Neugebauer R, Kline J, Shrout P, Skodol A, O'Connor P, Geller P A, Stein Z, Susser M
Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, New York, NY 10032, USA.
JAMA. 1997 Feb 5;277(5):383-8.
To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy.
Cohort study.
The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230).
Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study.
Major depressive disorder was measured using the Diagnostic Interview Schedule.
Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy.
Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.
检验先验假设，即流产女性在流产后6个月内首次发生或复发重度抑郁症的风险增加，且无子女的女性、有过流产史的女性以及35岁及以上的女性这一增加的风险更高；并评估风险是否因妊娠时间或对妊娠的态度而有所不同。
队列研究。
流产队列包括在一家医疗中心进行自然流产的女性（n = 229）；对照组是从社区选取的基于人群的女性队列（n = 230）。
流产定义为在妊娠28周之前非自愿终止不可存活的宫内妊娠。所有参与者中有一半年龄在25至34岁之间；40%为白人，35%为西班牙裔；55%拥有高中以上学历。参与者占完成该队列研究第一阶段的流产女性的60%以及社区女性的72%。
使用诊断访谈表测量重度抑郁症。
将流产女性在流产后6个月内发生重度抑郁发作的风险与前一年未怀孕的社区女性的6个月风险进行比较。在流产女性中，10.9%经历了重度抑郁发作，而社区女性中这一比例为4.3%。流产女性发生重度抑郁发作的总体相对风险（RR）为2.5（95%置信区间[CI]，1.2 - 5.1），无子女的女性（RR，5.0；95% CI，1.7 - 14.4）的相对风险显著高于有子女的女性（RR，1.3；95% CI，0.5 - 3.5）（P <.06）。在流产女性中，72%的重度抑郁发作病例在流产后的第一个月内开始；在可比期间，社区病例中只有20%在此期间开始。在有重度抑郁症病史的流产女性中，54%经历了复发。然而，RR并未因既往流产史或母亲年龄而有显著差异，风险也未因妊娠时间或对妊娠的态度而有所不同。
医生应在流产后的头几周对流产女性进行监测，尤其是无子女或有重度抑郁症病史的女性。在适当情况下，应考虑给予支持性咨询或心理药物治疗。
