Howell Elizabeth A, Mora Pablo A, DiBonaventura Marco D, Leventhal Howard
Department of Health Policy and Obstetrics, Gynecology and Reproductive Science, Mount Sinai Medical Center, New York, NY 10029-6574, USA.
Arch Womens Ment Health. 2009 Apr;12(2):113-20. doi: 10.1007/s00737-009-0056-7. Epub 2009 Feb 24.
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.
高达50%的母亲报告有产后抑郁症状，但医疗服务提供者在预测和预防这些症状的发生方面做得很差。我们的目标是确定与产后抑郁症状相关的可改变因素（情境触发因素和缓冲因素）。对563名母亲进行观察性前瞻性队列电话研究，在产后2周和6个月时进行访谈。母亲们报告了人口统计学因素、身体和情绪症状、日常功能、婴儿行为、社会支持以及管理婴儿和家庭的技能。根据产后2周和6个月时是否存在抑郁症状，母亲们被分为四组：从未有过、一直有、晚发型和缓解型。52%的母亲在产后2周或6个月时没有抑郁症状（从未有过组），14%在两个时间点都有症状（一直有组），10%为晚发型，24%为早期有症状且后来缓解。与从未有过组的女性相比，一直有组和晚发型组的女性具有高风险特征（如过去有抑郁症病史）、更多的情境触发因素（如身体症状）以及更薄弱的社会和个人缓冲因素（即社会支持和自我效能感）。与从未有过组相比，缓解型组的母亲最初有更多的情境触发因素和更少的缓冲因素。四组的情境触发因素和缓冲因素的变化各不相同，且与组类别相关。身体症状和婴儿肠绞痛等情境触发因素，以及在应对情境需求方面社会支持水平低和自我效能感低，都与产后抑郁症状有关。需要进一步研究，以调查提供有关分娩身体后果的教育、提供社会支持以及教授增强自我效能感的技能是否会降低产后抑郁症状的发生率。
