Toler Sarah, Stapleton Susan, Kertsburg Kim, Callahan Tiffany J, Hastings-Tolsma Marie
Louise Herrington School of Nursing, Baylor University, Dallas, TX 75211, United States .
Research Committee Chair, American Association of Birth Centers, Perkiomenville, PA 180474, United States.
Midwifery. 2018 Jul;62:161-170. doi: 10.1016/j.midw.2018.03.016. Epub 2018 Apr 3.
Postpartum anxiety is a mental health problem that has largely been ignored by maternity care providers despite an estimated incidence as high as 28.9%. Though postpartum anxiety may or may not be accompanied by depression, and while screening for postpartum depression has become more common place, postpartum anxiety is often not assessed or addressed.
The purpose of this pilot quality improvement project was to implement a screening, treatment and referral program for postpartum anxiety in the birth centre environment.
Midwives from 10 geographically diverse birth centres, and all members of the American Association of Birth Centres, were recruited to participate in the project. An online video was developed which detailed postpartum anxiety, screening through use of the anxiety subscale of the Edinburgh Postnatal Depression Scale and a toolkit for treatment and/or referral for screen positive patients. Participants entered patient scores into the Perinatal Data Registry of the American Association of Birth Centres. Individual interviews of midwives were conducted following the 10-week pilot period.
There were a total of 387 participants across 9 participating sites. Among all screened participants with follow-up data, (n = 382), 9.69% (n = 37) were lost to follow-up. Among all participants screened with the Edinburgh Postpartum Depression Scale -3A and Edinburgh Postpartum Depression Scale (n = 318), 12.58% (n = 40) had a positive Edinburgh Postpartum Depression Scale -3A score of greater than six. Of all screened participants with an Edinburgh Postpartum Depression Scale score, 15 (6.98%) had a Edinburgh Postpartum Depression Scale score of less than 12 and an Edinburgh Postpartum Depression Scale -3A score greater than six, and would have not received follow up care if only screened for postpartum depression. Midwife participants expressed heightened awareness of the need to screen and felt screening was easy to integrate into clinical practice.
The Edinburgh Postpartum Depression Scale -3A is a valid, easy-to-use tool which should be considered for use in clinical practice. Modification of the electronic health record can serve as an important impetus triggering screening and treatment. It is important that clinicians are educated on the prevalence of postpartum anxiety, its risk factors, symptoms and implications.
产后焦虑是一个心理健康问题，尽管估计发病率高达28.9%，但很大程度上被产科护理人员忽视了。虽然产后焦虑可能伴有或不伴有抑郁，并且产后抑郁筛查已变得更为普遍，但产后焦虑往往未得到评估或处理。
这个试点质量改进项目的目的是在分娩中心环境中实施一项产后焦虑筛查、治疗和转诊计划。
招募了来自10个地理位置不同的分娩中心的助产士以及美国分娩中心协会的所有成员参与该项目。制作了一个在线视频，详细介绍产后焦虑、使用爱丁堡产后抑郁量表焦虑分量表进行筛查以及为筛查呈阳性的患者提供治疗和/或转诊的工具包。参与者将患者得分输入美国分娩中心协会的围产期数据登记处。在为期10周的试点期结束后，对助产士进行了个人访谈。
9个参与站点共有387名参与者。在所有有随访数据的筛查参与者中（n = 382），9.69%（n = 37）失访。在所有使用爱丁堡产后抑郁量表-3A和爱丁堡产后抑郁量表进行筛查的参与者中（n = 318），12.58%（n = 40）的爱丁堡产后抑郁量表-3A得分大于6，呈阳性。在所有有爱丁堡产后抑郁量表得分的筛查参与者中，15人（6.98%）的爱丁堡产后抑郁量表得分低于12且爱丁堡产后抑郁量表-3A得分大于6，如果仅筛查产后抑郁，他们将不会得到后续护理。助产士参与者表示对筛查的必要性有了更高的认识，并认为筛查很容易融入临床实践。
爱丁堡产后抑郁量表-3A是一种有效且易于使用的工具，临床实践中应考虑使用。修改电子健康记录可作为触发筛查和治疗的重要推动力。临床医生了解产后焦虑的患病率、危险因素、症状及影响非常重要。
