Treatment gap and help-seeking for postpartum depression in a rural African setting.
Treatment gap and help-seeking for postpartum depression in a rural African setting.
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DOI：
10.1186/s12888-016-0892-8
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发表时间：
2016-06-10
期刊：
影响因子：
4.4
通讯作者：
Hanlon C
中科院分区：
文献类型：
--
作者：
Azale T;Fekadu A;Hanlon C
产后抑郁症（PPD）影响超过十分之一的妇女，并与母亲，儿童和家庭的不良后果有关。建议将精神卫生保健纳入孕产妇保健平台，作为改善获得有效护理和减少低收入和中等收入国家“治疗差距”的一种手段。本研究的目的是确定产后抑郁症的妇女谁寻求帮助，形成卫生设施和相关因素的比例。在埃塞俄比亚南部进行了一项以社区为基础的横断面调查。共有3147名产后1至12个月的妇女在家中使用经文化验证的患者健康问卷（PHQ-9）进行抑郁症状筛查。得分为5分或以上（表明潜在的抑郁症）的妇女（n = 385）进行了采访求助行为。多元逻辑回归分析被用来确定与寻求卫生服务独立相关的因素。只有4.2%的产后抑郁症症状严重的妇女（n = 16）获得了精神卫生保健，只有12.7%的妇女（n = 49）自症状发作以来一直与任何卫生服务机构接触。多因素分析中，城市居民，校正比值比（aOR）：4.39（95%置信区间（CI）1.23，15.68）;强社会支持，aOR：2.44（95% CI 1.30，4.56）;感知的身体原因，aOR：6.61（95% CI 1.76，24.80）;感知的更高严重程度aOR：2.28（95% CI 1.41，5.47）;认为需要治疗aOR：1.46（95%CI 1.57，18.99）、PHQ评分aOR：1.14（95%CI 1.04，1.25）和残疾aOR：1.06（95%CI 1.01，1.15）与寻求卫生服务显著相关。超过一半的患有高水平PPD症状的女性（n = 231; 60.0%）将其症状归因于心理社会原因，269（69.9%）认为需要治疗。同样比例的人赞同生物医学治疗和传统或宗教治疗是适当的干预措施。在没有可获得的孕产妇心理健康服务的情况下，治疗差距非常大。有必要提高公众对产后抑郁症、其原因和后果以及寻求帮助的必要性的认识。然而，症状归因和寻求帮助的偏好表明，潜在的可接受的干预措施，位于孕产妇保健服务在初级保健。
Postpartum depression (PPD) affects more than one in ten women and is associated with adverse consequences for mother, child and family. Integrating mental health care into maternal health care platforms is proposed as a means of improving access to effective care and reducing the ‘treatment gap’ in low- and middle-income countries. This study aimed to determine the proportion of women with PPD who sought help form a health facility and the associated factors. A community based, cross-sectional survey was conducted in southern Ethiopia. A total of 3147 women who were between one and 12 months postpartum were screened for depressive symptoms in their home using a culturally validated version of the Patient Health Questionnaire (PHQ-9). Women scoring five or more (indicating potential depressive disorder) (n = 385) were interviewed regarding help-seeking behavior. Multiple logistic regression was used to identify factors associated independently with help-seeking from health services. Only 4.2 % of women (n = 16) with high PPD symptoms had obtained mental health care and only 12.7 % of women (n = 49) had been in contact with any health service since the onset of their symptoms. In the multivariable analysis, urban residence, adjusted odds ratio (aOR): 4.39 (95 % confidence interval (CI) 1.23, 15.68); strong social support, aOR: 2.44 (95 % CI 1.30, 4.56); perceived physical cause, aOR: 6.61 (95 % CI 1.76, 24.80); perceived higher severity aOR: 2.28 (95 % CI 1.41, 5.47); perceived need for treatment aOR: 1.46 (95 % CI 1.57, 18.99); PHQ score, aOR: 1.14 (95 % CI 1.04, 1.25); and disability, aOR: 1.06 (95 % CI 1.01, 1.15) were associated significantly with help-seeking from health services. More than half of the women with high levels of PPD symptoms (n = 231; 60.0 %) attributed their symptoms to a psychosocial cause and 269 (69.9 %) perceived a need for treatment. Equal proportions endorsed biomedical treatment and traditional or religious healing as the appropriate intervention. In the absence of an accessible maternal mental health service the treatment gap was very high. There is a need to create public awareness about PPD, its causes and consequences, and the need for help seeking. However, symptom attributions and help-seeking preferences indicate potential acceptability of interventions located in maternal health care services within primary care.