Rahman Atif, Creed Francis
Department of Child and Adolescent Psychiatry, University of Manchester and Human Development Research Foundation, Islamabad, Pakistan.
J Affect Disord. 2007 Jun;100(1-3):115-21. doi: 10.1016/j.jad.2006.10.004. Epub 2006 Nov 13.
Rates of prenatal and postnatal depression in developing countries are high. Prolonged depression during the postnatal period is associated with impaired infant growth and development. Little is known about the factors predicting the persistence of prenatal depression beyond the first few postnatal months.
From a sample of 701 women in a rural sub-district of Pakistan, the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to identify those with ICD-10 depressive disorder in the third trimester of pregnancy (n=160). Depressed women were re-assessed at 3, 6 and 12 months postnatal. Persistently depressed women (depressed at all time points) were compared with the remainder. Psychiatric symptoms, disability and life events were measured using the Self-Reporting Questionnaire (SRQ), Brief Disability Questionnaire (BDQ), and a modified Life Events Checklist.
Of 129 mothers who completed follow-up, 73 (56%) were depressed at all points of assessment. These persistently depressed mothers had higher SRQ and BDQ scores prenatally and had experienced more life events in the year preceding the third pregnancy trimester than the mothers whose depressive disorder resolved (none received treatment). Persistent depression was significantly associated also with poverty, having 5 or more children, an uneducated husband and lack of a confidant or friend. On multivariate analysis, higher SRQ score and poverty during pregnancy predicted persistent depression.
The sample was from one rural sub-district only. We did not assess the women for physical conditions such as anaemia and thyroid-deficiency.
Women who are poor and have more psychological symptoms during pregnancy are more likely to remain depressed one year after giving birth. This study highlights the need for developing mechanisms of early identification and suitable psychosocial interventions to minimise the damaging effects of persistent postnatal depression in poor communities.
发展中国家产前和产后抑郁症的发病率很高。产后长期抑郁与婴儿生长发育受损有关。关于产后头几个月后预测产前抑郁症持续存在的因素，人们知之甚少。
从巴基斯坦一个农村地区的701名妇女样本中，使用神经精神病学临床评估量表（SCAN）来识别妊娠晚期患有国际疾病分类第10版（ICD-10）抑郁症的妇女（n = 160）。对抑郁妇女在产后3个月、6个月和12个月进行重新评估。将持续抑郁的妇女（在所有时间点都抑郁）与其余妇女进行比较。使用自我报告问卷（SRQ）、简易残疾问卷（BDQ）和改良的生活事件清单来测量精神症状、残疾和生活事件。
在129名完成随访的母亲中，73名（56%）在所有评估点都抑郁。这些持续抑郁的母亲在产前的SRQ和BDQ得分更高，并且在妊娠晚期前一年经历的生活事件比抑郁症得到缓解的母亲更多（均未接受治疗）。持续抑郁还与贫困、生育5个或更多孩子、丈夫未受过教育以及缺乏知己或朋友显著相关。多因素分析显示，较高的SRQ得分和孕期贫困可预测持续抑郁。
样本仅来自一个农村地区。我们没有评估这些妇女的身体状况，如贫血和甲状腺功能减退。
贫困且孕期有更多心理症状的妇女在分娩后一年更有可能持续抑郁。本研究强调需要建立早期识别机制和合适的社会心理干预措施，以尽量减少贫困社区中产后持续抑郁的有害影响。
