导,做到预防为主。与此同时,应加强社区护理人员培训、强化社区服务的规范化管理。     

产妇产后抑郁症的发生和护理干预

在经历怀孕、分娩、哺乳等一系列生理过程后,孕产妇会产生各种心理、生理的改变,性格上出现一段不稳定情绪,比如莫明的哭泣、情绪沮丧、焦虑、失眠,这是最新被医学界认识到的“产后抑郁症”。     

围产期心理干预对产后抑郁症的影响

目的探讨围产期心理干预对产后抑郁症发病率的影响。方法将在产科行产前检查的并在我院住院分娩的806例初产妇随机分成2组,干预组400例,对照组406例。干预组采用从围产建卡开始就加强对孕妇的精神关怀,实施全程心理干预,对照组采用常规护理。于产后42 d比较2组的抑郁情况。结果干预组的抑郁症发生率(1.50%)明显低于对照组(10.1%),2=27.13,p<0.05。结论进行围产期心理干预能有效降低产后抑郁症的发生率,促进产妇心理、生理康复,在促进母婴健康方面有着重要作用,值得推广。     

Repeated Depression Screening During the First Postpartum Year

PURPOSE

Postpartum depression (PPD) screening at 4 to 12 weeks’ postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear.

METHODS

We report a substudy of a large pragmatic trial of early PPD screening and practice management, the Translating Research into Practice for Postpartum Depression (TRIPPD) study. Outcome analyses were based on demographic information and Patient Health Questionnaire (PHQ-9) screening scores from questionnaires mailed to all enrolled women at baseline (4 to 12 weeks’ postpartum) and again at 6 and at 12 months’ postpartum. The main outcomes of this substudy were the 6- and 12-month rates of PHQ-9 scores that were 10 or greater for women whose baseline PHQ-9 scores were less than 10. Women whose scores were 10 or greater would be considered at high risk of PPD and appropriate for further evaluation.

RESULTS

At 6 months, 134 (10.9%) of the 1,235 women who did not have PHQ-9 scores greater than 10 at baseline had elevated scores appropriate for further evaluation. At 12 months, 59 (6.1%) of the 969 women who did not have PHQ-9 scores greater than 10 at baseline or at 6 months had elevated scores. Together the 6- and 12-month repeated screenings identified 193 women at high risk of depression. This finding represents 13.5% of the 1,432 women whose screening results were negative for PPD at baseline.

CONCLUSIONS

Repeated PPD screening at 6 and 12 months’ postpartum increases the percentage of women identified as being at high risk of PPD. Further work will be required to understand the impact of this repeated screening on patient outcomes.     

Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9

PURPOSE Postpartum depression affects up to 22% of women who have recently given birth. Most mothers are not screened for this condition, and an ideal screening tool has not been identified. This study investigated (1) the validity of a 2-question screen and the 9-item Patient Health Questionnaire (PHQ-9) for identifying postpartum depression and (2) the feasibility of screening for postpartum depression during well-child visits.     

The Association between Postpartum Practice and Chinese Postpartum Depression: Identification of a Postpartum Depression-Related Dietary Pattern

Conflicting results of Chinese traditional postpartum practices have aroused concerns over their health effects. The role of postpartum practices in postpartum depression (PPD) is still a matter of discussion, especially from a dietary practice point of view. The current study was designed to (1) explore the association between postpartum practices and PPD, (2) to identify the dietary pattern related to PPD, and (3) to identify the possible pathways among postpartum practices and PPD. This study is part of the YI Study, which was a cross-sectional study conducted in 10 cities in China. Data for 955 postpartum women were used in the current analysis. The Edinburgh Postnatal Depression Scale (EPDS-10) was used to evaluate PPD with a cutoff value of 9. Postpartum practice was based on the participants’ self-reported practices. Individual practices were recorded and categorized as dietary and non-dietary practices. The dietary pattern was identified based on the food intake frequencies of 25 food groups using the method of reduced rank regression. Structural equation modeling was used to explore the potential pathways between postpartum practices and PPD. The current study observed significant associations between postpartum practices and PPD (Adjusted OR = 1.41, 95% CI: 1.04–1.90). A similar trend was also found between dietary postpartum practices and PPD (Adjusted OR = 1.39, 95%CI: 1.03–1.88) but not for non-dietary practices and PPD (Adjusted OR = 1.26, 95%CI: 0.92–1.75). A PPD-related dietary pattern was identified with the characteristics of a high intake of meat and eggs and a lower intake of vegetables, mushrooms, and nuts. This dietary pattern was significantly associated with a higher chance of adhering to postpartum practice (Adjusted OR = 1.26, 95% CI: 1.10–1.44). Based on the pathway analysis, this study also observed the association between postpartum practices and PPD, and the association between dietary practices and PPD were both mediated by sleep quality. In conclusion, this study demonstrated that a substantial proportion of women in modern China experience traditional postpartum Chinese practices and that either overall or dietary-related postpartum practices are associated with a higher risk of PPD. The current dietary practices in postpartum rituals may play an important role in developing PPD. A culturally embedded, science-based dietary guideline is required to help women to achieve both physical and psychological health in the postpartum period.     

