Boston University School of Public Health, Boston, MA, USA.
Division of General Pediatrics, Boston University School of Medicine, Boston, MA, USA.
Birth. 2022 Mar;49(1):132-140. doi: 10.1111/birt.12584. Epub 2021 Aug 30.
Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling.
This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4-item Patient Health Questionnaire (PHQ-4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression.
We found non-Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non-Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6-21.7) to report counseling.
These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color.
由于对围产期抑郁的关注，多个州已颁布立法，要求对产妇进行产后抑郁症的普遍筛查。尽管存在这种担忧，但在怀孕期间和产后接受心理健康咨询的女性比例仍然很低。本研究考察了与接受围产期心理健康咨询相关的因素，特别是种族/民族方面的不平等。
本研究基于加利福尼亚州倾听母亲调查的数据，该调查对 2016 年分娩的女性出生证明文件的代表性样本进行了调查，共纳入了 2539 名女性。调查包括一系列心理健康问题，基于 4 项患者健康问卷（PHQ-4），以及关于咨询服务的接受情况、从业者是否询问受访者的心理健康状况以及受访者是否因焦虑或抑郁而服用药物的问题。
我们发现，非拉丁裔黑人女性在产前出现抑郁症状的比例更高，产后接受咨询服务和服用药物的比例明显低于非拉丁裔白人女性。在有抑郁症状的女性中，那些被从业者询问心理健康状况的女性中，有 46%的人接受了咨询，而没有被询问的女性中只有 20%接受了咨询。在多变量分析中，被询问的女性报告接受咨询的可能性几乎是未被询问的女性的六倍（优势比 5.96；95%置信区间 1.6-21.7）。
这些发现为那些倡导要求普遍筛查抑郁症状的州立法律提供了证据，以减少不平等现象，并帮助解决所有有抑郁症状的女性，特别是有色人种女性中咨询服务使用率低的问题。
