Bitew Tesera, Hanlon Charlotte, Kebede Eskinder, Medhin Girmay, Fekadu Abebaw
Department of Psychiatry, College of Health Sciences School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Psychology, College of Social Science and Humanities, Debre Markos University, Debre Markos, Ethiopia.
BMC Pregnancy Childbirth. 2016 Oct 10;16(1):301. doi: 10.1186/s12884-016-1099-1.
Depressive symptoms during pregnancy can have multiple adverse effects on perinatal outcomes, including maternal morbidity and mortality. The potential impact of antenatal depressive symptoms on maternal health care use, however, has been little explored in low and middle-income countries (LMICs). This paper investigates whether maternal health care utilisation varies as a function of antenatal depressive symptoms.
In a population-based cross-sectional survey, 1311 women in the second or third trimesters of pregnancy were recruited in Sodo district, Gurage Zone, southern Ethiopia. Depressive symptoms were measured using a locally validated version of the Patient Health Questionnaire (PHQ-9). The association between antenatal depressive symptoms and number of antenatal care (ANC) visits was examined using Poisson regression and the association of depression symptoms with emergency health care visits using negative binomial regression. Binary logistic regression was used to investigate the association of depressive symptoms with initiation, frequency and adequacy of antenatal care.
At PHQ-9 cut off of five or more, 29.5 % of participants had depressive symptoms. The majority (60.5 %) of women had attended for one or more ANC visits. Women with depressive symptoms had an increased risk of having more non-scheduled ANC visits (adjusted Risk Ratio (aRR) = 1.41, 95 % CI: 1.20, 1.65), as well as an increased number of emergency health care visits to both traditional providers (aRR = 1.64, 95 % CI: 1.17, 2.31) and biomedical providers (aRR = 1.31, 95 % CI: 1.04, 1.69) for pregnancy-related emergencies. However, antenatal depressive symptoms were not significantly associated with initiation of ANC.
Increased non-scheduled ANC and emergency health care visits may be indicators of undetected depression in antenatal women, and have the potential to overwhelm the capacity and resources of health care systems, particularly in LMICs. Establishment of a system for detection, referral and treatment of antenatal depression, integrated within existing antenatal care, may reduce antenatal morbidity and treatment costs and promote efficiency of the health care system.
孕期抑郁症状会对围产期结局产生多种不利影响，包括孕产妇发病率和死亡率。然而，在低收入和中等收入国家（LMICs），产前抑郁症状对孕产妇医疗保健利用的潜在影响鲜有研究。本文调查孕产妇医疗保健利用情况是否因产前抑郁症状而异。
在埃塞俄比亚南部古拉格地区索多区开展的一项基于人群的横断面调查中，招募了1311名处于妊娠中期或晚期的妇女。使用当地验证过的患者健康问卷（PHQ-9）测量抑郁症状。采用泊松回归分析产前抑郁症状与产前检查（ANC）次数之间的关联，采用负二项回归分析抑郁症状与急诊医疗就诊之间的关联。二元逻辑回归用于研究抑郁症状与产前检查的开始、频率和充分性之间的关联。
在PHQ-9评分达到5分及以上时，29.5%的参与者有抑郁症状。大多数（60.5%）妇女进行了一次或多次产前检查。有抑郁症状的妇女进行更多非计划内产前检查的风险增加（调整风险比（aRR）=1.41，95%置信区间：1.20, 1.65），因妊娠相关紧急情况前往传统医疗服务提供者处（aRR=1.64，95%置信区间：1.17, 2.31）和生物医学医疗服务提供者处（aRR=1.31，95%置信区间：1.04, 1.69）进行急诊医疗就诊的次数也增加。然而，产前抑郁症状与产前检查的开始并无显著关联。
非计划内产前检查和急诊医疗就诊次数增加可能是产前妇女未被发现的抑郁的指标，并且有可能使医疗保健系统的能力和资源不堪重负，尤其是在低收入和中等收入国家。建立一个在现有产前保健中整合的产前抑郁检测、转诊和治疗系统，可能会降低产前发病率和治疗成本，并提高医疗保健系统的效率。
