COVID-19 大流行期间的产后精神疾病：基于人群的重复横断面研究。
Postpartum mental illness during the COVID-19 pandemic: a population-based, repeated cross-sectional study.
机构信息
Women's College Research Institute (Vigod, Brown, Barker, Wright), Women's College Hospital; Department of Psychiatry (Vigod, Brown, Barker, Wright, Grigoriadis), Temerty Faculty of Medicine, University of Toronto; ICES Central (Vigod, Brown, Huang, Fung, Barker, Gozdyra, Moineddin); Institute for Health Policy, Management and Evaluation (Vigod, Brown, Barker, Hussain-Shamsy, Moineddin), Dalla Lana School of Public Health, University of Toronto; Department of Health and Society (Brown), University of Toronto Scarborough; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto; Sunnybrook Health Sciences Centre (Grigoriadis), Toronto, Ont.; Department of Obstetrics and Gynecology (Corsi, Walker), University of Ottawa, Ottawa, Ont.; Department of Family & Community Medicine (Moineddin), Faculty of Medicine, University of Toronto, Toronto, Ont.
出版信息
CMAJ. 2021 Jun 7;193(23):E835-E843. doi: 10.1503/cmaj.210151.
BACKGROUND
It is unclear whether the clinical burden of postpartum mental illness has increased during the COVID-19 pandemic. We sought to compare physician visit rates for postpartum mental illness in Ontario, Canada, during the pandemic with rates expected based on prepandemic patterns.
METHODS
In this population-based, repeated cross-sectional study using linked health administrative databases in Ontario, Canada, we used negative binomial regression to model expected visit rates per 1000 postpartum people for March-November 2020 based on prepandemic data (January 2016-February 2020). We compared observed visit rates to expected visit rates for each month of the pandemic period, generating absolute rate differences, incidence rate ratios (IRRs) and their 95% confidence intervals (CIs). The primary outcome was a visit to a primary care physician or a psychiatrist for any mental disorder. We stratified analyses by maternal sociodemographic characteristics.
RESULTS
In March 2020, the visit rate was 43.5/1000, with a rate difference of 3.11/1000 (95% CI 1.25-4.89) and an IRR of 1.08 (95% CI 1.03-1.13) compared with the expected rate. In April, the rate difference (10.9/1000, 95% CI 9.14-12.6) and IRR (1.30, 95% CI 1.24-1.36) were higher; this level was generally sustained through November 2020. From April-November, we observed elevated visit rates across provider types and for diagnoses of anxiety, depressive and alcohol or substance use disorders. Observed increases from expected visit rates were greater for people 0-90 days postpartum compared with 91-365 days postpartum; increases were small among people living in low-income neighbourhoods. Public health units in the northern areas of the province did not see sustained elevations in visit rates after July; southern health units had elevated rates through to November.
INTERPRETATION
Increased visits for mental health conditions among postpartum people during the first 9 months of the COVID-19 pandemic suggest an increased need for effective and accessible mental health care for this population as the pandemic progresses.
背景
目前尚不清楚在 COVID-19 大流行期间，产后精神疾病的临床负担是否增加。我们旨在比较加拿大安大略省大流行期间产后精神疾病的医生就诊率与基于大流行前模式的预期就诊率。
方法
在这项基于人群的重复横断面研究中，我们使用加拿大安大略省的链接健康管理数据库，使用负二项回归模型来预测 2020 年 3 月至 11 月的预期就诊率，预测率基于大流行前数据（2016 年 1 月至 2020 年 2 月）。我们将大流行期间每个月的观察就诊率与预期就诊率进行比较，生成绝对就诊率差异、发病率比（IRR）及其 95%置信区间（CI）。主要结局是初级保健医生或精神科医生就诊任何精神障碍。我们按产妇社会人口特征进行分层分析。
结果
2020 年 3 月，就诊率为 43.5/1000，实际就诊率比预期就诊率高 3.11/1000（95%CI 1.25-4.89），IRR 为 1.08（95%CI 1.03-1.13）。4 月，就诊率差异（10.9/1000，95%CI 9.14-12.6）和 IRR（1.30，95%CI 1.24-1.36）更高；这种水平在 2020 年 11 月之前基本维持。从 4 月至 11 月，我们观察到各种类型的提供者的就诊率都有所上升，焦虑、抑郁和酒精或药物使用障碍的诊断也有所上升。与 91-365 天产后相比，0-90 天产后的实际就诊率与预期就诊率差异更大；在居住在低收入社区的人群中，增幅较小。该省北部地区的公共卫生部门在 7 月后没有看到就诊率持续上升；南部卫生部门的就诊率一直持续到 11 月。
结论
在 COVID-19 大流行的前 9 个月，产后人群中精神健康状况的就诊率增加，这表明随着大流行的发展，该人群对有效和可及的精神卫生保健的需求增加。
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