Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study.
Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study.
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DOI：
10.1016/s2215-0366(22)00110-9
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发表时间：
2022-07
影响因子：
64.3
通讯作者：
John-Stewart, Grace
中科院分区：
文献类型：
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作者：
Larsen, Anna;Pintye, Jillian;Marwa, Mary M.;Watoyi, Salphine;Kinuthia, John;Abuna, Felix;Richardson, Barbra A.;Gomez, Lauren;Dettinger, Julia C.;John-Stewart, Grace
在撒哈拉以南非洲，在了解围产期抑郁症状的纵向模式和预测因素方面仍然存在差距。这项研究旨在探索肯尼亚妇女从怀孕到产后9个月期间抑郁症状及其相关因素的轨迹。在这项前瞻性队列研究中，我们分析了肯尼亚西部20家公共部门妇幼保健诊所的PrEP实施产前护理研究的数据，在该研究中，艾滋病毒阴性的妇女在怀孕期间和产后9个月进行了跟踪调查。研究护士使用流行病学研究中心抑郁量表(CESD-10)、亲密伴侣暴力(IPV)和伤害、侮辱、威胁、尖叫量表和社会支持量表对抑郁症状进行系列评估。使用广义估计方程来确定中到重度抑郁症状(CESD10分、≥10)和基于群体的轨迹建模确定的模式之间的相关性。在3555名女性中，年龄中位数为24.0岁(IQR 21.0-28.7)，1330名(38%)社会支持程度低，278名(8%)报告孕期IPV。所有参与者(3555人，100%)是女性，所有(3555人，100%)都是非洲肯尼亚人。妊娠期MSD患病率高于产后(24.5%vs.597/3555，16.8%，p<；0.001)。抑郁症状有5种类型：妊娠和产后持续的MSD(295例，8%)，妊娠期缓解产后的MSD(139例，4%)，产后出现的MSD(40例，1%)，慢性轻度症状(2709例，76%)，无抑郁症状(372例，10%)。新出现的MSD与年龄较大有关。紧急、持续和缓解的MSD与妊娠IPV、持续的MSD和低社会支持和高HIV风险的MSD的缓解相关(p<；0.05)。IPV、低社会支持和伴侣HIV阳性状态的MSD风险是1.5-2.1倍(p<；0.05)；23%的围产期MSD病例可归因于低社会支持。三分之一的女性患有围产期MSD；13%(474)的MSD有更严重的消退、持续性和新兴MSD表型，可能需要量身定制的干预措施。在常规妇幼保健护理中，应优先为患有IPV和前孕丢失等心理社会应激源的围产期妇女提供心理健康服务，以增加社会支持。美国国立卫生研究院
Gaps remain in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy through 9 months postpartum among Kenyan women. In this prospective cohort study, we analyzed data from the PrEP Implementation for Mothers in Antenatal Care study in which HIV-negative women were enrolled in pregnancy and followed through 9 months postpartum in 20 public sector maternal child health clinics in Western Kenya. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence (IPV) with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalized estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (MSD) (CESD-10 score ≥10) and group-based trajectory modelling (GBTM) identified patterns. Among 3555 women, median age was 24.0 years (IQR 21.0–28.7), 1330 (38%) had low social support, and 278 (8%) reported IPV in pregnancy. All participants (3555, 100%) were female sex and all (3555, 100%) were African Kenyan ethnicity. Prevalence of MSD was higher in pregnancy than postpartum (870/3555, 24.5% vs. 597/3555, 16.8%, p<0.001). Five patterns of depressive symptoms were identified; persistent MSD in pregnancy and postpartum (295, 8%), MSD in pregnancy which resolved postpartum (139, 4%), MSD that emerged postpartum (40, 1%), chronically mild symptoms (2,709, 76%), and no depressive symptoms (372, 10%). Emergent MSD was associated with older age. Emergent, persistent, and resolving MSD were associated with pregnancy IPV; persistent MSD and resolving MSD with low social support and high HIV risk (p<0.05). MSD risk was 1.5- to 2.1-times higher with IPV, low social support, and partner HIV-positive status (p<0.05); 23% of perinatal MSD cases were attributable to low social support. One third of women had perinatal MSD; 13% (474) had higher severity phenotypes of resolving, persistent and emerging MSD that may require tailored interventions. Perinatal women with comorbid psychosocial stressors such as IPV and prior pregnancy loss should be prioritized for mental health services that augment social support within routine MCH care. National Institutes of Health