Chaudron Linda H, Szilagyi Peter G, Kitzman Harriet J, Wadkins Holly I M, Conwell Yeates
Department of Psychiatry, University of Rochester School of Medicine, Rochester, New York, USA.
Pediatrics. 2004 Mar;113(3 Pt 1):551-8. doi: 10.1542/peds.113.3.551.
To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening.
The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals.
The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores > or =10, and 27% of women who completed the EPDS had scores > or =10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]).
Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.
评估1）在出生后第一年的健康儿童检查中进行普遍产后抑郁筛查的可行性；2）参加第一年健康儿童检查的母亲中产后抑郁症状的患病率；3）在每次第一年健康儿童检查中进行普遍筛查前后，儿科诊所中产后抑郁症状的检出情况；4）普遍筛查前后的社会工作转诊情况。
该医疗机构在第一年健康儿童检查期间使用爱丁堡产后抑郁量表（EPDS）对产后抑郁症状进行普遍筛查。我们在筛查开始前随机选择了110份婴儿病历（队列1），在筛查开始后随机选择了110份（队列2）。测量指标包括人口统计学信息、健康儿童检查记录中抑郁或抑郁症状的记录以及抑郁转诊情况。仅为队列2收集了EPDS分数。对抑郁或抑郁症状的检出情况以及心理健康转诊情况进行前后比较。
46%的健康儿童检查病历中包含EPDS。其中88%的表格填写完整。21%填写完整的EPDS表格得分≥10，27%完成EPDS的女性在产后一年内某些时候得分≥10。普遍筛查开始后，使用EPDS记录的抑郁症状显著增加（队列1中为1.6%的检查，队列2中为8.5%）。因心理健康原因进行的社会工作转诊显著增加（队列1中为0.2%的检查，队列2中为3.6%）。
产后抑郁症状严重的女性在城市人群中很常见，儿科医生在产后第一年的健康儿童检查中使用标准化筛查工具可以检测出这些女性。由于使用标准化筛查工具在健康儿童检查期间筛查抑郁是可行的，儿科医生可以在产后抑郁的早期检测和转诊中发挥积极作用。
