Cankorur Vesile Senturk, Abas Melanie, Berksun Oguz, Stewart Robert
Department of Psychiatry, Ankara University Faculty of Medicine, Ankara, Turkey.
King's College London (Institute of Psychiatry), London, UK.
BMJ Open. 2015 Apr 1;5(4):e006456. doi: 10.1136/bmjopen-2014-006456.
This study aims to measure incidence and persistence of depression and to investigate the influence of self-reported antenatal social support and traditional/nuclear family structure on incidence and persistence of depression between the third trimester of pregnancy and following childbirth. We hypothesised that lower antenatal social support would be associated with incidence and persistence of case-level depressive symptoms and the family structure would have an effect on the incidence and persistence of depressive symptoms.
The cohort study described here was carried out in and around Ankara the capital of Turkey, because of the considerable heterogeneity of the population in terms of traditional Middle Eastern and 'modern' Western lifestyle and social environment. Samples were drawn from 20 urban and rural antenatal clinics (mainly primary care settings) within the geographic catchment.
Of 730 women recruited in their third trimester, 578 (79.2%) were re-examined between 2 and 6 months after childbirth. Exclusion criteria were as follows: aged younger than 18 years, illiteracy, significant health problems and refusal to participate.
Close Persons Questionnaire items enquired about relationships with the husband, mother and mother-in-law and depression was ascertained using the Edinburgh Postnatal Depression Scale at the each assessments.
In those followed, onset of postnatal depression occurred in 13.9% and persistence of antenatal depression in 49.7%. After adjustment, worse emotional support from the mother-in-law was significantly associated with postnatal depression incidence (OR=0.93, 95% CI 0.87 to 0.99) and worse emotional support from the husband with postnatal persistence (OR=0.89, 95% CI 0.83 to 0.96) of antenatal depression. Family structure was not a risk or modifying factor.
The incidence and persistence of postnatal depression in this Middle Eastern cohort were comparable to international findings. Certain family relationships predicted incidence and persistence of postnatal depression but no role of traditional/nuclear family structure was found.
本研究旨在测量抑郁症的发病率和持续时间，并调查自我报告的产前社会支持以及传统/核心家庭结构对妊娠晚期至产后抑郁症发病率和持续时间的影响。我们假设较低的产前社会支持与病例级抑郁症状的发病率和持续时间相关，并且家庭结构会对抑郁症状的发病率和持续时间产生影响。
由于土耳其首都安卡拉及其周边地区的人口在传统中东和“现代”西方生活方式及社会环境方面存在相当大的异质性，因此在此处开展了队列研究。样本取自地理范围内的20家城乡产前诊所（主要是初级保健机构）。
在孕晚期招募的730名女性中，578名（79.2%）在产后2至6个月接受了复查。排除标准如下：年龄小于18岁、文盲、严重健康问题以及拒绝参与。
亲密关系问卷项目询问了与丈夫、母亲和婆婆的关系，并在每次评估时使用爱丁堡产后抑郁量表确定是否患有抑郁症。
在接受随访的人群中，产后抑郁症的发病率为13.9%，产前抑郁症的持续率为49.7%。调整后，婆婆给予的情感支持较差与产后抑郁症的发病率显著相关（比值比=0.93，95%置信区间0.87至0.99），丈夫给予的情感支持较差与产前抑郁症的产后持续率相关（比值比=0.89，95%置信区间0.83至0.96）。家庭结构不是一个风险因素或调节因素。
这个中东队列中产后抑郁症的发病率和持续时间与国际研究结果相当。某些家庭关系可预测产后抑郁症的发病率和持续时间，但未发现传统/核心家庭结构的作用。
