Mora Pablo A, Bennett Ian M, Elo Irma T, Mathew Leny, Coyne James C, Culhane Jennifer F
Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA.
Am J Epidemiol. 2009 Jan 1;169(1):24-32. doi: 10.1093/aje/kwn283. Epub 2008 Nov 10.
Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.
尽管孕产妇抑郁症状出现的时间和持续时间的异质性对筛查、治疗以及相关的母婴健康结局有影响，但对于这种变异性却知之甚少。一项前瞻性观察研究对2000年至2002年孕期招募的1735名低收入、多民族、市中心的女性进行了前瞻性跟踪，直至2004年（1次产前访谈和3次产后访谈），以确定能否界定从孕期到产后2年抑郁症状的不同轨迹。通过一般生长混合模型进行分析。一个包含5种轨迹类别的模型描述了来自宾夕法尼亚州费城的研究参与者在抑郁症状出现时间和严重程度方面的异质性。这些类别包括：1）始终存在或慢性抑郁症状（7%）；2）仅在产前出现（6%）；3）产后出现，在产后第一年缓解（9%）；4）较晚出现，在产后25个月出现（7%）；5）从未有过抑郁症状（71%）。这些轨迹类别的女性在人口统计学特征（出生地、教育程度、种族、产次）、健康状况、健康行为以及心理社会特征（对怀孕的矛盾心理和高客观压力）方面存在差异。在孕产妇抑郁症项目中应考虑这种异质性。需要进一步的研究来确定这些轨迹类别与母婴健康结局之间的关联。
