Heneghan A M, Morton S, DeLeone N L
Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children's Hospital, 11000 Euclid Avenue, Cleveland, OH 44106, USA.
Child Care Health Dev. 2007 May;33(3):333-9. doi: 10.1111/j.1365-2214.2006.00648.x.
To assess paediatricians' beliefs about discussing maternal depressive symptoms during a paediatric visit, and methods paediatricians use to identify mothers with depressive symptoms.
In-depth telephone interviews were conducted with 23 primary care paediatricians from a practice-based research network. We asked a series of previously developed questions about discussing maternal depressive symptoms during a paediatric visit; methods used to identify mothers at risk; barriers encountered, and potential strategies to improve recognition and treatment of maternal depression. Interviews were audiotaped and transcribed. Data were codified and analysed using standard qualitative data techniques.
All paediatricians agreed that it is appropriate to ask mothers about their own health during a well-child visit, because a mother's well-being affects her children. Paediatricians relied on observational cues to identify a mother with depressive symptoms, especially mother-child interactions. Few used direct questions or a checklist. Almost all paediatricians felt that lack of time was the barrier most often faced in addressing maternal depression. Lack of training, inadequate knowledge of resources and distractions encountered in the primary care setting were additional barriers cited. One-third of paediatricians acknowledged the fear of judgement and stigma that a mother may face when discussing maternal stresses. Paediatricians desired better ability to refer mothers to social workers for help.
Observational cues are used more often than direct questions or screening tools to identify mothers at risk of depression. This may under-identify mothers at risk. Paediatricians prefer to rely on other professionals, particularly social services, to address maternal depression, yet mothers may be hesitant or ambivalent about such assistance because of fear of judgement. Paediatricians, in fact, may be the professional mothers most want to communicate with. Thus, appreciation of mothers' perspectives, empathetic communication skills and knowledge of community resources can enhance paediatricians' abilities to assist mothers at risk for depression.
评估儿科医生对于在儿科就诊时讨论母亲抑郁症状的看法，以及儿科医生识别有抑郁症状母亲的方法。
对来自一个基于实践的研究网络的23名基层医疗儿科医生进行了深入的电话访谈。我们询问了一系列先前制定的关于在儿科就诊时讨论母亲抑郁症状的问题；用于识别有风险母亲的方法；遇到的障碍，以及改善母亲抑郁识别和治疗的潜在策略。访谈进行了录音和转录。使用标准的定性数据技术对数据进行编码和分析。
所有儿科医生都认为，在儿童健康检查时询问母亲自身健康状况是合适的，因为母亲的幸福会影响到她的孩子。儿科医生依靠观察线索来识别有抑郁症状的母亲，尤其是母婴互动。很少有人使用直接提问或清单。几乎所有儿科医生都认为，时间不足是在解决母亲抑郁问题时最常面临的障碍。缺乏培训、对资源的了解不足以及在基层医疗环境中遇到的干扰也是提到的其他障碍。三分之一的儿科医生承认，母亲在讨论自身压力时可能会面临被评判和污名化的担忧。儿科医生希望能有更好的能力将母亲转介给社会工作者寻求帮助。
与直接提问或筛查工具相比，观察线索更常用于识别有抑郁风险的母亲。这可能会导致对有风险母亲的识别不足。儿科医生更愿意依靠其他专业人员，特别是社会服务机构来解决母亲的抑郁问题，但母亲可能会因为担心被评判而对这种帮助犹豫不决或矛盾。事实上，儿科医生可能是母亲最想与之交流的专业人员。因此，了解母亲的观点、具备同理心的沟通技巧以及对社区资源的了解，可以提高儿科医生帮助有抑郁风险母亲的能力。
