Haight Sarah C, Ko Jean Y, Yogman Michael W, Farr Sherry L
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Commissioned Corps of the U.S. Public Health Service, U.S. Department of Health and Human Services, Washington, DC, USA.
J Womens Health (Larchmt). 2021 May;30(5):731-738. doi: 10.1089/jwh.2020.8373. Epub 2020 Jul 6.
The American College of Obstetricians and Gynecologists recommends that providers screen women for depression at the postpartum checkup. If this checkup is the only screening opportunity, women who do not attend or whose depressive episode occurs at a different time may not be identified. We evaluated women's encounters with postpartum health care to identify screening opportunities for postpartum depressive symptoms (PDS). Pregnancy Risk Assessment Monitoring System (PRAMS) data for 2012-2015 from eight jurisdictions ( = 23,990, representing 1,939,865 women) were used to calculate percentage of women reporting attendance at postpartum checkups, well-child visits, or postpartum home visitation, by presence of PDS. PDS were assessed using a modified two-item Patient Health Questionnaire. Using Modified Poisson regression, adjusted prevalence ratios (aPR) and confidence intervals (95% CI) were calculated to compare health services by PDS, adjusted for sociodemographic characteristics. Almost all women with or without PDS attended a postpartum checkup (85.1% and 91.4%; aPR: 0.96; 95% CI: 0.93-0.99) and their infants attended a well-child visit (97.3% and 98.9%; aPR: 0.99; 95% CI: 0.98-1.00); 13.7% and 10.9% received home visitation (aPR: 1.18; 95% CI: 1.02-1.35). Of women with PDS who missed their postpartum checkup, 13.5% reported infant attendance at well-child visits, and 2.0% received home visitation. Of women with PDS, 98.8%, 86.1%, and 11.2% attended 1, 2, or 3 health services. A large percentage of women with PDS may attend well-child visits or receive home visitation, representing opportunities for depression screening and referral for care.
美国妇产科医师学会建议医疗服务提供者在产后检查时对女性进行抑郁症筛查。如果这次检查是唯一的筛查机会，那么未参加检查或在其他时间出现抑郁发作的女性可能无法被识别出来。我们评估了女性产后保健的就诊情况，以确定产后抑郁症状（PDS）的筛查机会。利用来自八个司法管辖区2012 - 2015年的妊娠风险评估监测系统（PRAMS）数据（n = 23,990，代表1,939,865名女性），按是否存在PDS来计算报告参加产后检查、儿童健康检查或产后家访的女性比例。使用改良的两项患者健康问卷评估PDS。采用修正泊松回归计算调整患病率比（aPR）和置信区间（95% CI），以比较有无PDS情况下的医疗服务，并对社会人口学特征进行调整。几乎所有有或没有PDS的女性都参加了产后检查（分别为85.1%和91.4%；aPR：0.96；95% CI：0.93 - 0.99），且她们的婴儿参加了儿童健康检查（分别为97.3%和98.9%；aPR：0.99；95% CI：0.98 - 1.00）；13.7%和10.9%接受了家访（aPR：1.18；95% CI：1.02 - 1.35）。在错过产后检查的有PDS的女性中，13.5%报告其婴儿参加了儿童健康检查，2.0%接受了家访。在有PDS的女性中，98.8%、86.1%和11.2%分别参加了1次、2次或3次医疗服务。很大比例的有PDS的女性可能会参加儿童健康检查或接受家访，这为抑郁症筛查和转诊治疗提供了机会。
