孕期心理保健方案的构建与实践

Construction and practice of prenatal mental health care practice protocol

目的在循证方法学指导下构建孕期心理保健理论及其实践方案。方法在“促进健康的综合干预措施发展和评价框架”的方法学指导下,通过文献评阅确定证据基础,通过逻辑推演和专家咨询形成孕期心理保健方案。根据循证医学原理具化方案中的关键要素,整合形成初步的干预路径和具体方案,根据专家意见修改完善,通过模拟测试,确定最终的适宜干预路径和实践方案。结果构建了以助产士为基础、以多学科合作为支撑的孕期心理保健方案,对不同心理危险等级的孕妇予以普遍性干预、选择性干预、指征性干预。模拟测试期间有4878名初诊登记孕妇接受了心理筛查,占同期孕妇的97.99%,11.02%的孕妇按照干预路径接受心理保健服务,有6名孕妇全程参与了模拟测试过程。结论所构建的孕期心理保健方案基于实践人员能力,契合干预场所情境,符合心理卫生服务发展趋势。为了充分发挥孕期心理保健方案的潜力,需要全面提高产科医务人员的心理保健能力。

Objective To construct a prenatal mental health care model and its related practice protocol under the guidance of evidence-based methodology.Methods Under the guidance of the"MRC framework for the design and evaluation of complex interventions to improve health",the evidence foundation was identified through literature review,and the prenatal mental health care model was formed through logical deduction and expert consultation.The key elements of the model were specified and integrated into the preliminary intervention path and practice protocol according to the philosophy and methods of evidence-based medicine.The practice protocol was finalized through expert consultation and simulation test.Results The established prenatal mental health care model was characterized with midwife-based and multidisciplinary cooperation,and could manage the mental health of pregnant women according to their different psychological risk levels by universal,selective and indicated intervention.During the simulation test,4878 pregnant women received mental health screening,accounting for 97.99%of the total pregnant women;11.02%accessed the intervention path and received mental health services.Six pregnant women participated in the whole test process.Conclusion The model suits local situation and the compentence of the practitioner and is in line with the trend of mental health services.In order to exploit the potential of the prenatal mental health care model,it is necessary to comprehensively improve the ability of providing mental health care by obstetric professionals.