Xiangya School of Public Health, Central South University, Changsha, China.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Epidemiol Psychiatr Sci. 2020 Jul 17;29:e143. doi: 10.1017/S2045796020000554.
Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions.
This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT).
Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35-50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51-69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23-41%) (odds ratio 1.31, 95% CI 1.13-1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p ＜ 0.01).
Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.
围产期抑郁症威胁着产妇及其后代的健康。尽管存在围产期抑郁症的筛查项目，但筛查后未能转诊至进一步的心理健康护理，降低了这些项目的效用。阳性筛查妇女的转诊接受率在研究之间差异很大，对于如何提高转诊接受率知之甚少。本研究旨在系统地回顾现有的接受率证据，估计总体接受率，确定提高转诊接受率的干预措施，并探讨这些干预措施的效果。
本系统评价已在 PROSPERO（注册号：CRD42019138095）中注册。我们检索了 Pubmed、Web of Science、Cochrane 图书馆、Ovid、Embase、CNKI、万方数据库和 VIP 数据库，检索时间为数据库建立至 2019 年 1 月 13 日，并对相关研究的参考文献进行了扫描，以获取发表在英文或中文的研究。符合纳入标准的研究提供了接受率信息和/或干预措施对转诊接受率的影响。如果研究未报告转诊过程的详细信息或未提供确切的接受率，则将其排除。观察性研究和准实验研究提供的数据用于通过荟萃分析估计总体接受率。我们还进行了荟萃回归和亚组分析，以探讨异质性的潜在来源。由于仅有一项随机对照试验（RCT），我们对干预措施的效果进行了描述性分析，而不是荟萃分析。
在 2302 条记录中，有 41 项研究符合纳入标准，包括 39 项观察性研究（n=9337）、1 项准实验研究（n=43）和 1 项 RCT（n=555）。除了两项研究外，所有研究均在高收入国家进行。纳入研究报告的接受率差异很大，采用随机效应模型的总体转诊接受率为 43%（95%置信区间[CI] 35-50%）。荟萃回归和亚组分析均表明，与转介至心理健康服务（32%，95%CI 23-41%）相比，转介至现场评估或治疗（60%，95%CI 51-69%）的接受率显著更高（比值比 1.31，95%CI 1.13-1.52）。纳入的 RCT 表明，转诊干预显著提高了接受率（p＜0.01）。
近五分之三的阳性筛查结果的妇女在围产期抑郁症筛查后不接受转诊。转介至现场评估和治疗可能会提高转诊接受率，但提高转诊接受率的干预措施的证据质量较弱。需要进行更有力的研究，特别是在中低收入国家。
