Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings
Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings
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DOI：
10.1089/jwh.2016.6089
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发表时间：
2017-09-01
影响因子：
3.5
通讯作者：
Horwitz, Sarah M.
中科院分区：
文献类型：
--
作者：
Olin, Su-chin Serene;McCord, Mary;Horwitz, Sarah M.
未经治疗的产后抑郁症（PD）对女性及其婴儿的负面后果已得到充分证实。母亲抑郁症的影响促使人们建议进行系统性的围产期抑郁症筛查。不幸的是，大规模的产后抑郁症筛查举措并未发现有任何益处，除非有相应的系统来为筛查结果呈阳性的女性提供适当的干预措施。儿科初级保健一直是支持产后抑郁症筛查和管理工作的重点，因为与成人医疗服务提供者不同，儿科服务提供者通过儿童保健就诊与产后女性有最频繁的接触。因此，儿童保健就诊为发现和干预产后抑郁症提供了一个无与伦比的机会。文献综述表明，在儿科环境中采取特定策略是可行的，并且对女性及其孩子都有益。在本文中，我们提出了一种用于筛查和管理产后抑郁症的阶梯式护理方法，整合了现有基于儿科的模型中的常见要素。阶梯式护理方法是理想的，因为产后抑郁症是一种异质性疾病，有多种表现形式，因此对各种干预措施的反应也不同。这种护理路径始于对抑郁症状的系统性筛查，接着对筛查结果呈阳性的女性进行系统性风险评估，并根据风险状况和反应性进行护理管理。这种方法使儿科服务提供者在以家庭为中心的医疗之家的环境中，能够以最佳的灵活性和反应性来处理大多数产后抑郁症女性的问题，以改善儿童的健康状况。文中还讨论了在儿科中管理产后抑郁症面临的挑战，包括应对这些挑战的策略。同时也讨论了对研究、政策和实践的影响。
The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.