Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, British Columbia, Canada.
Depress Anxiety. 2013 Nov;30(11):1129-36. doi: 10.1002/da.22137. Epub 2013 Jun 18.
To identify specific quantitative and qualitative factors that govern the decision to adhere or decline antidepressant medication in antenatal women with moderate-to-severe mood and anxiety disorders.
Fifty women (30 adherers, 20 decliners) were recruited between 18 and 34 weeks gestation in a tertiary care clinic for perinatal mothers. They were prospectively monitored 4 weeks apart up to 1-month postpartum on the: Hamilton Anxiety Scale, Hamilton Depression Scale, Mood Disorders Insight Scale, Antidepressant Compliance Questionnaire, Penn State Worry Questionnaire, and NEO Personality Inventory. Qualitative interviews were conducted at baseline. Hierarchical linear modeling determined illness trajectories of the two groups.
Significantly different course of illness was observed in adherers versus decliners. Adherers had healthier attitudes toward depression and compliance with medication (P < .005). Decliners had less illness insight (P < .001) and cited fear of fetal exposure, and thought medication was unwarranted.
Pregnant women experienced significantly divergent illness trajectories depending on if they accepted antidepressant medication therapy for their illness. Risk perception, attitudes, and illness insight impacted decisions surrounding adherence and decline.
确定影响中重度孕期情绪和焦虑障碍女性患者是否坚持或拒绝使用抗抑郁药物的具体定量和定性因素。
在一家围产期母婴护理的三级医疗诊所中，招募了 50 名孕妇（30 名坚持用药者，20 名拒绝用药者）。在妊娠 18 周到 34 周期间，对她们进行前瞻性监测，每 4 周监测一次，直到产后 1 个月。监测的项目包括汉密尔顿焦虑量表、汉密尔顿抑郁量表、心境障碍认知量表、抗抑郁药物依从性问卷、宾夕法尼亚大学忧虑问卷和 NEO 人格量表。在基线时进行定性访谈。分层线性模型确定了两组患者的疾病轨迹。
坚持用药组和拒绝用药组患者的疾病轨迹存在显著差异。坚持用药组患者对抑郁和药物治疗的态度更健康（P <.005）。拒绝用药组患者对疾病的认知程度较低（P <.001），并表示担心胎儿暴露，认为用药没有必要。
孕妇是否接受抗抑郁药物治疗取决于其对疾病的不同认知。风险感知、态度和对疾病的认知会影响患者对坚持或拒绝用药的决策。
