Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
J Womens Health (Larchmt). 2020 Jul;29(7):944-951. doi: 10.1089/jwh.2019.7903. Epub 2020 Feb 20.
Individuals with depression have increased nonpsychiatric health care utilization. Associations between depression and utilization have not been studied in perinatal women, despite their heightened depression risk. We examined patterns of nonpsychiatric health care utilization by symptoms of perinatal depression, expecting more frequent use of acute services while being less likely to have routine medical care. We identified 1,103 perinatal participants from the 2005 to 2016 National Health and Nutrition Examination Surveys. The Patient Health Questionnaire was used to identify depression (score ≥10). We evaluated associations between perinatal depressive symptoms and health care utilization using logistic models and relative excess risk due to interaction (RERI) using adjusted models with appropriate weighting to provide national estimates. Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured ( < 0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0). Perinatal depression is a prevalent, high-risk illness that requires more nonpsychiatric services and increased psychiatric care. Approaches that facilitate establishing a place for routine care and decreasing acute care use are necessary.
患有抑郁症的个体有更多的非精神病医疗保健利用。尽管围产期女性的抑郁症风险增加，但尚未研究抑郁症与利用之间的关系。我们检查了围产期抑郁症症状的非精神病医疗保健利用模式，预计急性服务的使用频率更高，而常规医疗保健的可能性较低。我们从 2005 年至 2016 年的国家健康和营养检查调查中确定了 1103 名围产期参与者。使用病人健康问卷识别抑郁症（得分≥10）。我们使用逻辑模型评估了围产期抑郁症状与医疗保健利用之间的关联，并使用适当加权的调整模型评估了交互的相对超额风险（RERI），以提供全国性估计。在美国围产期妇女中，有 7.3%有抑郁症状。与没有这些症状的妇女相比，有抑郁症状的妇女年龄较小，贫困程度较高，并且没有保险（<0.05）。与没有抑郁症状的妇女相比，有抑郁症状的妇女没有常规医疗保健的可能性是其两倍（21.6%比 12.5%，调整后的优势比[aOR]：2.1，95%置信区间[CI]：1.1 至 4.1），并且更频繁地使用紧急护理（26.5%比 15.1%，aOR：1.9，95% CI：1.0 至 3.9）。抑郁症状与缺乏保险相结合通常会增加没有常规护理的可能性（RERI：8.4，95%CI：-0.5 至 17.3）和更频繁地使用紧急护理（RERI：7.1，95%CI：-2.7 至 17.0）。围产期抑郁症是一种普遍存在的高风险疾病，需要更多的非精神病服务和增加的精神病护理。需要采取措施促进建立常规护理场所并减少急性护理的使用。
