Geier Michelle L, Hills Nancy, Gonzales Marco, Tum Karoline, Finley Patrick R
1Department of Behavioral Health Services,San Francisco Department of Public Health,San Francisco,California,USA.
2Department of Neurology and Department of Epidemiology and Biostatistics,University of California San Francisco School of Medicine San Francisco,California,USA.
CNS Spectr. 2015 Feb;20(1):11-9. doi: 10.1017/S1092852914000510. Epub 2014 Oct 13.
The purpose of this investigation was to assess detection and treatment rates for perinatal depression among women enrolled in the California State Medicaid (Medi-Cal) program in comparison to female beneficiaries of reproductive age who did not give birth during the same study period.
Investigators conducted a retrospective longitudinal cohort analysis of women between the ages of 18 and 39 years old who were continuously enrolled in the Medi-Cal fee-for-service program between January 2006 and December 2009. The perinatal cohort consisted of women with evidence of a live birth occurring between October 2007 and March 2009. The control cohort consisted of women in the same age group and health plan without evidence of pregnancy during this time frame. The primary outcome of this investigation was diagnosis of depression during 3 contiguous 9-month time frames: immediately prior to presumed conception, during pregnancy, and throughout the postpartum period. Secondary outcomes included within-group and cohort comparisons of treatment patterns (antidepressant or psychotherapy). A multivariable analysis of demographic factors predicting depression diagnosis or treatment was conducted as well.
A total of 6030 women was identified in the perinatal cohort, and 56,709 women were included in the control group. The perinatal cohort was significantly less likely than nonpregnant controls to receive a diagnosis of depression both during pregnancy (prevalence=1.6% vs 3.5%; OR=0.45; 95% CI=0.35-0.55) and postpartum (2.2% vs 3.6%; OR=0.59; 95% CI=0.50-0.71). Similar differences were noted in antidepressant prescribing patterns apparent during these 2 time frames. A subgroup analysis of women who received a depression diagnosis revealed that only 48% of the perinatal cohort was provided any treatment during pregnancy (vs 72% of the control group; p<0.0001) or postpartum (57% vs 73%; p<0.0001). Specific demographic factors predicting a lower prevalence of depression detection or treatment included Hispanic descent, age <25 years, or primary residence in an rural setting.
Depression was often overlooked and undertreated among women who are pregnant or postpartum in comparison to services delivered to similar nonpregnant controls. Significant disparities in the healthcare received by certain subpopulations of perinatal women suggest that research into barriers to care and subsequent interventions are warranted.
本调查的目的是评估参加加利福尼亚州医疗补助计划（Medi-Cal）的女性围产期抑郁症的检出率和治疗率，并与在同一研究期间未生育的育龄女性受益人进行比较。
研究人员对2006年1月至2009年12月期间持续参加Medi-Cal按服务收费计划的18至39岁女性进行了回顾性纵向队列分析。围产期队列包括2007年10月至2009年3月期间有活产证据的女性。对照组由同一年龄组且在同一健康计划下在此时间段内无怀孕证据的女性组成。本调查的主要结局是在连续3个9个月时间段内抑郁症的诊断：假定受孕前、怀孕期间以及整个产后期间。次要结局包括治疗模式（抗抑郁药或心理治疗）的组内和队列比较。还对预测抑郁症诊断或治疗的人口统计学因素进行了多变量分析。
围产期队列共识别出6030名女性，对照组纳入56709名女性。围产期队列在孕期（患病率=1.6%对3.5%；OR=0.45；95%CI=0.35 - 0.55）和产后（2.2%对3.6%；OR=0.59；95%CI=0.50 - 0.71）被诊断为抑郁症的可能性均显著低于未怀孕的对照组。在这两个时间段内抗抑郁药处方模式也存在类似差异。对被诊断为抑郁症的女性进行的亚组分析显示，围产期队列中只有48%的女性在孕期接受了任何治疗（对照组为72%；p<0.0001）或产后（57%对73%；p<0.0001）。预测抑郁症检出率或治疗率较低的具体人口统计学因素包括西班牙裔血统、年龄<25岁或主要居住在农村地区。
与为类似未怀孕对照组提供的服务相比，怀孕或产后女性的抑郁症常被忽视且治疗不足。围产期女性某些亚群体在医疗保健方面存在显著差异，这表明有必要研究护理障碍及后续干预措施。
