Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI 02905, USA.
Matern Child Health J. 2013 Aug;17(6):1071-9. doi: 10.1007/s10995-012-1089-5.
Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004-2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49-1.99 among adolescents; 3.32, 95 % CI 2.01-5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08-3.86 among adolescents; 0.49, 95 % CI 0.33-0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37-2.97 among adolescents; 2.67, 95 % CI 1.51-4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.
我们的目的是评估产后抑郁症的风险因素在青少年和成年母亲之间是否存在差异，并评估是否需要针对青少年的特定筛查工具。我们使用 2004-2008 年罗德岛妊娠风险评估监测系统的数据进行了回顾性队列研究。我们使用加权逻辑回归确定了特定于产妇年龄的风险因素，并使用向前选择的加权逻辑回归开发了预测模型。对于风险因素，例如产妇种族（OR 西班牙裔与白人：青少年中为 0.99，95%CI 0.49-1.99；成年人中为 3.32，95%CI 2.01-5.49）、孕前饮酒（OR 使用与不使用：青少年中为 2.04，95%CI 1.08-3.86；成年人中为 0.49，95%CI 0.33-0.73）和妊娠意图（OR 意外与计划：青少年中为 1.05，95%CI 0.37-2.97；成年人中为 2.67，95%CI 1.51-4.74），比值比存在显著差异。在预测模型中，青少年产后抑郁症状受既往抑郁和社会支持的影响最大，而成年产后抑郁症状与包括产妇种族、妊娠意图、社会经济地位、既往抑郁、孕期心理健康、压力源和社会支持在内的风险因素有关。我们能够识别青少年和成年妇女产后抑郁症状的风险因素的相似之处和不同之处。在一般孕妇人群中开发的预测模型在青少年中的表现相对较差，而特定于年龄的预测模型表现较好，这表明当前的筛查工具可能无法充分识别高风险青少年。
