The psychosocial outcome of pregnancy in women with psychotic disorders
The psychosocial outcome of pregnancy in women with psychotic disorders
复制标题
DOI：
10.1016/j.schres.2004.01.003
复制
发表时间：
2004-11-01
影响因子：
4.5
通讯作者：
Thornicroft, G
中科院分区：
文献类型：
--
作者：
Howard, LM;Goss, C;Thornicroft, G
目的：在一个具有流行病学代表性的样本中，调查有精神障碍病史的妇女妊娠的心理社会结局，并确定婴儿在出生后第一年接受社会服务照顾的预测因素。方法：采用匿名初级保健数据库全科医学研究数据库(GPRD)，对1996~1998年分娩的有精神障碍史的妇女进行历史配对对照队列研究和嵌套病例对照研究(199例和787例对照)。结果：27%的病例在出生后第一年有精神病发作，另有38%的病例有非精神病性抑郁。与对照组相比，患有非情感性精神病的女性发生产后抑郁的风险显著增加(调整后的比率比为2.07，95%可信区间为1.45-2.96，p<；0.001)。案例得到了很好的支持，72%的人处于同居关系中，只有38%的人享受福利。预测育儿困难的唯一重要因素是最近接触过精神科服务机构。结论：有精神障碍病史的妇女产后患精神疾病的风险很高，特别是产后抑郁的双重风险，即使她们在怀孕期间没有接触过精神科服务。然而，这一具有流行病学代表性的样本比之前报道的专科治疗病例的育儿结果更好。在怀孕期间和怀孕后参与照顾患有精神障碍的母亲的所有专业人员之间的联络，对于优化对她们及其家人的护理是至关重要的。(C)2004爱思唯尔B.V.保留所有权利。
Objective: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. Method: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996-1998 (199 cases and 787 controls). Results: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45-2.96, p < 0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. Conclusions: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families. (C) 2004 Elsevier B.V. All rights reserved.