School of Nursing, University of Texas at Austin, Austin, Texas, United States of America.
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America.
PLoS One. 2024 Jul 12;19(7):e0290059. doi: 10.1371/journal.pone.0290059. eCollection 2024.
Depression is one of the most common yet underdiagnosed perinatal complications and our understanding of its pathophysiology remains limited. Though perinatal depression is considered to have a multifactorial etiology, integrative approaches to investigation are minimal. This review takes an integrative approach to systematically evaluate determinants (e.g., biological, behavioral, environmental, social) and interactions among determinants of perinatal depression and the quality of methods applied.
Four databases (i.e., PubMed, CINAHL, APA PsycInfo, Web of Science) were systematically searched to identify studies examining determinants of perinatal depression in adult perinatal persons (≥ 18 years). Articles were excluded if the outcomes were not focused on perinatal persons and depression or depression symptoms, depression was examined in a specific subpopulation evidenced to have psychological consequences due to situational stressors (e.g., fetal/infant loss, neonatal intensive care unit admission), or was considered grey literature. The Critical Appraisal Skills Programme and AXIS tools were used to guide and standardize quality appraisal assessments and determine the level of risk of bias.
Of the 454 articles identified, 25 articles were included for final review. A total of 14 categories of determinants were investigated: biological (5), behavioral (4), social and environmental (5). Though only 32% of studies simultaneously considered determinants under more than one domain, a pattern of interactions with the tryptophan pathway emerged. Concerns for risk of bias were noted or were unclear for three types of bias: 13 (52%) selection bias, 3 (12%) recall bias, and 24 (96%) measurement bias.
Future research is needed to explore interactions among determinants and the tryptophan pathway; to strengthen the methods applied to this area of inquiry; and to generate evidence for best practices in reporting, selecting, and applying methods for measuring determinants and perinatal depression.
抑郁症是最常见但诊断不足的围产期并发症之一,我们对其病理生理学的理解仍然有限。尽管围产期抑郁症被认为具有多因素病因,但综合调查方法却很少。本综述采用综合方法系统评估围产期抑郁症的决定因素(如生物、行为、环境、社会)及其相互作用,并评估应用方法的质量。
系统检索了 4 个数据库(PubMed、CINAHL、APA PsycInfo、Web of Science),以确定研究成年围产期个体(≥18 岁)围产期抑郁症决定因素的研究。如果研究结果不集中在围产期人群和抑郁症或抑郁症状上,如果抑郁症是在由于情境压力源(如胎儿/婴儿死亡、新生儿重症监护病房入院)而导致特定亚人群出现心理后果的特定亚人群中进行检查,或者被认为是灰色文献,则将文章排除在外。使用批判性评估技能计划和 AXIS 工具来指导和标准化质量评估,并确定偏倚风险的水平。
在确定的 454 篇文章中,有 25 篇文章被纳入最终综述。共调查了 14 类决定因素:生物(5)、行为(4)、社会和环境(5)。尽管只有 32%的研究同时考虑了一个以上领域的决定因素,但与色氨酸途径相互作用的模式出现了。注意到或不清楚三种类型的偏倚风险:13(52%)选择偏倚、3(12%)回忆偏倚和 24(96%)测量偏倚。
未来的研究需要探索决定因素之间以及色氨酸途径之间的相互作用;加强应用于这一研究领域的方法;并为报告、选择和应用决定因素和围产期抑郁症测量方法的最佳实践提供证据。