产后抑郁症全程综合性社区干预探讨

目的:探讨产后抑郁症全程综合性社区干预的效果。方法:采用自编一般情况和相关因素问卷、综合性医院所用焦虑抑郁量表(HAD)和总甲状腺素(TT4)、游离甲状腺素(FT4)测定孕晚期386例孕妇,筛查出产后抑郁症的高危孕妇122例,按随机自愿的原则分为干预组和对照组各61例;干预组给予全程综合性社区干预。2组均在产后1周、4周、8周、12周采用HAD、爱丁堡产后抑郁量表(EPDS)及美国精神障碍分类与诊断手册第4版-修订版轴Ⅰ障碍用临床定式检查(SCID)分别进行评估。结果:①产后4周、8周、12周HAD、EPDS评分,干预组比对照组明显降低,差异有统计学意义(P均0.05);②孕晚期、产后1周、4周、8周、12周干预组HAD、EPDS评分逐渐降低,差异有统计学意义(P0.01);③产后4个时点抑郁发生率:干预组分别为50%、29.09%、16.36%和9.09%,对照组分别为66.67%、57.89%、44.64%和23.21%。产后4周、8周、12周两组抑郁症发生率比较差异有统计学意义(P均0.05)。结论:全程综合性社区干预能显著降低产后抑郁症的发生率。

PostPartum dePression through comPrehensive community intervention

Objective：To investigate the effect of integrated community intervention on postpartum depression. Method：Total 386 pregnant women were screened and assesed by using self-designed questionnaire including demographics and relative factors,general hospital anxiety scale（HAD）and TT4、FT4 levels. Total 122 cases were determined as high risk of postpartum depression. Then,they were randomly divided into two groups voluntarily：integrated community intervention group and control group. They were interviewed by structured clinical interview for diagnostic and statistical manual of mental disorders-text revision axis Ⅰ（SCID）and were assessed by HAD scale and Edinburgh postnatal depression scale（EPDS）at the end of 1 week,4 week,8 week,and 12 week,respectively. Results：① The reduction of HAD score and EPDS score in integrated community intervention group were more than those in control group at the end of 4 week,8 week,and 12 week（P ﹤0. 02）. ② The HAD score and EPDS score in intervention group reducted at latter-pregnancy,the end of 1 week,4 week,8 week,and 12 week（P ﹤ 0. 01）. ③ The incidence of postpartum depression at week 1,4,8 and 12 were 20% ,29. 09% ,16. 36% ,and 9. 09% respectively in intervention group;while were 66. 67% , 27. 89% ,44. 64% ,and 23. 21% respectively in control group. There was significant difference of incidence of postpartum depression between the two groups at the end of 4 weeks,8 week,and 12 weeks（all P ﹤ 0. 02）. Conclusion：Full comprehensive integrated community intervention can significantly reduce the incidence of postpartum depression.