Hahn-Holbrook Jennifer, Cornwell-Hinrichs Taylor, Anaya Itzel
Department of Psychology, University of California, Merced, Merced, CA, United States.
Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States.
Front Psychiatry. 2018 Feb 1;8:248. doi: 10.3389/fpsyt.2017.00248. eCollection 2017.
Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence.
We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence.
291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations ( = 16,823, = 0.000, = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality ( = 41%), maternal mortality ( = 19%), infant mortality ( = 16%), or women of childbearing age working ≥40 h a week ( = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.
The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
产后抑郁症（PPD）是一项重大的全球公共卫生挑战。PPD是与分娩相关的最常见并发症，对儿童有有害影响。尽管已经发表了数百项关于PPD的研究，但我们缺乏准确的全球或国家PPD患病率估计，也不清楚为什么PPD在不同国家之间的差异如此之大。因此，我们进行了一项荟萃分析来估计全球和国家PPD的患病率，并进行了一项荟萃回归分析，以确定与国家PPD患病率相关的经济、健康、社会或政策因素。
我们对所有使用爱丁堡产后抑郁量表报告PPD患病率的论文进行了系统综述。从每项研究中提取PPD患病率和方法。采用随机效应荟萃分析来估计全球和国家PPD患病率。为了测试国家层面的预测因素，我们利用了联合国儿童基金会、世界卫生组织和世界银行的数据。采用随机效应荟萃回归分析来测试PPD患病率的国家预测因素。
确定了来自56个国家的296284名女性的291项研究。PPD的全球合并患病率为17.7%（95%置信区间：16.6 - 18.8%），各国之间存在显著异质性（= 16823，= 0.000，= 98%），从新加坡的3%（2 - 5%）到智利的38%（35 - 41%）不等。收入不平等率（= 41%）、孕产妇死亡率（= 19%）、婴儿死亡率（= 16%）或每周工作≥40小时的育龄妇女比例（= 31%）显著较高的国家，PPD患病率也较高。这些因素共同解释了PPD患病率在国家间差异的73%。
PPD的全球患病率高于先前的认识，且因国家而异。财富不平等和母婴健康因素的差异在很大程度上解释了PPD患病率在国家间的差异。
