Rathod Sujit D, Honikman Simone, Hanlon Charlotte, Shidhaye Rahul
1Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
2Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Int J Ment Health Syst. 2018 Nov 12;12:68. doi: 10.1186/s13033-018-0248-5. eCollection 2018.
Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is now possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression.
The Community Study was a multi-round population-based cross-sectional survey (n = 6087). The Facility Study was a multi-round facility-based cross-sectional survey (n = 1577). Both studies were conducted in Sehore District, Madhya Pradesh between 2013 and 2017. Field workers conducted structured interviews with perinatal women. The questionnaire had sections relating to sociodemographic characteristics, depression screening using the Patient's Health Questionnaire (PHQ9), treatment seeking for depression-related symptoms, and disability. Using data pooled from both studies, we tested each characteristic for association with the total screening score and with screening positive for depression.
We identified 224 perinatal women from the Community Study and 130 perinatal women from the Facility Study, of whom 8.8% and 18.5% screened positive for depression, respectively. For the continuous PHQ9 score, there was evidence of a "U" shaped association with age, and positive associations with pregnancy, disability score, suicidality and being a health facility attendee. For the binary PHQ9 score, there was evidence of positive associations with pregnancy, disability score, suicidality and being a health facility attendee.
This study highlights where the largest population-level variations in perinatal depression symptoms are present in this Indian sample, for which mental health service provision should be made a priority. Epidemiological evidence generated by this study, as well as new evidence on peer-delivered interventions for perinatal depression, must be utilized by policy-makers to prioritize mental health services for mothers along with maternal and child health services.
围产期抑郁症对儿童的行为、认知和情感发展、出生结局及身体发育均有负面影响。在印度，心理健康项目受到更多重视，这意味着现在有可能减轻围产期抑郁症在人群层面的负担。在对两项研究进行的二次分析中，我们旨在描述印度中部农村地区社区和医疗机构中围产期妇女抑郁症的流行病学特征，并描述筛查出抑郁症阳性的妇女的求助行为。
社区研究是一项多轮基于人群的横断面调查（n = 6087）。医疗机构研究是一项多轮基于医疗机构的横断面调查（n = 1577）。两项研究均于2013年至2017年在中央邦的塞霍雷区进行。现场工作人员对围产期妇女进行结构化访谈。问卷包括社会人口学特征、使用患者健康问卷（PHQ9）进行抑郁症筛查、针对抑郁症相关症状的治疗寻求以及残疾情况等部分。利用两项研究汇总的数据，我们检验了每个特征与总筛查分数以及抑郁症筛查阳性之间的关联。
我们从社区研究中识别出224名围产期妇女，从医疗机构研究中识别出130名围产期妇女，其中分别有8.8%和18.5%的人抑郁症筛查呈阳性。对于连续的PHQ9分数，有证据表明与年龄呈“U”形关联，与怀孕、残疾评分、自杀倾向以及是医疗机构就诊者呈正相关。对于二元PHQ9分数，有证据表明与怀孕、残疾评分、自杀倾向以及是医疗机构就诊者呈正相关。
本研究突出了该印度样本中围产期抑郁症症状在人群层面最大的差异所在，心理健康服务应优先针对这些方面提供。政策制定者必须利用本研究产生的流行病学证据以及关于同伴提供的围产期抑郁症干预措施的新证据，将母亲的心理健康服务与母婴健康服务置于优先地位。
