Detection of postpartum depressive symptoms by screening at well-child visits
Detection of postpartum depressive symptoms by screening at well-child visits
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DOI：
10.1542/peds.113.3.551
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发表时间：
2004-03-01
期刊：
影响因子：
8
通讯作者：
Conwell, Y
中科院分区：
文献类型：
--
作者：
Chaudron, LH;Szilagyi, PG;Conwell, Y
目标。目的：评估1)在新生儿出生后1年进行普遍产后抑郁筛查的可行性；2)参加新生儿1年随访的母亲中产后抑郁症状的患病率；3)在每次新生儿1年随访时进行普遍筛查前后儿科诊所中产后抑郁症状的检测情况；4)在普遍筛查前后社会工作转介情况。采用爱丁堡产后抑郁量表（EPDS）对第一年健康儿童进行产后抑郁症状的普遍筛查。我们随机选择了110份筛查前（队列1）和110份筛查后（队列2）的婴儿病历。测量方法包括人口统计数据、儿童就诊记录中抑郁或抑郁症状的标记以及抑郁症的转诊。仅收集队列2的EPDS评分。对抑郁症或抑郁症状的检测和心理健康转诊进行了前后比较。在46%的健康儿童就诊中，EPDS被包含在医疗记录中。88%的表格都完成了。21%完成的EPDS表格得分大于或等于10,27%完成EPDS的妇女在产后一年的某个时候得分大于或等于10。在开始普遍筛查后，EPDS记录的抑郁症状显著增加（1.6%的就诊[队列1]vs 8.5%的就诊[队列2]）。因心理健康原因转介到社会工作的人数显著增加（0.2%[队列1]至3.6%[队列2]）。产后抑郁症状严重的妇女在城市人群中很常见，并且可以在产后第一年的健康儿童访问中由儿科医生使用标准化筛查工具检测到。由于使用标准化的筛查工具在健康儿童访视期间筛查抑郁症是可行的，儿科医生可以在产后抑郁症的早期发现和转诊中发挥积极作用。
Objective. To assess 1) the feasibility of universal postpartum depression screening during well-child visits in the first year of life, 2) the prevalence of postpartum depressive symptoms among mothers who attend first-year well-child visits, 3) detection of postpartum depressive symptoms in a pediatric clinic before and after universal screening at each first-year well-child visit, and 4) social work referrals before and after universal screening.Methods. The practice instituted universal screening for postpartum depressive symptoms during first-year well-child visits using the Edinburgh Postnatal Depression Scale (EPDS). We randomly selected 110 infant medical records before (cohort 1) and 110 after (cohort 2) screening was initiated. Measures included demographics, notation of depression or depressive symptoms in the well-child visit note, and referral for depression. EPDS scores were collected for cohort 2 only. Before-after comparisons were made for detection of depression or depressive symptoms and mental health referrals.Results. The EPDS was included in the medical record in 46% of well-child visits. Eighty-eight percent of these forms were completed. Twenty-one percent of completed EPDS forms had scores greater than or equal to10, and 27% of women who completed the EPDS had scores greater than or equal to10 sometime during the postpartum year. There was a significant increase in documentation of depressive symptoms with the EPDS after initiation of universal screening (1.6% of visits [cohort 1] vs 8.5% [cohort 2]). Social work referrals for mental health reasons increased significantly (0.2% of visits [cohort 1] to 3.6% [cohort 2]).Conclusions. Women with high levels of postpartum depressive symptoms are common in an urban population and can be detected at well-child visits throughout the first postpartum year by pediatricians using a standardized screening tool. Because screening for depression during well-child visits is feasible using a standardized screening instrument, pediatricians can play an active role in early detection and referral for postpartum depression.