Dugravier Romain, Tubach Florence, Saias Thomas, Guedeney Nicole, Pasquet Blandine, Purper-Ouakil Diane, Tereno Susana, Welniarz Bertrand, Matos Joana, Guedeney Antoine, Greacen Tim
Unité de Périnatalité, Centre Hospitalier Sainte-Anne, Paris, France.
PLoS One. 2013 Aug 19;8(8):e72216. doi: 10.1371/journal.pone.0072216. eCollection 2013.
Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted alongside other factors in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed.
This study evaluates the impact on PND symptomatology of a multifocal perinatal home-visiting intervention using psychologists in a sample of women presenting risk factors associated with infant mental health difficulties.
440 primiparous women were recruited at their seventh month of pregnancy. All were future first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. The intervention consisted of intensive multifocal home visits through to the child's second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS).
At three months postpartum, mean (SD) EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The difference between the mean EPDS scores was 0.85 (95% CI: 0.35; 1.34). The intervention group had significantly lower EPDS scores than controls in certain subgroups: women with few depressive symptoms at inclusion (EPDS <8): difference = 1.66 (95%CI: 0.17; 3.15), p = 0.05, adjusted for baseline EPDS score), women who were planning to raise the child with the child's father: difference = 1.45 (95%CI: 0.27; 2.62), p = 0.04 (adjusted); women with a higher educational level: difference = 1.59 (95%CI: 0.50; 2.68) p = 0.05 (adjusted).
CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in terms of primary prevention and in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology for young, first-time mothers presenting additional psychosocial risk factors may require more tailored interventions.
ClinicalTrials.gov NCT00392847 Promoting Parental Skills and Enhancing Attachment in Early Childhood (CAPEDP).
产后母亲抑郁（PND）是婴儿心理健康的一个重要风险因素。尽管在针对弱势家庭的围产期家访项目中，PND常与其他因素一起被关注，但对PND的影响甚微。
本研究评估了在有婴儿心理健康问题相关风险因素的女性样本中，使用心理学家进行多焦点围产期家访干预对PND症状的影响。
招募了440名怀孕7个月的初产妇。她们均为未来的头胎母亲，年龄在26岁以下，且至少有以下三个社会心理风险因素之一：低教育水平、低收入或计划在没有孩子父亲的情况下抚养孩子。干预措施包括在孩子两岁前进行密集的多焦点家访。对照组接受常规护理。使用爱丁堡产后抑郁量表（EPDS）在基线和产后三个月评估PND症状。
产后三个月，对照组的平均（标准差）EPDS评分为9.4（5.4），干预组为8.6（5.4）（p = 0.18）。平均EPDS评分的差异为0.85（95%可信区间：0.35；1.34）。在某些亚组中，干预组的EPDS评分显著低于对照组：纳入时抑郁症状较少的女性（EPDS <8）：差异 = 1.66（95%可信区间：0.17；3.15），p = 0.05（根据基线EPDS评分调整）；计划与孩子父亲一起抚养孩子的女性：差异 = 1.45（95%可信区间：0.27；2.62），p = 0.04（调整后）；教育水平较高的女性：差异 = 1.59（95%可信区间：0.50；2.68），p = 0.05（调整后）。
围产期促进父母技能与增强依恋项目（CAPEDP）未能证明对PND有总体影响。然而，事后分析表明该干预在一级预防方面以及在没有某些风险因素的女性亚组中是有效的。对于有额外社会心理风险因素的年轻初产妇，要有效全面降低PND症状可能需要更具针对性的干预措施。
ClinicalTrials.gov NCT00392847围产期促进父母技能与增强依恋项目（CAPEDP）
