Mothers' Mental Health Care Use After Screening for Postpartum Depression at Well-Child Visits
Mothers' Mental Health Care Use After Screening for Postpartum Depression at Well-Child Visits
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DOI：
10.1016/j.acap.2018.11.013
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发表时间：
2019-08-01
影响因子：
3.1
通讯作者：
Guevara, James P.
中科院分区：
文献类型：
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作者：
Kallem, Stacey;Matone, Meredith;Guevara, James P.
目的：美国儿科学会建议进行产后抑郁症（PPD）筛查。目前还不清楚儿科医生是否能有效地将母亲与心理健康服务联系起来。本研究的目的是确定I）精神卫生保健使用的妇女与医疗补助保险后，一个积极的PPD屏幕和2）孕产妇和婴儿的因素，预测的可能性的精神卫生保健use.METHODS：回顾性队列设计的母亲参加他们的婴儿的2个月的好孩子的访问在1的5个城市初级保健的做法201 I和2014之间。使用了儿童电子健康记录、母亲医疗补助申请和出生证明的关联数据集。主要结局是PPD筛查阳性后6个月内的精神卫生保健使用情况。多变量Logistic回归被用来估计产妇和婴儿的临床和社会人口因素，预测service use.RESULTS：在总的，3052母亲符合研究标准，1986（65.1%）完成了PPD屏幕，和263（13.2%）筛选PPD阳性，其中195（74.1%）被转介服务。23名妇女（11.8%）在筛查后6个月内至少有1名医疗补助申请抑郁症。在多变量建模，母亲抑郁症的历史，在过去的一年（比值比= 3.80，1.20-12.11）更有可能接受心理健康服务后，积极screen.CONCLUSIONS：很少有母亲谁筛选阳性PPD接受心理健康服务。最近没有抑郁症治疗史的母亲可能特别容易受到护理不足的影响。需要更多的机制来改善PPD筛查后获得精神卫生服务的机会。
OBJECTIVE: The American Academy of Pediatrics recommends postpartum depression (PPD) screening. It is unknown whether pediatricians are effective in linking mothers to mental health services. The objectives of the current study are to determine I) mental health care use among women with Medicaid insurance after a positive PPD screen and 2) maternal and infant factors that predict the likelihood of mental health care use.METHODS: Retrospective cohort design of mothers attending their infants' 2-month well child visit at 1 of 5 urban primary care practices between 201 I and 2014. A linked dataset of the child's electronic health records, maternal Medicaid claims, and birth certificates was used. The primary outcome was mental health care use within 6 months of a positive PPD screen. Multivariate logistic regression was used to estimate maternal and infant clinical and sociodemographic factors that predict service use.RESULTS: In total, 3052 mothers met study criteria, 1986 (65.1%) completed the PPD screen, and 263 (13.2%) screened positive for PPD, of whom 195 (74.1%%) were referred for services. Twenty-three women (11.8%) had at least I Medicaid claim for depression within 6 months of screening. In multivariate modeling, mothers with a history of depression in the previous year (odds ratio = 3.80, 1.20-12.11) were more likely to receive mental health services after a positive screen.CONCLUSIONS: Few mothers who screened positive for PPD received mental health services. Mothers without a recent history of depression treatment may be especially at risk for inadequate care. Additional mechanisms to improve access to mental health services after PPD screening are needed.