Rochat T J, Houle B, Stein A, Pearson R M, Newell M L, Bland R M
1Africa Health Research Institute,Durban,South Africa.
5MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt),School of Public Health,Faculty of Health Sciences,University of the Witwatersrand,Johannesburg,South Africa.
J Dev Orig Health Dis. 2018 Feb;9(1):41-57. doi: 10.1017/S204017441700068X. Epub 2017 Sep 13.
Longitudinal maternal mental health data are needed from high HIV prevalence settings. The Siyakhula Cohort (SC) is a population-based cohort of HIV-positive and negative mothers (n=1506) with HIV-negative children (n=1536) from rural South Africa. SC includes 767 HIV-negative mothers; 465 HIV-positive in pregnancy; 272 HIV-positive since pregnancy (n=2 missing HIV status). A subgroup (n=890) participated in a non-randomized breastfeeding intervention [Vertical Transmission Study (VTS)]; the remaining (n=616) were resident in the same area and received antenatal care at the time of the VTS, but were not part of the VTS, instead receiving the standard of care Prevention of Mother-to-Child Transmission (PMTCT) Programme. In secondary analysis we investigated the prevalence of, and factors associated with, psychological morbidity amongst mothers who were still the primary caregiver of the child (1265 out of 1506) at follow-up (7-11 years post-birth). We measured maternal depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7) and parenting stress (Parenting Stress Index-36), using standardized cut-offs and algorithms. In total, 75 (5.9%) mothers met criteria for depression, 37 (2.9%) anxiety and 134 (10.6%) parenting stress. Using complete case logistic regression (n=1206 out of 1265 mothers) as compared to being HIV-negative, testing HIV-positive in pregnancy doubled odds of depression [adjusted odd ratios (aOR)=1.96 [1.0-3.7] P=0.039]. Parenting stress was positively associated with acquisition of HIV after pregnancy (aOR=3.11 [1.9-5.2] P<0.001) and exposure to household crime (aOR=2.02 [1.3-3.2] P=0.003); negatively associated with higher maternal education (aOR=0.29 [0.1-0.8] P=0.014), maternal employment (aOR=0.55 [0.3-0.9] P=0.024). Compared with the standard of care PMTCT, VTS mothers had reduced odds of parenting stress (aOR=0.61 [0.4-0.9] P=0.016). Integrating parental support into mostly bio-medical treatment programmes, during and beyond pregnancy, is important.
需要从艾滋病毒高流行地区获取纵向孕产妇心理健康数据。锡亚库拉队列研究（SC）是一项基于人群的队列研究，研究对象为来自南非农村地区的艾滋病毒阳性和阴性母亲（n = 1506）及其艾滋病毒阴性子女（n = 1536）。SC包括767名艾滋病毒阴性母亲；465名孕期艾滋病毒阳性母亲；272名自怀孕起即艾滋病毒阳性母亲（2名母亲艾滋病毒感染状况缺失）。一个亚组（n = 890）参与了一项非随机母乳喂养干预研究[垂直传播研究（VTS）]；其余（n = 616）居住在同一地区，在VTS研究期间接受产前护理，但未参与VTS研究，而是接受预防母婴传播（PMTCT）计划的标准护理。在二次分析中，我们调查了随访时（出生后7 - 11年）仍是孩子主要照料者的母亲（1506名中的1265名）中心理疾病的患病率及其相关因素。我们使用标准化临界值和算法测量了孕产妇抑郁（患者健康问卷 - 9）、焦虑（广泛性焦虑障碍量表 - 7）和育儿压力（育儿压力指数 - 36）。共有75名（5.9%）母亲符合抑郁标准，37名（2.9%）符合焦虑标准，134名（10.6%）符合育儿压力标准。与艾滋病毒阴性母亲相比，采用完全病例逻辑回归分析（1265名母亲中的1206名）显示，孕期检测艾滋病毒呈阳性使抑郁几率增加一倍[调整后的比值比（aOR）= 1.96 [1.0 - 3.7]，P = 0.039]。育儿压力与怀孕后感染艾滋病毒（aOR = 3.11 [1.9 - 5.2]，P < 0.001）以及遭受家庭犯罪（aOR = 2.02 [1.3 - 3.2]，P = 0.003）呈正相关；与母亲受教育程度较高（aOR = 0.29 [0.1 - 0.8]，P = 0.014）、母亲就业（aOR = 0.55 [0.3 - 0.9]，P = 0.024）呈负相关。与标准护理PMTCT相比，VTS研究中的母亲育儿压力几率降低（aOR = 0.61 [0.4 - 0.9]，P = 0.016）。在孕期及产后将父母支持纳入主要的生物医学治疗方案中很重要。
