Kaaya S F, Mbwambo J K, Kilonzo G P, Van Den Borne H, Leshabari M T, Fawzi M C Smith, Schaalma H
Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, P.O. Box 65023, Dar es Salaam, Tanzania.
Tanzan J Health Res. 2010 Jan;12(1):23-35. doi: 10.4314/thrb.v12i1.56276.
Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal depression in the logistic regression model; together explaining 21% of variance in depression scores. Attenuation of strength of multivariate associations suggests confounding between the independent risk factors and socio-demographic and economic measures. In conclusion, clinically significant depressive symptoms are common in mid and late trimester antenatal clinic attendees. Interventions for early recognition of depression should target women with a history of previous depressive episodes or low satisfaction with ability to access basic needs, conflict in partner relationships and relatively earlier booking for antenatal care. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.
孕期抑郁可能会对社交功能、分娩结局和产后心理健康产生负面影响。对一项前瞻性研究的基线调查进行了横断面分析，目的是确定坦桑尼亚城郊地区孕期抑郁发病的患病率及相关社会人口学因素。在两家初级卫生保健诊所，招募了787名孕中期至孕晚期的孕妇进行产前检查预约。产前结构化访谈评估了社会经济状况、伴侣关系质量和选定的身体健康指标。在招募时以及产后3个月和8个月，使用斯瓦希里语版的霍普金斯症状清单对抑郁症状进行测量。76.2%的参与者有完整的产前测量数据，其中抑郁患病率为39.5%。既往有抑郁发作史（比值比4.35, P<0.01）、对基本需求获取能力的满意度低（比值比2.18, P<0.01）或中等（比值比1.86, P=0.04）、与现任伴侣发生冲突（比值比1.89, P<0.01）或更早进行产前检查预约（比值比1.87, P=0.02）是逻辑回归模型中产前抑郁的独立预测因素；这些因素共同解释了抑郁评分中21%的变异。多变量关联强度的减弱表明独立危险因素与社会人口学和经济指标之间存在混杂。总之，在孕中期和孕晚期的产前门诊就诊者中，具有临床意义的抑郁症状很常见。早期识别抑郁的干预措施应针对既往有抑郁发作史、对基本需求获取能力满意度低、伴侣关系冲突以及相对较早进行产前检查预约的女性。研究结果支持一项建议，即产前服务应考虑在常规产前护理中纳入抑郁筛查。
