University of Washington, Seattle, WA.
Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and.
J Acquir Immune Defic Syndr. 2022 Aug 15;90(5):473-481. doi: 10.1097/QAI.0000000000002998.
We examined longitudinal patterns and cofactors of depressive symptoms among pregnant and postpartum women living with HIV (WLWH).
This study used data from a randomized trial of a text messaging intervention. WLWH were serially assessed for depressive symptoms from pregnancy through 24 months postpartum at 6 time points (pregnancy, 6 weeks, and 6, 12, 18, and 24 months postpartum). Depressive symptoms were assessed using Patient Health Questionnaire-9 and longitudinal patterns using group-based trajectory modeling. Moderate-to-severe depressive symptoms (MSD) correlates were assessed using generalized estimating equations.
Among 824 enrolled women, 14.6% ever had MSD during pregnancy or postpartum; 8.6% of WLWH had MSD in pregnancy and 9.0% any postpartum MSD. MSD was associated with abuse [RR: 3.8, 95% confidence interval (CI): 2.6 to 5.4], stigma (RR: 4.4, 95% CI: 3.1 to 6.3), and food insecurity (RR: 2.7, 95% CI: 1.9 to 3.8). Unintended pregnancy (RR: 1.6, 95% CI: 1.1 to 2.3) and recent HIV diagnosis (RR: 1.8, 95% CI: 1.2 to 2.6) were associated with higher MSD risk, whereas HIV status disclosure to partner (RR: 0.3, 95% CI: 0.2 to 0.6) and social support (RR: 0.97, 95% CI: 0.96 to 0.98) were associated with lower risk. Trajectory modeling identified 4 phenotypes of peripartum depressive symptoms: persistent no/low symptoms (38.5%), mild symptoms resolving postpartum (12.6%), low symptoms increasing slightly in postpartum (47.9%), and persistent moderate-severe symptoms throughout (1.1%).
WLWH attending PMTCT services had varied patterns of depressive symptoms, which were associated with stressors (recent diagnosis and food insecurity) and factors reflecting low social power (abuse, stigma, and unintended pregnancy). Women experiencing concurrent abuse, stigma, and food insecurity should be prioritized for interventions to prevent persistent depression.
我们研究了 HIV 阳性（WLWH）孕妇和产后妇女抑郁症状的纵向模式和影响因素。
本研究使用了一项短信干预随机试验的数据。WLWH 在怀孕至产后 24 个月期间，每隔 6 周进行一次 6 次（怀孕、6 周、6、12、18 和 24 个月）的抑郁症状评估。使用患者健康问卷-9 评估抑郁症状，使用基于群组的轨迹建模评估纵向模式。使用广义估计方程评估中度至重度抑郁症状（MSD）的相关因素。
在 824 名入组的女性中，14.6%的女性在怀孕期间或产后曾有过 MSD；8.6%的 WLWH 在怀孕期间有 MSD，9.0%的女性在任何产后时期都有 MSD。MSD 与虐待（RR：3.8，95%置信区间（CI）：2.6 至 5.4）、污名化（RR：4.4，95%CI：3.1 至 6.3）和食物不安全（RR：2.7，95%CI：1.9 至 3.8）有关。意外怀孕（RR：1.6，95%CI：1.1 至 2.3）和近期 HIV 诊断（RR：1.8，95%CI：1.2 至 2.6）与更高的 MSD 风险相关，而 HIV 状况向伴侣披露（RR：0.3，95%CI：0.2 至 0.6）和社会支持（RR：0.97，95%CI：0.96 至 0.98）与更低的风险相关。轨迹建模确定了围产期抑郁症状的 4 种表型：持续无/低症状（38.5%）、产后轻度症状缓解（12.6%）、产后轻度症状略有增加（47.9%）和持续中重度症状（1.1%）。
参加 PMTCT 服务的 WLWH 有不同的抑郁症状模式，这些模式与压力源（近期诊断和食物不安全）以及反映社会权力低下的因素（虐待、污名化和意外怀孕）有关。同时经历虐待、污名化和食物不安全的妇女应优先考虑采取干预措施，以预防持续的抑郁症。
