a Department of Obstetrics & Gynecology, Department of Psychiatry , University of Massachusetts Medical School , Worcester , MA , USA.
b Department of Quantitative Health Sciences , UMass Memorial Health Care , Worcester , MA , USA.
Int Rev Psychiatry. 2019 May;31(3):210-228. doi: 10.1080/09540261.2018.1534725. Epub 2019 Jan 31.
Perinatal depression is common and can have deleterious effects on mothers, infants, children, partners, and families. Despite this, few women who screen positive for depression receive psychiatric treatment. A comprehensive perinatal depression care pathway includes: (1) screening, (2) assessment, (3) triage and referral, (4) treatment access, (5) treatment initiation, (6) symptom monitoring, and (7) adaptation of treatment based on measurement until symptoms remit. This depression care pathway provides a scaffold on which to frame the challenges encountered when, and the opportunities that exist for, addressing depression in obstetric settings. Comprehensive interventions that address each step on the care pathway are needed to support obstetric practices in providing high-quality, evidence-based, effective treatment including pro-active follow-up for depression management. Despite recent attention being brought to, and significant progress in the field of maternal mental health, gaps in care persist. Ultimately, depression care needs to be fully integrated into obstetric care. Additionally, more targeted maternal mental health support and structure are needed for integration to occur and ultimately be optimized. Specific areas requiring more attention include consistency of screening, evaluation of patients with a positive depression screen for bipolar disorder, anxiety or substance use disorders, and monitoring of symptom improvement.
围产期抑郁症很常见，会对母亲、婴儿、儿童、伴侣和家庭造成不良影响。尽管如此，很少有筛查出抑郁症阳性的女性接受精神科治疗。全面的围产期抑郁症护理途径包括：（1）筛查，（2）评估，（3）分诊和转诊，（4）治疗途径，（5）治疗开始，（6）症状监测，（7）根据测量结果调整治疗，直到症状缓解。这条抑郁症护理途径为解决产科环境中抑郁症提供了一个框架，指出了挑战和机遇。需要全面的干预措施来解决护理途径中的每一个步骤，以支持产科实践提供高质量、基于证据、有效的治疗，包括积极主动的抑郁管理随访。尽管最近对产妇心理健康领域给予了关注，并取得了重大进展，但护理方面仍存在差距。最终，抑郁症护理需要完全融入产科护理。此外，还需要更有针对性的产妇心理健康支持和结构来实现和最终优化整合。需要更多关注的具体领域包括筛查的一致性、对抑郁症筛查阳性的患者进行双相情感障碍、焦虑或物质使用障碍的评估，以及监测症状改善情况。
