Alves Stephanie, Fonseca Ana, Canavarro Maria Cristina, Pereira Marco
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
Midwifery. 2019 Feb;69:113-120. doi: 10.1016/j.midw.2018.11.006. Epub 2018 Nov 17.
This study examined the predictive validity of the prenatal and postnatal versions of the Postpartum Depression Predictors Inventory-Revised (PDPI-R) in European Portuguese women, considering two gold standards to determine postpartum depression (PPD).
Prospective longitudinal study conducted between November 2015 and September 2017.
One public referral maternity hospital in the central region of Portugal.
A total of 140 Portuguese women participated in the study.
Participants completed the PDPI-R during the second trimester of pregnancy (T1) and at 6 weeks postpartum (T2). At T2, participants also answered the Edinburgh Postnatal Depression Scale (EPDS). During the fourth month postpartum (T3), women were interviewed with the Structured Clinical Interview for DSM-IV Disorders, and between 6 and 9 months postpartum (T4), they completed the EPDS.
Rates of clinically significant depressive symptoms (EPDS ≥ 10) were 16.4% (23/140) at T2 and 23.2% (23/99) at T4. Six (4.3%) women met the criteria for a clinical diagnosis of PPD (major depressive episode) at T3. Overall, the postnatal version of the PDPI-R performed better than did the prenatal version (average area under the curve = 82% vs. 71%), but both versions accurately predicted women who developed a clinical diagnosis of PPD, at a cut-off score of 4.5 for the prenatal version (sensitivity = 83.3%; specificity = 85.8%) and 9.5 for the postnatal version (sensitivity = 83.3%; specificity = 94.8%).
Despite the low prevalence of PPD (albeit consistent with prior estimates of major depression at three months postpartum), this clinical condition has very serious consequences for the mother, the baby and the whole family when present. The PDPI-R is a valid screening tool to estimate the psychosocial risk for developing PPD among Portuguese women and can be used in research (e.g., for cross-cultural comparisons) and clinical practice. The recommended cut-off scores could assist health professionals (namely, midwives) in identifying the women who would benefit from appropriate referrals and/or closer monitoring to prevent them from developing PPD.
本研究在欧洲葡萄牙女性中检验了修订版产后抑郁预测量表（PDPI-R）的产前和产后版本的预测效度，同时考虑了两种确定产后抑郁（PPD）的金标准。
2015年11月至2017年9月进行的前瞻性纵向研究。
葡萄牙中部地区的一家公立转诊妇产医院。
共有140名葡萄牙女性参与了本研究。
参与者在孕中期（T1）和产后6周（T2）完成PDPI-R。在T2时，参与者还回答了爱丁堡产后抑郁量表（EPDS）。在产后第四个月（T3），对女性进行DSM-IV障碍的结构化临床访谈，在产后6至9个月（T4），她们完成EPDS。
在T2时，具有临床显著抑郁症状（EPDS≥10）的发生率为16.4%（23/140），在T4时为23.2%（23/99）。在T3时，有6名（4.3%）女性符合PPD临床诊断标准（重度抑郁发作）。总体而言，PDPI-R的产后版本比产前版本表现更好（曲线下平均面积分别为82%和71%），但两个版本均能准确预测临床诊断为PPD的女性，产前版本的临界分为4.5（敏感性=83.3%；特异性=85.8%），产后版本的临界分为9.5（敏感性=83.3%；特异性=94.8%）。
尽管PPD患病率较低（尽管与先前产后三个月重度抑郁的估计一致），但这种临床状况一旦出现，会对母亲、婴儿和整个家庭产生非常严重的后果。PDPI-R是一种有效的筛查工具，可用于评估葡萄牙女性发生PPD的心理社会风险，可用于研究（如跨文化比较）和临床实践。推荐的临界分可帮助卫生专业人员（尤其是助产士）识别那些将从适当转诊和/或密切监测中受益的女性，以防止她们发生PPD。
