Antenatal depression and anxiety across pregnancy in urban South Africa
Antenatal depression and anxiety across pregnancy in urban South Africa
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南非城市地区的产前抑郁症和怀孕期间的焦虑症
DOI：
10.1016/j.jad.2020.08.010
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发表时间：
2020
影响因子：
6.6
通讯作者：
Redinger S
中科院分区：
文献类型：
--
作者：
Redinger S
背景孕期抑郁和焦虑对妇女及其后代有负面影响。高逆境使孕妇的心理健康风险增加，但在这些环境中缺乏纵向研究。鲜为人知的是，这些问题出现或坚持在pregnancy.MethodsWomen的途径被招募在南非索韦托（2014-2016年）的前瞻性怀孕队列，并使用有效的措施（爱丁堡产后抑郁量表EPDS ≥13;状态特质焦虑指数STAI ≥12）在早期（T1）和晚期妊娠（T2）进行评估。可获得n = 649名女性的数据。采用多项回归模型来确定与妊娠期短暂性与持续性抑郁和焦虑相关的因素。交叉滞后面板模型探讨抑郁症和焦虑症之间的影响方向，和stressresss.ResultsWe发现高抑郁症（T1：27%; T2：25%）和焦虑症（T1：15%; T2：17%）。认为伴侣使自己的生活更艰难增加了持续抑郁的风险（RR 5.92 95% CI [3.0-11.8]p<0.001）;家庭压力增加了持续焦虑的风险（RR 1.71 95% CI [1.1-2.7]p= 0.027）。我们发现早期抑郁症（T1）对后来的家庭压力（T2）的直接影响的证据;和早期的家庭压力（T1）对后来的焦虑（T2）。LimitationsWe使用的抑郁和焦虑，而不是临床interviews.ConclusionsStudies只集中在怀孕后期可能会低估风险的筛选措施。在怀孕的头三个月及早发现对预防和治疗至关重要。伴侣和家庭压力源是一个关键的干预目标。
BackgroundDepression and anxiety in pregnancy have negative consequences for women and their offspring. High adversity places pregnant women at increased mental health risk, yet there is a dearth of longitudinal research in these settings. Little is known about the pathways by which these problems emerge or persist in pregnancy.MethodsWomen were enrolled in a prospective pregnancy cohort in Soweto, South Africa (2014–2016) and assessed using validated measures (Edinburgh Postnatal Depression Scale EPDS ≥13; State Trait Anxiety Index STAI ≥12) in early (T1) and later pregnancy (T2). Data was available forn= 649 women. Multinominal regression modelling was used to determine factors associated with transient versus persistent depression and anxiety across pregnancy. Cross-lagged panel modelling explored direction of effect between depression and anxiety, and stressors.ResultsWe found high rates of depression (T1: 27%; T2: 25%) and anxiety (T1: 15%; T2: 17%). Perceiving a partner made one's life harder increased risk of persistent depression (RR 5.92 95% CI [3.0–11.8]p<0.001); family stress increased risk for persistent anxiety (RR 1.71 95% CI [1.1–2.7]p= 0.027). We find evidence of a direct effect of early depression (T1) on later family stress (T2); and early family stress (T1) on later anxiety (T2).LimitationsWe used screening measures of depression and anxiety rather than clinical interviews.ConclusionsStudies which focus only on late pregnancy may underestimate risk. Early identification, in the first trimester, is critical for prevention and treatment. Partner and family stressors are a key intervention target.