Leigh Bronwyn, Milgrom Jeannette
Parent-Infant Research Institute, Department of Clinical and Health Psychology, Heidelberg Repatriation Hospital Austin Health, 300 Waterdale Rd, Heidelberg Heights 3081, Victoria, Australia.
BMC Psychiatry. 2008 Apr 16;8:24. doi: 10.1186/1471-244X-8-24.
Given that the prevalence of antenatal and postnatal depression is high, with estimates around 13%, and the consequences serious, efforts have been made to identify risk factors to assist in prevention, identification and treatment. Most risk factors associated with postnatal depression have been well researched, whereas predictors of antenatal depression have been less researched. Risk factors associated with early parenting stress have not been widely researched, despite the strong link with depression. The aim of this study was to further elucidate which of some previously identified risk factors are most predictive of three outcome measures: antenatal depression, postnatal depression and parenting stress and to examine the relationship between them.
Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program 1. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26-32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10-12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI).
Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors.
Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important.
鉴于产前和产后抑郁症的患病率较高，估计约为13%，且后果严重，人们已努力确定风险因素以协助预防、识别和治疗。大多数与产后抑郁症相关的风险因素已得到充分研究，而产前抑郁症的预测因素研究较少。尽管与抑郁症有密切联系，但与早期育儿压力相关的风险因素尚未得到广泛研究。本研究的目的是进一步阐明一些先前确定的风险因素中哪些最能预测三种结果指标：产前抑郁症、产后抑郁症和育儿压力，并研究它们之间的关系。
作为beyondblue全国产后抑郁症项目1的一部分，从两家主要医院产前招募初产妇和经产妇。在这项子研究中，367名女性在妊娠26 - 32周时完成了一系列额外的经过验证的问卷，以确定产前风险因素。这些女性的一个子样本（N = 161）在产后10 - 12周也完成了问卷。抑郁水平通过贝克抑郁量表（BDI）测量。
回归分析确定了三种结果指标的显著风险因素。（1）产前抑郁症的显著预测因素：自卑、产前焦虑、社会支持低、消极认知风格、重大生活事件、低收入和虐待史。（2）产后抑郁症的显著预测因素：产前抑郁症和抑郁症病史，同时控制并发的育儿压力，这是一个显著变量。产前抑郁症被确定为七个风险因素与产后抑郁症之间的中介因素。（3）产后抑郁症是育儿压力的唯一显著预测因素，并且也是其他风险因素的中介因素。
产前抑郁症、产后抑郁症和育儿压力的风险因素特征不同但相互关联。产前抑郁症是产后抑郁症最强的预测因素，而产后抑郁症又是育儿压力最强的预测因素。这些结果提供了临床指导，表明围产期抑郁症的早期识别和治疗很重要。
