Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.
Am J Perinatol. 2024 May;41(S 01):e2396-e2402. doi: 10.1055/a-2113-2739. Epub 2023 Jun 20.
Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes.
This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with < 0.05 considered significant.
Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food ( = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7.
Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health.
· Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..
鉴于美国孕产妇发病率和死亡率不断上升，以及精神疾病的影响，特别是在资源匮乏社区的人群中，本研究旨在评估未满足的与健康相关的社会需求的流行率及其对围产期心理健康结果的影响。
这是一项针对居住在围产期结局较差和社会人口差异较大地区的产后患者的前瞻性观察研究。患者于 2020 年 10 月 1 日至 2021 年 10 月 31 日期间参加了一项多学科公共卫生倡议“产后延续母婴保健（eMCAP）”。在分娩时评估未满足的与健康相关的社会需求。在产后 1 个月时，利用爱丁堡产后抑郁量表（EPDS）和广泛性焦虑障碍 7 项量表（GAD7）筛查工具分别评估产后抑郁和焦虑症状。比较有无未满足的与健康相关的社会需求的个体的平均 EPDS 和 GAD7 评分以及筛查阳性（评分≥10）的几率，以 p 值<0.05 为差异有统计学意义。
在参加 eMCAP 的参与者中，有 603 名至少完成了一次 EPDS 或 GAD7 筛查，在产后 1 个月时。大多数人至少有一种社会需求，最常见的是依赖社会项目获取食物（413/603；68%）。缺乏交通去医疗（优势比[OR]：4.0，95%置信区间[CI]：1.2-13.32）和非医疗预约（OR：4.17，95% CI：1.08-16.03）的个体在 EPDS 上的筛查阳性几率显著更高，而缺乏交通去医疗预约（OR：2.73，95% CI：0.97-7.70）的个体在 GAD7 上的筛查阳性几率显著更高。
在服务不足社区的产后人群中，社会需求与较高的抑郁和焦虑筛查评分相关。这凸显了满足社会需求以改善产妇心理健康的必要性。
·社会需求在服务不足的患者中很普遍。·可以以结构化或非结构化的方式评估需求。·未满足的需求与不良心理健康结局相关。·类似的需求与抑郁和焦虑相关。
