Cleary Susan, Orangi Stacey, Garman Emily, Tabani Hanani, Schneider Marguerite, Lund Crick
University of Cape Town, Health Economics Unit, School of Public Health and Family Medicine, South Africa.
KEMRI-Wellcome Trust Research Programme Nairobi, Health Economics Research Unit, Kenya.
BJPsych Open. 2020 Apr 3;6(3):e36. doi: 10.1192/bjo.2020.15.
Maternal depression is a notable concern, yet little evidence exists on its economic burden in low- and middle-income countries.
This study assessed societal costs and economic outcomes across pregnancy to 12 months postpartum comparing women with depression with those without depression. Trial registration: ClinicalTrials.gov: NCT01977326 (registered on 24 October 2013); Pan African Clinical Trials Registry (www.pactr.org): PACTR201403000676264 (registered on 11 October 2013).
Participants were recruited during the first antenatal visit to primary care clinics in Khayelitsha, Cape Town. In total, 2187 women were screened, and 419 women who were psychologically distressed were retained in the study. Women were interviewed at baseline, 8 months gestation and at 3 and 12 months postpartum; the Hamilton Rating Scale for Depression was used to categorise women as having depression or not having depression at each interview. Collected data included sociodemographics; health service costs; user fees; opportunity costs of accessing care; and travelling expenses for the women and their child(ren). Using Markov modelling, the incremental economic burden of maternal depression was estimated across the period.
At 12 months postpartum, women with depression were significantly more likely to be unemployed, to have lower per capita household income, to incur catastrophic costs and to be in a poorer socioeconomic group than those women without depression. Costs were higher for women with depression and their child(ren) at all time points. Modelled provider costs were US$805 among women without depression versus US$1303 in women with depression.
Economic costs and outcomes were worse in perinatal women with depression. The development of interventions to reduce this burden is therefore of significant policy importance.
孕产妇抑郁症是一个值得关注的问题，但在低收入和中等收入国家，关于其经济负担的证据很少。
本研究评估了从孕期到产后12个月抑郁症女性与非抑郁症女性的社会成本和经济结局。试验注册：ClinicalTrials.gov：NCT01977326（2013年10月24日注册）；泛非临床试验注册中心（www.pactr.org）：PACTR201403000676264（2013年10月11日注册）。
在开普敦凯伊利沙的初级保健诊所首次产前检查期间招募参与者。总共对2187名女性进行了筛查，419名心理困扰的女性被纳入研究。在基线、妊娠8个月、产后3个月和12个月对女性进行访谈；使用汉密尔顿抑郁评定量表在每次访谈时将女性分为患有抑郁症或未患有抑郁症。收集的数据包括社会人口统计学；卫生服务成本；用户费用；获得护理的机会成本；以及女性及其子女的差旅费。使用马尔可夫模型估计了整个时期孕产妇抑郁症的增量经济负担。
产后12个月时，与未患抑郁症的女性相比，患抑郁症的女性失业的可能性显著更高，人均家庭收入更低，产生灾难性成本的可能性更大，且社会经济群体更贫困。在所有时间点，患抑郁症的女性及其子女的成本都更高。模拟的医疗服务提供者成本在未患抑郁症的女性中为805美元，在患抑郁症的女性中为1303美元。
围产期患抑郁症的女性的经济成本和结局更差。因此，制定减少这种负担的干预措施具有重要的政策意义。
