Lydsdottir Linda B, Howard Louise M, Olafsdottir Halldora, Thome Marga, Tyrfingsson Petur, Sigurdsson Jon F
Mental Health Services, Landspitali-The National University Hospital of Iceland, Hringbraut, 101 Reykjavik, Iceland
J Clin Psychiatry. 2014 Apr;75(4):393-8. doi: 10.4088/JCP.13m08646.
Few studies are available on the effectiveness of screening tools such as the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or the extent to which such tools may identify women with mental disorders other than depression. We therefore aimed to investigate the mental health characteristics of pregnant women who screen positive on the EPDS.
Consecutive women receiving antenatal care in primary care clinics (from November 2006 to July 2011) were invited to complete the EPDS in week 16 of pregnancy. All women who scored above 11 (screen positive) on the EPDS and randomly selected women who scored below 12 (screen negative) were invited to participate in a psychiatric diagnostic interview.
2,411 women completed the EPDS. Two hundred thirty-three women (9.7%) were screened positive in week 16, of whom 153 (66%) agreed to a psychiatric diagnostic interview. Forty-eight women (31.4%) were diagnosed with major depressive disorder according to DSM-IV criteria, 20 (13.1%) with bipolar disorder, 93 (60.8%) with anxiety disorders (including 27 [17.6%] with obsessive-compulsive disorder [OCD]), 8 (5.2%) with dysthymia, 18 (11.8%) with somatoform disorder, 3 (2%) with an eating disorder, and 7 (4.6%) with current substance abuse. Women who screened positive were significantly more likely to have psychosocial risk factors, including being unemployed (χ(2)(1) = 23.37, P ≤.001), lower educational status (χ(2)(1)= 31.68, P ≤ .001), and a history of partner violence (χ(2)(1) = 10.30, P ≤ 001), compared with the women who screened negative.
Use of the EPDS early in the second trimester of pregnancy identifies a substantial number of women with potentially serious mental disorders other than depression, including bipolar disorder, OCD, and eating disorders. A comprehensive clinical assessment is therefore necessary following use of the EPDS during pregnancy to ensure that women who screen positive receive appropriate mental health management.
关于诸如爱丁堡产后抑郁量表（EPDS）等筛查工具在孕期的有效性，以及此类工具能够识别出除抑郁症之外的精神障碍患者的程度，相关研究较少。因此，我们旨在调查在EPDS筛查中呈阳性的孕妇的心理健康特征。
邀请在初级保健诊所接受产前护理的连续孕妇（2006年11月至2011年7月）在妊娠第16周完成EPDS。所有在EPDS上得分高于11分（筛查呈阳性）的女性以及随机选取的得分低于12分（筛查呈阴性）的女性均被邀请参加精神科诊断访谈。
2411名女性完成了EPDS。233名女性（9.7%）在第16周筛查呈阳性，其中153名（66%）同意参加精神科诊断访谈。根据《精神疾病诊断与统计手册》第四版（DSM-IV）标准，48名女性（31.4%）被诊断为重度抑郁症，20名（13.1%）为双相情感障碍，93名（60.8%）为焦虑症（包括27名[17.6%]患有强迫症[OCD]），8名（5.2%）为心境恶劣障碍，18名（11.8%）为躯体形式障碍，3名（2%）为进食障碍，7名（4.6%）目前存在药物滥用问题。与筛查呈阴性的女性相比，筛查呈阳性的女性更有可能具有社会心理风险因素，包括失业（χ(2)(1)=23.37，P≤.001）、教育程度较低（χ(2)(1)=31.68，P≤.001）以及有伴侣暴力史（χ(2)(1)=10.30，P≤001）。
在妊娠中期早期使用EPDS可识别出大量除抑郁症之外还患有潜在严重精神障碍的女性，包括双相情感障碍、强迫症和进食障碍。因此，孕期使用EPDS后进行全面的临床评估很有必要，以确保筛查呈阳性的女性能够得到适当的心理健康管理。
