护士家访与产妇心理健康：一项随机试验的 3 年随访结果。

Nurse Home Visiting and Maternal Mental Health: 3-Year Follow-Up of a Randomized Trial.

机构信息

Centre for Community Child Health, Royal Children's Hospital, Parkville, Victoria, Australia;

Population Health and.

出版信息

Pediatrics. 2021 Feb;147(2). doi: 10.1542/peds.2020-025361.

DOI:10.1542/peds.2020-025361

PMID:33483450

Abstract

BACKGROUND

Poor mental health is recognized as one of the greatest global burdens of disease. Maternal mental health is crucial for the optimal health of mothers and their children. We examined the effects of an Australian Nurse Home Visiting (NHV) program (right@home), offered to pregnant women experiencing adversity, on maternal mental health and well-being at child age 3 years.

METHODS

A randomized controlled trial of NHV delivered via universal child and family health services (2013-2016). Pregnant women experiencing adversity (≥2 of 10 risk factors) were recruited from 10 antenatal clinics across 2 states. Intervention comprised 25 home visits until child age 2 years. The outcomes assessed 1-year postintervention completion were maternal self-report of mental health symptoms (Depression Anxiety Stress Scales) and positive aspects of mental health (personal well-being and self-efficacy).

RESULTS

Of the 722 women enrolled in the trial, 255 of 363 (70%) intervention and 240 of 359 (67%) control group women provided data at 3 years. Compared with controls, the intervention group reported better mental health (reverse Depression Anxiety Stress Scales scores): effect sizes of 0.25 (depression; 95% confidence interval [CI]: 0.08 to 0.32), 0.20 (anxiety; 95% CI: 0.05 to 0.30), 0.17 (stress; 95% CI: 0.09 to 0.37), and 0.23 (total score; 95% CI: 0.12 to 0.38); 0.16 (95% CI: 0.04 to 0.29) for personal well-being; and an odds ratio of 1.60 (95% CI: 1.19 to 2.16) for self-efficacy.

CONCLUSIONS

An NHV designed to support mothers experiencing adversity can lead to later maternal mental health benefits, even after the program ends.

摘要

背景

不良心理健康被认为是全球最大疾病负担之一。孕产妇心理健康对母亲及其子女的最佳健康至关重要。我们研究了澳大利亚护士家访（NHV）计划（right@home）对经历逆境的孕妇的心理健康和福祉的影响，该计划在儿童 3 岁时提供。

方法

这是一项在 2013 年至 2016 年期间通过普遍的儿童和家庭健康服务进行的 NHV 随机对照试验。从 2 个州的 10 个产前诊所招募了经历逆境（≥10 个风险因素中的 2 个）的孕妇。干预措施包括在孩子 2 岁之前进行 25 次家访。在干预完成后 1 年评估的结局是孕产妇自我报告的心理健康症状（抑郁焦虑压力量表）和心理健康的积极方面（个人幸福感和自我效能感）。

结果

在参加试验的 722 名女性中，363 名干预组的 255 名（70%）和 359 名对照组的 240 名（67%）女性在 3 岁时提供了数据。与对照组相比，干预组报告的心理健康状况更好（抑郁焦虑压力量表得分呈反向变化）：抑郁的效应量为 0.25（95%置信区间[CI]：0.08 至 0.32），焦虑为 0.20（95%CI：0.05 至 0.30），压力为 0.17（95%CI：0.09 至 0.37），总分 0.23（95%CI：0.12 至 0.38）；个人幸福感为 0.16（95%CI：0.04 至 0.29）；自我效能感的优势比为 1.60（95%CI：1.19 至 2.16）。