Stone Sarah Lederberg, Diop Hafsatou, Declercq Eugene, Cabral Howard J, Fox Matthew P, Wise Lauren A
1 Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts.
J Womens Health (Larchmt). 2015 May;24(5):384-93. doi: 10.1089/jwh.2014.4857. Epub 2015 Mar 9.
Understanding the influence of perinatal stressors on the prevalence of postpartum depressive symptoms (PDS) and help-seeking for PDS using surveillance data can inform service provision and improve health outcomes.
We used Massachusetts Pregnancy Risk Assessment Monitoring System (MA-PRAMS) 2007-2010 data to evaluate associations between selected perinatal stressors and PDS and with subsequent help-seeking behaviors. We categorized 12 stressors into 4 groups: partner, traumatic, financial, and emotional. We defined PDS as reporting "always" or "often" to any depressive symptoms on PRAMS Phase 5, or to a composite score ≥10 on PRAMS Phase 6 depression questions, compared with women reporting "sometimes," "rarely" or "never" to all depressive symptoms. The median response time to MA-PRAMS survey was 3.2 months (interquartile range, 2.9-4.0 months). We estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using modified Poisson regression models, controlling for socioeconomic status indicators, pregnancy intention and prior mental health visits.
Among 5,395 participants, 58% reported ≥1 stressor (partner=26%, traumatic=16%, financial=29% and emotional=30%). Reporting of ≥1 stressor was associated with increased prevalence of PDS (PR=1.68, 95% CI: 1.42-1.98). The strongest association was observed for partner stress (PR=1.90, 95% CI: 1.51-2.38). Thirty-eight percent of mothers with PDS sought help. Mothers with partner-related stressors were less likely to seek help, compared with mothers with other grouped stressors.
Women who reported perinatal common stressors-particularly partner-related stressors-had an increased prevalence of PDS. These data suggest that women should be routinely screened during pregnancy for a range of stressors and encouraged to seek help for PDS.
利用监测数据了解围产期应激源对产后抑郁症状（PDS）患病率及寻求PDS帮助行为的影响，可为服务提供提供信息并改善健康结局。
我们使用2007 - 2010年马萨诸塞州妊娠风险评估监测系统（MA - PRAMS）数据，评估选定的围产期应激源与PDS之间以及与后续寻求帮助行为之间的关联。我们将12种应激源分为4组：伴侣相关、创伤性、经济和情绪性。我们将PDS定义为在PRAMS第5阶段报告对任何抑郁症状“总是”或“经常”，或在PRAMS第6阶段抑郁问题上综合得分≥10，与之相比，那些报告对所有抑郁症状“有时”“很少”或“从不”的女性。对MA - PRAMS调查的中位响应时间为3.2个月（四分位间距，2.9 - 4.0个月）。我们使用修正的泊松回归模型估计患病率比（PRs）和95%置信区间（95% CIs），控制社会经济状况指标、妊娠意愿和既往心理健康就诊情况。
在5395名参与者中，58%报告有≥1种应激源（伴侣相关 = 26%，创伤性 = 16%，经济 = 29%，情绪性 = 30%）。报告有≥1种应激源与PDS患病率增加相关（PR = 1.68，95% CI：1.42 - 1.98）。伴侣应激的关联最强（PR = 1.90，95% CI：1.51 - 2.38）。38%有PDS的母亲寻求了帮助。与有其他分组应激源的母亲相比，有伴侣相关应激源的母亲寻求帮助的可能性较小。
报告有围产期常见应激源——尤其是伴侣相关应激源——的女性，PDS患病率增加。这些数据表明，应在孕期对女性进行一系列应激源的常规筛查，并鼓励她们为PDS寻求帮助。