产后抑郁症及其严重程度对母乳喂养的影响

目的研究产后抑郁症及其严重程度对母乳喂养的影响。方法采用产后抑郁筛查量表（PDSS）对205名初产妇进行问卷式调查．根据PDSS诊断标准以总分≥60分作为筛查产后抑郁产妇的临界值,总分≥80分作为筛查严重产后抑郁产妇的临界值．按得分情况分为3组研究泌乳指标。结果产妇泌乳始动时间延迟随产后抑郁程度递增,而泌乳量则递减;无抑郁组、轻度组、重度组产后1天泌乳率分别为59.3％、11．76％和0,产后3天泌乳量分别为83．51％、41．18％和0,三者比较有显著性差异（P〈0．05）。结论产后抑郁症可影响母乳喂养,且其严重程度与母乳喂养成负相关,应该积极预防及早期对症治疗。     

孕妇情绪与产后抑郁症相关因素的研究

为了探讨孕妇抑郁、焦虑情绪、产后抑郁症的发生率，及其关系和有关影响因素，随机抽取1997年1～11月在本院分娩的部分孕妇共1052例进行情绪测定（HAD）问卷调查，其中以艾氏广后抑郁量表（EPDS）跟踪至产后7天的有866例。调查结果：EPDS阳性率为15．01％，HAD问卷中A值总分、D值总分≥11分的分别为5．13％及437％；随着A值、D值的增高，EPDS阳性率也随之升高。据此分析了影响EPDS和A值、D值的有关因素，并提出了相应措施。     

Violence Against Women and Postpartum Depression: The Experience of Chilean Women

This article is based on the findings from a cross-sectional study of women (N = 163) who were at least two weeks postpartum and attending primary care clinics in Arica, Chile. The researcher in this study examined the prevalence of history of violence and its association with postpartum depression. The Women Abuse Screen and the Postpartum Depression Screening Scale–Spanish version were used to assess interpersonal violence and postpartum depression. A history of violence was reported by 64% of the women. Of those who experienced abuse, 44% reported ongoing abuse during their pregnancy. Women who experienced violence screened positive for elevated symptoms categories of postpartum depression such as anxiety/insecurity, emotional lability, and mental confusion compared to women who had not experienced violence. Postpartum depression symptom reporting decreased with increasing number of pregnancies (OR = 0.70, 95% CI 0.54–0.97) and greater social support (OR = 0.64, 95% CI 0.46–0.88). Postpartum depression symptom reporting increased with smoking (OR = 1.71, 95% CI 1.00–2.86), and with reporting history of violence (OR = 1.79, 95% CI 1.24–2.34). Acknowledgment of the strong association between domestic violence and postpartum depression should lead to routine screening during prenatal and postpartum periods as a way to isolate risk for postpartum depression.     

健康教育对产后抑郁症的有效干预

产后抑郁症严重影响产妇身心健康和婴儿生长发育,其发病因素可分为生理和心理社会两大类。健康教育是减低产后抑郁症发病率的重要手段,具体内容包括:孕期教育,入院教育,产时教育,产后指导,出院指导,完善产褥期家庭访视。定期开展健康教育,不仅提高了孕妇自身的素质,提高应激能力,而且端正了孕妇及家庭对生育的态度,预防、缓解了孕妇外部压力,体现了社会的关怀和支持。有利于形成其家庭的支持和保护性环境,可极大地降低产后抑郁症的发病率,提高妇、婴健康水平。     

Prevalence of Postpartum Depression in a Native American Population

Objectives: Data were collected on postpartum depression from 151 women, ages 16–40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic make-up of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. Methods: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. Results: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. Conclusions: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.     

产后抑郁筛查量表的研译及评价

目的:研译产后抑郁筛查量表(PDSS),通过应用验证其信度、效度水平。方法:用研译的产后抑郁筛查量表对550例健康初产妇在产后3～5天进行测量,通过问卷调查结果,分析问卷的信度、效度。结果:PDSS用于产妇产后3～5天时,有令人满意的信度和结构效度。量表总的内部一致性信度为0.913,各因子的Cronbach'α系数在0.873～0.919之间,量表具有较高的信度。对35个条目进行因子分析,产生7个公因子,它们总共能够解释总体方差的71.631%,35个条目因子负荷在0.694～0.860之间,而且所有条目在相应因子上的因子负荷均>0.60。结论:PDSS中文译本经过分析具有比较令人满意的信度、效度,可以用于产后抑郁症的测定。     

Postpartum Depression Among Rural Women From Developed and Developing Countries: A Systematic Review

Purpose: Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta‐analysis examines the prevalence of and risk factors for PPD in rural communities within developed and developing countries, and where possible, compares rates to those among urban women. Methods: Five databases were searched, from start dates through early May 2010, using key words relevant to PPD and rural residence. Peer‐reviewed articles were eligible if a standardized assessment of depression was administered to rural mothers within the first year postpartum. Data on PPD were extracted from 19 articles, of which 17 provided data for meta‐analyses. Findings: The overall prevalence of PPD among rural women was 27.0% (95% CI, 18.8%‐37.2%). Prevalence was somewhat higher among women in developing countries (31.3%; 95% CI, 21.3%‐43.5%) than among women in developed countries (21.5%; 95% CI, 10.9%‐38.0%), although there was significant heterogeneity among both groups of studies. Comparisons between rural and urban women yielded conflicting results. Although established PPD risk factors were associated with depression in rural women, additional risk factors were reported for rural women from developing countries, such as having 2 or more young children. Conclusions: Longitudinal studies with clearly defined “rural” and “comparison” groups are needed to determine whether rural residence is associated with increased risk for PPD. The results can inform prevention and treatment programs tailored to serve rural women.