van Heyningen T, Myer L, Tomlinson M, Field S, Honikman S
Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Glob Ment Health (Camb). 2019 Oct 7;6:e24. doi: 10.1017/gmh.2019.21. eCollection 2019.
The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation.
A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis.
The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78-0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%.
This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.
低收入和中等收入国家常见围产期精神障碍（CPMD）的负担显著高于高收入国家，在资源有限的环境中，此类障碍的检测、服务提供和治疗水平较低。我们描述了一种超短筛查工具的开发过程，该工具用于检测产前抑郁、焦虑症和产妇自杀意念。
在一家基层产科诊所招募了376名女性作为样本。发放了五份抑郁和焦虑症状筛查问卷、人口统计学和社会心理风险问卷。所有参与者均接受了《迷你国际神经精神访谈》（MINI），这是一种结构化的诊断访谈。使用多元逻辑回归和受试者工作特征曲线（ROC）分析，根据诊断数据对筛查工具项目进行分析。
MINI定义的重度抑郁发作（MDE）和/或焦虑症的患病率为33%。总体而言，18%的参与者表达了自杀意念和行为，其中54%没有抑郁或焦虑诊断。多元逻辑回归确定了四个筛查项目，这些项目可独立预测MDE和焦虑症，包括抑郁情绪、快感缺失、焦虑症状和自杀意念。对这些综合项目进行ROC分析，曲线下面积为0.83（95%CI 0.78 - 0.88）。截断分数为2分或更高时，灵敏度为78%，特异度为82%。
这种新型筛查工具是南非开发的首个用于CPMD的测量工具，涵盖了抑郁情绪、焦虑症状和自杀意念。虽然该工具需要进一步研究，但它可能有助于在围产期早期识别心理健康症状和发病率。
