Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Public Health Research Institute of India, Mysore, Karnataka, India.
Soc Psychiatry Psychiatr Epidemiol. 2020 Oct;55(10):1323-1333. doi: 10.1007/s00127-020-01854-4. Epub 2020 Mar 7.
In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety.
Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale.
The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women.
ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.
在印度，产前焦虑的患病率估计范围为 6%至 48%。社会支持与心理健康密切相关，但大多数研究都考察了来自伴侣和家庭成员的支持，而不是同龄人、社区成员或医疗保健提供者的支持。本研究探讨了认证社会卫生活动家（ASHA）接触者对产前焦虑的支持作用。
数据来自 Saving Children, Improving Lives 项目，这是一项在印度农村地区进行的准实验性研究，对象为孕妇。使用回归模型来估计 ASHA 接触频率与产前焦虑之间的关系，并计算调整后的患病率比（aPR）和 95%置信区间。产前焦虑使用 Edinburgh Postnatal Depression Scale 的一个子量表进行测量。
样本由 480 名孕妇组成。报告的产前焦虑患病率为 27%（95%CI 23%，31%）。与 ASHAs 在家中接触更频繁的参与者（aPR：0.90；95%CI 0.76，0.98）和与 ASHAs 一起去产前护理就诊更频繁的参与者（aPR：0.86，95%CI 0.78，0.95）报告产前焦虑的可能性较低。ASHA 家访对最脆弱的妇女（初产妇和遭受家庭暴力的妇女）具有保护作用，而 ASHA 陪同产前护理就诊对所有妇女都具有同等的保护作用。
ASHA 因其对孕产妇健康教育和将育龄妇女与医疗保健服务联系起来的贡献而受到重视。我们的研究结果还表明，ASHA 在为孕妇提供社会支持方面发挥着重要作用，特别是对那些最容易出现产前焦虑的孕妇。
