Soffer Marti D, Adams Zoe M, Chen Yiting S, Fox Nathan S
Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Maternal Fetal Medicine Associates, PLLC, New York, NY, USA.
J Matern Fetal Neonatal Med. 2019 Dec;32(24):4154-4158. doi: 10.1080/14767058.2018.1484096. Epub 2018 Jul 1.
To determine risk factors for a positive postpartum depression screen among women with private health insurance and 24/7 access to care. Retrospective cohort study of all patients delivered by a single MFM practice from April 2015 to September 2016. All patients had private health insurance and 24/7 access to care. All patients were scheduled to undergo the Edinburgh Postnatal Depression Scale (EPDS) at their 6-week postpartum visit and a positive screen was defined as a score of 10 or higher, or a score greater than zero on question 10 (thoughts of selfharm). Using logistic regression, risk factors for postpartum depression were compared between women with and without a positive screen. Of the 1237 patients delivered, 1113 (90%) were screened with the EPDS. 81 patients (7.3, 95%CI 5.9-9.0%) of those tested had a positive screen. On regression analysis, risk factors associated with a positive screen were nulliparity (aOR 1.8, 95%CI 1.1, 2.9), cesarean delivery (aOR 1.7, 95%CI 1.1, 2.8), non-White race (aOR 2.0, 95%CI 1.1, 3.5), and a history of depression or anxiety (aOR 4.6, 95%CI 2.6, 8.1). Among the 100 women with a history of depression or anxiety, selective serotonin reuptake inhibitor (SSRI) use in the postpartum period was not associated with a reduced risk of a positive screen (25.5% in those taking an SSRI versus 18.4% of those not taking an SSRI, = .39). Among women with private health insurance and access to care, the incidence of a positive screen for postpartum depression is approximately 7%. The use of an SSRI did not eliminate this risk. All women should be screened for postpartum depression.
确定拥有私人医疗保险且能随时获得医疗服务的女性产后抑郁筛查呈阳性的风险因素。对2015年4月至2016年9月期间由单一母胎医学诊所接生的所有患者进行回顾性队列研究。所有患者均拥有私人医疗保险且能随时获得医疗服务。所有患者均计划在产后6周就诊时接受爱丁堡产后抑郁量表（EPDS）筛查，筛查呈阳性定义为得分10分或更高，或第10题（自杀念头）得分大于零。使用逻辑回归分析，比较筛查呈阳性和未呈阳性的女性之间产后抑郁的风险因素。在1237例分娩患者中，1113例（90%）接受了EPDS筛查。其中81例（7.3%，95%置信区间5.9 - 9.0%）检测呈阳性。回归分析显示，与筛查呈阳性相关的风险因素包括初产（调整后比值比1.8，95%置信区间1.1, 2.9）、剖宫产（调整后比值比1.7，95%置信区间1.1, 2.8）、非白人种族（调整后比值比2.0，95%置信区间1.1, 3.5）以及有抑郁或焦虑病史（调整后比值比4.6，95%置信区间2.6, 8.1）。在100例有抑郁或焦虑病史的女性中，产后使用选择性5-羟色胺再摄取抑制剂（SSRI）与筛查呈阳性风险降低无关（服用SSRI者为25.5%，未服用者为18.4%，P = 0.39）。在拥有私人医疗保险且能获得医疗服务的女性中，产后抑郁筛查呈阳性的发生率约为7%。使用SSRI并不能消除这种风险。所有女性都应接受产后抑郁筛查。
