“妈妈好心境”对产前抑郁改善作用的预研究

A pilot study on the ameliorative effect of"Mom’s Good Mood"on antenatal depression

目的通过预研究,初步评估“妈妈好心境”(MGM)的实施对产前抑郁的改善作用,为开展实施性研究提供证据支持。方法本研究为“基于初级卫生保健系统的围生期抑郁的筛查与管理项目”实施性研究的预研究。于2019年在马鞍山市妇幼保健院招募1189例孕周≤14^(+6)周的孕妇作为实施组,使用爱丁堡产后抑郁量表(EPDS)在孕早、中、晚3个时期对其进行连续筛查,对抑郁症状筛查阳性者提供MGM干预。于2020年在马鞍山市妇幼保健院招募接受孕早期、孕中期、孕晚期任一时期进行EPDS筛查的孕妇作为对照组,共计1708例。使用Mann-Whitney U检验、χ^(2)检验、Logistic回归模型比较实施组与对照组在孕期同一时期的EPDS得分及抑郁症状检出率的差异,评估MGM整体(筛查+干预)对产前抑郁的改善作用。结果在孕早期,两组孕妇EPDS得分、抑郁症状检出率差异均无统计学意义(P>0.05);孕中期和孕晚期实施组EPDS得分及抑郁症状检出率均低于对照组(P<0.05);调整混杂因素后,Logistic回归分析显示实施组在孕中期和孕晚期的抑郁发生风险均低于对照组[OR_(孕中期)=0.55,95%CI(0.37,0.81),P=0.003;OR_(孕晚期)=0.51,95%CI(0.35,0.74),P<0.001]。结论在初级保健系统内实施MGM可有效降低产前抑郁的发生风险,为进一步的扩展研究提供了科学依据。

Objective To preliminarily assess the ameliorative effect of Mom’s Good Mood(MGM)on the prevalence of antenatal depression based on a pilot study,and to provide evidence for a scale-up study.Methods This study was conducted in Ma’anshan Maternal and Child Health Center as a pilot study of an implementation study conducted in China called the Perinatal Depression Screening and Management(PDSM)program.In 2019,1189participants(gestational week≤14^(+6) weeks)were included in the implementation group.Females were recruited in the first trimester and followed up in the second and third trimesters.At each time point,the participants’depression status was screened by the Edinburgh postpartum depression scale(EPDS),and those who were screened as having depression were provided the MGM intervention.In 2020,1708 participants who underwent screening with the EPDS in either the first,second or third trimester at Ma’anshan Maternal and Child Health Center were included in the control group.Mann-Whitney U test,Chi-square,and multivariate logistic regression analysis were used to compare the EPDS scores and depression prevalence between the control and implementation groups to assess the ameliorative effect of MGM(screening and intervention)on antenatal depression.Results In the first trimester,there were no statistically significant differences in EPDS scores or depression prevalence between the two groups(P>0.05).In the second and third trimesters,both the EPDS scores and depression prevalence of the implementation group were lower than those of the control group(P<0.05).After adjusting for confounders,logistic regression analysis showed that the risks of depression in the implementation group in both the second and third trimesters were lower than those in the control group(OR_(second trimester)=0.55,95%CI 0.37 to 0.81,P=0.003;OR_(third trimester)=0.51,95%CI 0.35 to 0.74,P<0.001).Conclusion Implementation of the MGM based on the primary care system can effectively reduce the prevalence of antenatal depression,providing evidence for further scale up.