Koire Amanda, Van Horne Bethanie S, Nong Yen H, Cain Cary M, Greeley Christopher S, Puryear Lucy
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Arch Womens Ment Health. 2022 Jun;25(3):603-610. doi: 10.1007/s00737-022-01223-x. Epub 2022 Mar 24.
The purpose of this study was to examine peripartum depression (PD) screening patterns within and across the prenatal and postpartum periods and assess the incidence of new positive screens during standard screening protocol timepoints to inform practice, particularly when limited screenings can be conducted.This is a retrospective observational study of women screened for PD through a large, integrated health system using the Edinburgh Postnatal Depression Scale (EPDS) within their obstetrics and pediatric practices. Pregnancies with an EPDS score for at least one obstetric and one pediatric appointment between November 2016 and October 2019 were included (n = 3240). The data were analyzed using chi-squared test, Student's t-test, and binary logistic regression analyses. An EPDS score of 10 or higher was considered a positive screen.The positive screening rate for this cohort was 18.5%, with a prenatal positive rate of 9.9% and a postpartum positive rate of 8.6%. Single relationship status showed a higher rate of PD overall. Two thirds of women were not screened until their third trimester, resulting in delayed detection for an estimated 28% of women who ultimately screened positive. Few new positive screens (1.3%) were detected after 9 weeks postpartum in women who had completed all recommended prior screens.Obstetric providers should screen for PD as early in pregnancy as possible and continue to screen as often as feasible regardless of previous negative EPDS scores. Prioritizing screening more often in pregnancy and before 9 weeks postpartum is optimal to avoid delays in detection and intervention.
本研究的目的是检查产前和产后期间内及跨期间的围产期抑郁症（PD）筛查模式，并评估在标准筛查方案时间点新出现的阳性筛查的发生率，以为实践提供参考，尤其是在只能进行有限筛查时。这是一项回顾性观察研究，研究对象是通过一个大型综合医疗系统在产科和儿科诊所使用爱丁堡产后抑郁量表（EPDS）进行PD筛查的女性。纳入了在2016年11月至2019年10月期间至少有一次产科和一次儿科预约且有EPDS评分的妊娠（n = 3240）。使用卡方检验、学生t检验和二元逻辑回归分析对数据进行分析。EPDS评分10分或更高被视为阳性筛查。该队列的阳性筛查率为18.5%，产前阳性率为9.9%，产后阳性率为8.6%。单身关系状态总体上显示出较高的PD发生率。三分之二的女性直到孕晚期才接受筛查，导致估计28%最终筛查呈阳性的女性检测延迟。在完成所有推荐的先前筛查的女性中，产后9周后很少检测到新的阳性筛查（1.3%）。产科医护人员应在孕期尽早对PD进行筛查，并无论之前EPDS评分是否为阴性，都应尽可能频繁地继续筛查。优先在孕期和产后9周前更频繁地进行筛查，以避免检测和干预的延迟，这是最佳做法。
