Antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner-city obstetric population
Antenatal psychiatric illness and adequacy of prenatal care in an ethnically diverse inner-city obstetric population
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DOI：
10.1007/s00737-005-0117-5
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发表时间：
2006-03-01
影响因子：
4.5
通讯作者：
Buchberger, RL
中科院分区：
文献类型：
--
作者：
Kim, HG;Mandell, M;Buchberger, RL
目的：本研究评估了城市产科诊所中低收入、种族多样的患者产前精神疾病的患病率，并研究了阳性精神筛查与产前护理利用不足之间的关联。方法：双语研究助理对154名英语和西班牙语的患者进行了精神障碍患者健康问卷和情绪障碍问卷的初级保健评估，正在接受常规产前检查的孕妇我们评估了患者的特征，当前和过去的精神病诊断，产前护理的利用率之间的关联。结果：45（29%）妇女筛选阳性的标准，目前的精神疾病的最高比率为重大或轻微抑郁症（26%）和焦虑症（10%）。产前护理利用不足与过去一年的精神病史和家庭暴力显著相关，但与当前的精神病诊断、酗酒、年龄、产次、婚姻状况无关。接受政府援助或意外怀孕。即使在调整了可能的混杂风险因素后（如过去的药物滥用，单身婚姻状况，不稳定的住房，教育程度低于高中，并有其他孩子），过去的精神病史仍然显着与产前保健利用不足和延迟开始护理。结论：在常规产前检查中，很大比例的弱势孕妇符合精神疾病筛查标准。在常规产前检查中筛查既往精神病史可以识别出产前护理利用不足的风险患者。
Objective: This study assessed the prevalence of antenatal psychiatric illness in low-income, ethnically diverse patients in an urban obstetric clinic and examined associations between positive psychiatric screens and inadequate utilization of prenatal care.Methods: Bilingual research assistants administered the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire and the Mood Disorder Questionnaire to 154 English- and Spanish-speaking pregnant patients attending routine prenatal visits. We assessed associations between patient characteristics, current and past psychiatric diagnoses, and utilization of prenatal care.Results: Forty-five (29%) women screened positive for criteria for current psychiatric disorders with the highest rates for major or minor depression (26%) and anxiety disorders (10%). Inadequate prenatal care utilization was significantly associated with past psychiatric history and domestic abuse in the last year, but not with current psychiatric diagnosis, alcohol abuse, age, primiparity, marital status. receipt of government assistance, or unplanned pregnancy. Even after adjustment for possible confounding risk factors (e.g. past substance abuse, single marital status, unstable housing, education less than high school, and having other children), past psychiatric history was still significantly associated with inadequate prenatal care utilization and delayed initiation of care.Conclusions: A high percentage of disadvantaged pregnant women meet screening criteria for psychiatric disorders when screened during routine prenatal visits. Screening for past psychiatric history in routine prenatal visits could identify patients at risk for inadequate utilization of prenatal care.