Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics
Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics
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DOI：
10.1176/appi.ps.55.4.407
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发表时间：
2004-04-01
影响因子：
3.8
通讯作者：
Yonkers, KA
中科院分区：
文献类型：
--
作者：
Smith, MV;Rosenheck, RA;Yonkers, KA
目的：本研究评估了在公共部门产科诊所接受产前护理的孕妇中轻度和重度抑郁症、惊恐障碍和创伤后应激障碍的检出率和治疗率。方法：访谈者系统地筛选了387名产前访视的妇女。筛查过程在每位妇女接受检查之前开始。访问结束后，患者被问到他们的临床医生是否认识到情绪或焦虑障碍。审查了医疗记录，以记录精神疾病和治疗。结果如下：只有26%的精神疾病筛查阳性的患者被他们的医疗保健提供者确认为患有情绪或焦虑症。此外，临床医生发现只有12%的患者有自杀意念的证据。患有恐慌症或一生有家庭暴力史的女性更有可能在怀孕前或怀孕期间的某个时候被医疗保健提供者确定为患有精神疾病。所有惊恐障碍筛查阳性的妇女都接受过或目前正在接受产前检查以外的心理健康治疗，而26%的重度或轻度抑郁症筛查阳性的妇女接受过或目前正在接受产前检查以外的治疗。结论：产科环境中抑郁症的检出率低于惊恐障碍，也低于其他初级保健环境中报告的检出率。因此，很大一部分孕妇在整个怀孕期间继续默默地遭受抑郁症的折磨。鉴于抑郁症在围产期妇女中非常普遍，可能对婴儿和儿童产生深远影响，需要做更多的工作来加强发现和转诊。
Objective: This study assessed rates of detection and treatment of minor and major depressive disorder, panic disorder, and posttraumatic stress disorder among pregnant women receiving prenatal care at public-sector obstetric clinics. Methods: Interviewers systematically screened 387 women attending prenatal visits. The screening process was initiated before each woman's examination. After the visit, patients were asked whether their clinician recognized a mood or anxiety disorder. Medical records were reviewed for documentation of psychiatric illness and treatment. Results: Only 26 percent of patients who screened positive for a psychiatric illness were recognized as having a mood or anxiety disorder by their health care provider. Moreover, clinicians detected disorders among only 12 percent of patients who showed evidence of suicidal ideation. Women with panic disorder or a lifetime history of domestic violence were more likely to be identified as having a psychiatric illness by a health care provider at some point before or during pregnancy. All women who screened positive for panic disorder had received or were currently receiving mental health treatment outside the prenatal visit, whereas 26 percent of women who screened positive for major or minor depression had received or were currently receiving treatment outside the prenatal visit. Conclusions: Detection rates for depressive disorders in obstetric settings are lower than those for panic disorder and lower than those reported in other primary care settings. Consequently, a large proportion of pregnant women continue to suffer silently with depression throughout their pregnancy. Given that depressive disorders among perinatal women are highly prevalent and may have profound impact on infants and children, more work is needed to enhance detection and referral.