Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
J Affect Disord. 2019 Dec 1;259:279-287. doi: 10.1016/j.jad.2019.08.052. Epub 2019 Aug 19.
Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries.
Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership.
Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use.
Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories.
Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
围产期抑郁症影响了南非 21-50%的女性，对母亲和儿童的健康构成了重大威胁。在中低收入国家，抑郁症状的轨迹随时间而变化，在围产期并未得到很好的描述。
对参加南非帕尔人口基础出生队列研究的女性进行数据分析，这些女性在妊娠期间至产后 18 个月至少有 3 次抑郁测量值（N=831）。使用爱丁堡产后抑郁量表（EPDS）连续测量抑郁症状。使用基于群组的轨迹模型估计围产期抑郁症状的轨迹模式，并使用多变量模型识别轨迹群组成员的预测因素。
确定了五种不同的抑郁症状轨迹模式：妊娠期间有中度抑郁症状，但产后轻微（3.5%）、妊娠期间轻度且产后逐渐增加（3.7%）、产后 12 个月达到峰值的不稳定水平（6.6%）、产后轻微下降的轻度水平（82.9%）和妊娠及产后严重水平（3.1%）。慢性严重症状组的成员与生活压力事件、性亲密伴侣暴力和吸烟有关。
建模限制阻止了确定心理社会预测因素随时间的变化如何影响抑郁症状轨迹。
在南非这个队列中，妊娠和产后轻度到重度抑郁症状很常见。迫切需要针对患有严重慢性抑郁症状且伴有并存心理社会问题的女性进行治疗。
