Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care.
Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care.
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DOI：
10.1017/s0033291710001467
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发表时间：
2011-04
影响因子：
6.9
通讯作者：
Walters, S. J.
中科院分区：
文献类型：
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作者：
Brugha, T. S.;Morrell, C. J.;Slade, P.;Walters, S. J.
关键词：
目的 测试接受受过识别和心理干预方法培训的健康访视员 (HV) 的护理是否可以预防产后 6 周未出现抑郁症的女性产后 6-18 个月的抑郁症。该研究是一项前瞻性整群试验，由全科医生随机分组，对英格兰特伦特地区的 101 个初级保健小组进行了为期 18 个月的随访。参与者是产后 6 周时邮政爱丁堡产后抑郁量表 (EPDS) 得分 <12 的女性（1474 名干预女性和 767 名对照女性）。干预 HV（n=89，63 组）接受了使用 EPDS 和面对面临床评估识别抑郁症状以及根据认知行为或以人为本原则提供心理导向课程的培训。对照组包括照常提供护理 (CAU) 的 HV（n=49，37 个集群）。主要结局指标是产后 6 个月时 EPDS 得分≥12 的女性比例。次要结局是平均 EPDS 评分、常规评估临床结果 – 结果测量 (CORE-OM) 评分、状态-特质焦虑量表 (STAI)、12 项简短健康调查 (SF-12) 和 6、12 和 18 个月时的育儿压力指数简短 (PSI-SF) 评分。调整个体水平协变量、独居、既往产后抑郁症 (PND)、存在一种或多种不良生活事件以及 6 周 EPDS 评分后，与对照组 (CAU) 组女性相比，干预组 (IG) 女性在 6 个月时 EPDS ⩾12 的比值比 (OR) 为 0.71 [95% 置信区间 (CI) 0.53–0.97，p=0.031]。根据基线严重程度划分为两个亚组：“阈下”亚组，6 周 EPDS 评分为 6-11 (n=999)；“最低严重程度”亚组，6 周 EPDS 评分为 0-5 (n=1242)。不同亚组的心理有效性没有差异（交互作用项：z=−0.28，p=0.782）。这项研究提供了新的证据，证明对于产后抑郁症筛查呈阴性的女性来说，抑郁症具有普遍、持久的预防作用。
To test whether receiving care from a health visitor (HV) trained in identification and psychological intervention methods prevents depression 6–18 months postnatally in women who are not depressed 6 weeks postnatally. The study was a prospective cluster trial, randomized by GP practice, with follow-up for 18 months in 101 primary care teams in the Trent area of England. The participants were women scoring <12 on the postal Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postnatally (1474 intervention and 767 control women). Intervention HVs (n=89, 63 clusters) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles. The control group comprised HVs (n=49, 37 clusters) providing care as usual (CAU). The primary outcome measure was the proportion of women scoring ⩾12 on the EPDS at 6 months postnatally. Secondary outcomes were mean EPDS score, Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) score, State–Trait Anxiety Inventory (STAI), 12-item Short Form Health Survey (SF-12) and Parenting Stress Index Short Form (PSI-SF) scores at 6, 12 and 18 months. After adjusting for individual-level covariates, living alone, previous postnatal depression (PND), the presence of one or more adverse life events and the 6-week EPDS score, the odds ratio (OR) for EPDS ⩾12 at 6 months was 0.71 [95% confidence interval (CI) 0.53–0.97, p=0.031] for the intervention group (IG) women compared with the control (CAU) group women. Two subgroups were formed by baseline severity: a ‘subthreshold’ subgroup with a 6-week EPDS score of 6–11 (n=999) and a ‘lowest severity’ subgroup with a 6-week EPDS score of 0–5 (n=1242). There was no difference in psychological effectiveness by subgroup (interaction term: z=−0.28, p=0.782). This study provides new evidence of a universal, enduring preventive effect for depression in women who screen negative for depression postnatally.