Van Horne Bethanie S, Nong Yen H, Cain Cary M, Sampson McClain, Greeley Christopher S, Puryear Lucy
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Division of Public Health Pediatrics, Texas Children's Hospital, Houston, Texas, USA.
Health Soc Care Community. 2022 Sep;30(5):e2203-e2213. doi: 10.1111/hsc.13658. Epub 2021 Dec 5.
Postpartum depression (PPD), a perinatal mood and anxiety disorder (PMAD), is a leading cause of complications of pregnancy and childbirth. In the United States, approximately 20 percent of women suffer from PMADs. In Houston, Texas, an estimation of 12,000 - 15,000 women experience PPD each year. Within the Texas Children's Paediatrics network, a large paediatric network located in Houston, Texas, mothers are screened during paediatric well-child visits and those screening positive receive a referral to a psychiatrist with the network. However, there are not enough psychiatrists to meet the demand of services and Black, Latina, and women on Medicaid during pregnancy are less likely to attend a psychiatric visit compared to White, non-Hispanic women. This study used a randomised control trial design to measure the effectiveness of an alternative treatment option for a racially diverse population of postpartum women with mild to moderate symptoms of PPD, a five-session home visitation program using the Problem-Solving Tools for PPD (PST4PPD) model delivered by master's level social workers. The control group was allocated to standard treatment with a psychiatrist. A total of 118 women gave consent and were randomised, 72 to home visiting and 46 to psychiatry. Results demonstrated that all participating mothers had significant decreases in PPD symptoms. The change in PPD symptoms among those in the home visitation program was not significantly different from the change in the control condition, indicating that the home visitation program was as effective as psychiatric treatment in significantly reducing PPD symptoms. Additionally, a high proportion of women in the home visitation program completed visits and demonstrated increased maternal self-efficacy. Based on these results, a short-term home visitation program by a social worker (PST4PPD) appears to be a promising treatment option for postpartum women with mild to moderate PPD symptoms.
产后抑郁症（PPD）是一种围产期情绪和焦虑障碍（PMAD），是妊娠和分娩并发症的主要原因。在美国，约20%的女性患有围产期情绪和焦虑障碍。在得克萨斯州休斯敦，估计每年有12000至15000名女性患有产后抑郁症。在位于得克萨斯州休斯敦的大型儿科网络——得克萨斯儿童儿科网络中，母亲们在儿科健康检查时接受筛查，筛查呈阳性的母亲会被转介给该网络的精神科医生。然而，精神科医生数量不足以满足服务需求，与非西班牙裔白人女性相比，孕期参加医疗补助计划的黑人、拉丁裔女性以及其他女性更不太可能去看精神科医生。本研究采用随机对照试验设计，以衡量一种替代治疗方案对患有轻度至中度产后抑郁症症状的不同种族产后女性群体的有效性，该方案是由硕士水平的社会工作者实施的一项为期五节的家访计划，采用产后抑郁症问题解决工具（PST4PPD）模型。对照组被分配接受精神科医生的标准治疗。共有118名女性同意参与并被随机分组，72人接受家访，46人接受精神科治疗。结果表明，所有参与的母亲产后抑郁症症状均显著减轻。家访计划参与者产后抑郁症症状的变化与对照组的变化没有显著差异，这表明家访计划在显著减轻产后抑郁症症状方面与精神科治疗同样有效。此外，家访计划中有很大比例的女性完成了家访，并表现出母亲自我效能感的提高。基于这些结果，由社会工作者实施的短期家访计划（PST4PPD）似乎是治疗轻度至中度产后抑郁症症状产后女性的一种有前景的治疗选择。
