Lumley Judith, Watson Lyndsey, Small Rhonda, Brown Stephanie, Mitchell Creina, Gunn Jane
Mother and Child Health Research, La Trobe University, 251 Faraday St, Carlton, Victoria 3053, Australia.
BMC Public Health. 2006 Feb 17;6:37. doi: 10.1186/1471-2458-6-37.
In the year after birth one in six women has a depressive illness, 94% experience at least one major health problem (e.g. back pain, perineal pain, mastitis, urinary or faecal incontinence), 26% experience sexual problems and almost 20% have relationship problems with partners. Women with depression report less practical and emotional support from partners, less social support, more negative life events, and poorer physical health and see factors contributing to depression as lack of support, isolation, exhaustion and physical health problems. Fewer than one in three seek help in primary care despite frequent health care contacts.
Primary care and community-based strategies embedded in existing services were implemented in a cluster-randomised trial involving 16 rural and metropolitan communities, pair-matched, within the State of Victoria, Australia. Intervention areas were also provided with a community development officer for two years. The primary aim was to reduce the relative risk of depression by 20% in mothers six months after birth and to improve their physical health. Primary outcomes were obtained by postal questionnaires. The analysis was by intention-to-treat, unmatched, adjusting for the correlated nature of the data.
6,248 of 10,144 women (61.6%) in the intervention arm and 5057/ 8,411 (60.1%) in the comparison arm responded at six months, and there was no imbalance in major covariates between the two arms. Women's mental health scores were not significantly different in the intervention arm and the comparison arm (MCS mean score 45.98 and 46.30, mean EPDS score 6.91 and 6.82, EPDS > or = 13 ('probable depression') 15.7% vs. 14.9%, Odds ratio(adj) 1.06 (95% CI 0.91-1.24). Women's physical health scores were not significantly different in intervention and comparison arms (PCS mean scores 52.86 and 52.88).
The combined community and primary care interventions were not effective in reducing depression, or in improving the physical health of mothers six months after birth.
在产后一年内，六分之一的女性会患抑郁症，94%的女性至少经历过一种主要健康问题（如背痛、会阴疼痛、乳腺炎、尿失禁或大便失禁），26%的女性有性方面的问题，近20%的女性与伴侣存在关系问题。患有抑郁症的女性报告称，从伴侣那里得到的实际支持和情感支持较少，社会支持较少，负面生活事件较多，身体健康状况较差，她们认为导致抑郁症的因素包括缺乏支持、孤立、疲惫和身体健康问题。尽管频繁就医，但在初级保健机构寻求帮助的女性不到三分之一。
在澳大利亚维多利亚州进行的一项整群随机试验中，将基于现有服务的初级保健和社区策略应用于16个农村和城市社区（进行配对）。干预地区还配备了一名社区发展官员，为期两年。主要目标是在产后六个月时将母亲患抑郁症的相对风险降低20%，并改善她们的身体健康状况。主要结果通过邮寄问卷获得。分析采用意向性治疗，不进行匹配，并对数据的相关性进行调整。
干预组10144名女性中有6248名（61.6%）在六个月时做出回应，对照组8411名中有5057名（60.1%）做出回应，两组之间的主要协变量没有失衡。干预组和对照组女性的心理健康得分没有显著差异（MCS平均得分分别为45.98和46.30，EPDS平均得分分别为6.91和6.82，EPDS≥13（“可能患有抑郁症”）的比例分别为15.7%和14.9%，调整后的优势比为1.06（95%置信区间为0.91 - 1.24）。干预组和对照组女性的身体健康得分没有显著差异（PCS平均得分分别为52.86和52.88）。
社区和初级保健相结合的干预措施在降低产后六个月母亲的抑郁症患病率或改善其身体健康方面没有效果。
