Rajendran Bharathi, Ibrahim Syed Ummar, Ramasamy Sureshkumar
Dept. of Psychiatry Government medical college and hospital, Ramanathapuram, Tamil Nadu, India.
Dept. of Psychiatry, PSG Institute of Medical Sciences and Research Hospital, Coimbatore, Tamil Nadu, India.
Indian J Psychol Med. 2024 Jan;46(1):24-31. doi: 10.1177/02537176231176405. Epub 2023 Jul 6.
Perinatal depression (PND) is often under-treated and under-recognized. It has a negative impact on infant development and mother-child interactions. This study aims to estimate the prevalence of PND during pregnancy and in the postpartum period and the effect of sociodemographic factors, psychosocial stressors, and obstetric and neonatal factors on PND.
166 antenatal mothers attending tertiary center, who completed the 1st-trimester, were evaluated on baseline sociodemographic, psychosocial, obstetric, neonatal, and post neonatal factors by using a semi-structured questionnaire. Periodic prospective assessments were done using Hamilton depression rating scale (HAMD) at the end of the second and third trimesters and first and sixth weeks of the postpartum period.
Prevalence of PND was 21.7%, 32.2%, 35%, 30.4%, and 30.6%, at the end of the first trimester, during second, and third trimesters, and first and sixth week postpartum, respectively. Factors significantly associated with depressive symptoms included history of previous children with illness (P: 0.013, OR-5.16, CI-1.3-19.5) and preterm birth (P: 0.037, OR-3.73, CI-1.1- 13.2) at the time of recruitment; history of abuse (P: 0.044, OR-3.26, CI-1.1-10.8) and marital conflicts (P: 0.003, OR-3.2, CI-1.4-6.9) by the end of second trimester; history of miscarriages (P: 0.012, OR-2.58, CI-1.2-5.4) by the end of third trimester; lower SES (P: 0.001, OR-3.48, CI-1.64-7.37), unsatisfied living conditions (P: 0.004, OR-2.9, CI-1.4-6.04), alcohol use in husband (P: 0.049, OR-2.01, CI-1.1-4.11), history of depressive episodes (P: 0.049, OR-2.09, CI-1.1-4.46), history of high-risk pregnancy (P: 0.008, OR-2.7, CI-1.29-5.64), history of miscarriages (P: 0.049, OR-2.04, CI-1.1-4.2), stressful events in the postpartum period (P: 0.043, OR-2.58, CI-1.01-6.59), IUD (P: 0.002), preterm birth (P: 0.001), congenital malformations (P: 0.001), dissatisfaction with the sex of the child (P: 0.005, OR-3.75, CI-1.42-9.91), poor family support (P: 0.001), and low birth weight (P: 0.001, OR-16.78, CI-6.32-44.53) in the postpartum period. These analyses are purely exploratory.
PND is highly prevalent from the early antenatal period onwards; this warrants periodic assessment of depression among high-risk mothers, using a validated tool, for early diagnosis and management.
围产期抑郁症（PND）常常治疗不足且未得到充分认识。它对婴儿发育和母婴互动有负面影响。本研究旨在估计孕期和产后PND的患病率，以及社会人口学因素、心理社会压力源、产科和新生儿因素对PND的影响。
166名在三级中心就诊且完成孕早期检查的产前母亲，通过使用半结构化问卷对其基线社会人口学、心理社会、产科、新生儿及产后因素进行评估。在孕中期和孕晚期结束时以及产后第一周和第六周，使用汉密尔顿抑郁量表（HAMD）进行定期前瞻性评估。
在孕早期结束时、孕中期、孕晚期、产后第一周和第六周，PND的患病率分别为21.7%、32.2%、35%、30.4%和30.6%。与抑郁症状显著相关的因素包括：招募时曾有患病子女的病史（P：0.0(13)，OR - 5.16，CI - 1.3 - 19.5）和早产（P：0.0(37)，OR - 3.73，CI - 1.1 - 13.2）；孕中期结束时曾遭受虐待的病史（P：0.0(44)，OR - 3.26，CI - 1.1 - 10.8）和婚姻冲突（P：0.0(03)，OR - 3.2，CI - 1.4 - 6.9）；孕晚期结束时流产史（P：0.0(12)，OR - 2.58，CI - 1.2 - 5.4）；较低的社会经济地位（P：0.0(01)，OR - 3.48，CI - 1.64 - 7.37）、生活条件不满意（P：0.0(04)，OR - 2.9，CI - 1.4 - 6.04）、丈夫饮酒（P：0.0(49)）、抑郁发作史（P：0.0(49)，OR - 2.09，CI - 1.1 - 4.46）、高危妊娠史（P：0.0(08)，OR - 2.7，CI - 1.29 - 5.64）、流产史（P：0.0(49)，OR - 2.04，CI - 1.1 - 4.2）、产后压力事件（P：0.0(43)，OR - 2.58，CI - 1.01 - 6.59）、宫内节育器（P：0.0(02)）、早产（P：0.0(01)）、先天性畸形（P：0.0(01)）、对孩子性别不满意（P：0.0(05)，OR - 3.75，CI - 1.42 - 9.91）、家庭支持不足（P：0.0(01)）以及产后低出生体重（P：0.0(01)，OR - 16.78，CI - 6.32 - 44.53）。这些分析纯粹是探索性的。
从产前早期开始，PND就非常普遍；这需要使用经过验证的工具对高危母亲进行定期抑郁评估，以便早期诊断和管理。
