在乌干达，接受抗逆转录病毒疗法的 HIV 感染妇女在孕期和产后期间的抑郁情况。
Depression during pregnancy and the postpartum among HIV-infected women on antiretroviral therapy in Uganda.
机构信息
*Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; †Center for Global Health & Division of Infectious Disease, Massachusetts General Hospital, Boston, MA; ‡Mbarara University of Science and Technology, Mbarara, Uganda; §Harvard Medical School, Boston, MA; ‖Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA; ¶Center for Global Health, Massachusetts General Hospital, Boston, MA; #School of Population and Public Health, University of British Columbia, Vancouver, Canada; **Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA; ††Epicentre Mbarara, Mbarara, Uganda; ‡‡Center for Global Health & Department of Medicine, Massachusetts General Hospital, Boston, MA; and §§University of California, San Francisco (UCSF), San Francisco, CA.
出版信息
J Acquir Immune Defic Syndr. 2014 Dec 1;67 Suppl 4(Suppl 4):S179-87. doi: 10.1097/QAI.0000000000000370.
BACKGROUND
Among HIV-infected women, perinatal depression compromises clinical, maternal, and child health outcomes. Antiretroviral therapy (ART) is associated with lower depression symptom severity but the uniformity of effect through pregnancy and postpartum periods is unknown.
METHODS
We analyzed prospective data from 447 HIV-infected women (18-49 years) initiating ART in rural Uganda (2005-2012). Participants completed blood work and comprehensive questionnaires quarterly. Pregnancy status was assessed by self-report. Analysis time periods were defined as currently pregnant, postpartum (0-12 months post-pregnancy outcome), or non-pregnancy-related. Depression symptom severity was measured using a modified Hopkins Symptom Checklist 15, with scores ranging from 1 to 4. Probable depression was defined as >1.75. Linear regression with generalized estimating equations was used to compare mean depression scores over the 3 periods.
RESULTS
At enrollment, median age was 32 years (interquartile range: 27-37), median CD4 count was 160 cells per cubic millimeter (interquartile range: 95-245), and mean depression score was 1.75 (s = 0.58) (39% with probable depression). Over 4.1 median years of follow-up, 104 women experienced 151 pregnancies. Mean depression scores did not differ across the time periods (P = 0.75). Multivariable models yielded similar findings. Increasing time on ART, viral suppression, better physical health, and "never married" were independently associated with lower mean depression scores. Findings were consistent when assessing probable depression.
CONCLUSIONS
Although the lack of association between depression and perinatal periods is reassuring, high depression prevalence at treatment initiation and continued incidence across pregnancy and non-pregnancy-related periods of follow-up highlight the critical need for mental health services for HIV-infected women to optimize both maternal and perinatal health.
背景
在感染 HIV 的女性中，围产期抑郁会影响临床、母婴健康结局。抗逆转录病毒治疗（ART）与较低的抑郁症状严重程度相关，但这种影响在整个孕期和产后期间是否一致尚不清楚。
方法
我们分析了在乌干达农村地区（2005-2012 年）开始接受抗逆转录病毒治疗的 447 名感染 HIV 的女性（18-49 岁）的前瞻性数据。参与者每季度完成血液检查和全面的问卷调查。通过自我报告评估妊娠状况。分析时间段定义为当前怀孕、产后（产后结局后 0-12 个月）或与妊娠无关。使用改良的霍普金斯症状清单 15 测量抑郁症状严重程度，得分范围为 1-4 分。得分>1.75 定义为可能抑郁。使用广义估计方程的线性回归比较了 3 个时间段的平均抑郁评分。
结果
在入组时，中位年龄为 32 岁（四分位距：27-37），中位 CD4 计数为 160 个细胞/立方毫米（四分位距：95-245），平均抑郁评分为 1.75（s=0.58）（39%的人有抑郁可能）。在 4.1 年的中位随访期间，有 104 名女性经历了 151 次妊娠。在不同的时间段，平均抑郁评分没有差异（P=0.75）。多变量模型得出了类似的结果。在 ART 上的治疗时间、病毒抑制、身体状况改善和“从未结婚”与较低的平均抑郁评分独立相关。当评估可能的抑郁时，发现也是一致的。
结论
虽然抑郁与围产期之间缺乏关联令人欣慰，但在治疗开始时抑郁的高患病率以及在整个孕期和非孕期随访期间持续发生，突显了为感染 HIV 的女性提供心理健康服务的迫切需要，以优化母婴健康。
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