Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice
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DOI：
10.1542/peds.2018-3259
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发表时间：
2019-01-01
期刊：
影响因子：
8
通讯作者：
Wissow, Lawrence
中科院分区：
文献类型：
--
作者：
Earls, Marian F.;Yogman, Michael W.;Wissow, Lawrence
围产期抑郁(PND)是美国最常见的产科并发症。即使筛查结果呈阳性，母亲往往也不会接受进一步的评估，即使当PND被诊断出来，母亲也不会接受循证治疗。研究表明，产后抑郁症(PPD)是PND的一个子集，会导致医疗费用增加、婴儿接受不适当的医疗、停止母乳喂养、家庭功能障碍以及虐待和忽视的风险增加。具体地说，产后抑郁会对婴儿大脑发育的这一关键早期阶段产生不利影响。PND是儿童不良经历的一个例子，这种经历对母亲、她的伴侣、婴儿和母婴二人组具有潜在的长期不良健康并发症。然而，PND可以得到有效的治疗，对婴儿的压力可以得到缓解。儿科医疗机构应更有效地与产前诊断为产妇抑郁的妇女的保健提供者协调护理；建立一个系统，在1个月、2个月、4个月和6个月的健康儿童就诊时进行产后抑郁筛查；利用社区资源治疗和转介患有抑郁症的母亲；并为母婴关系提供支持，包括母乳喂养支持。美国儿科学会的各州分会与各州公共卫生部、公共和私人支付者以及妇幼保健项目合作，应该倡导付费，并增加对PND筛查和治疗的培训。美国儿科学会建议倡导为照顾幼儿和母婴二人组的精神健康专业人员培养劳动力，并促进注重健康依恋和亲子关系的循证干预。
Perinatal depression (PND) is the most common obstetric complication in the United States. Even when screening results are positive, mothers often do not receive further evaluation, and even when PND is diagnosed, mothers do not receive evidence-based treatments. Studies reveal that postpartum depression (PPD), a subset of PND, leads to increased costs of medical care, inappropriate medical treatment of the infant, discontinuation of breastfeeding, family dysfunction, and an increased risk of abuse and neglect. PPD, specifically, adversely affects this critical early period of infant brain development. PND is an example of an adverse childhood experience that has potential long-term adverse health complications for the mother, her partner, the infant, and the mother-infant dyad. However, PND can be treated effectively, and the stress on the infant can be buffered. Pediatric medical homes should coordinate care more effectively with prenatal providers for women with prenatally diagnosed maternal depression; establish a system to implement PPD screening at the 1-, 2-, 4-, and 6-month well-child visits; use community resources for the treatment and referral of the mother with depression; and provide support for the maternal-child (dyad) relationship, including breastfeeding support. State chapters of the American Academy of Pediatrics, working with state departments of public health, public and private payers, and maternal and child health programs, should advocate for payment and for increased training for PND screening and treatment. American Academy of Pediatrics recommends advocacy for workforce development for mental health professionals who care for young children and mother-infant dyads, and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.