中国女性生育全程抑郁检出率的Meta分析

The detection rate of depression during childbearing process among Chinese women:a Meta-analysis

目的采用Meta分析对既往研究报告的中国女性从孕早期到产后6个月的抑郁检出率分阶段进行合并,为制定和实施围产期抑郁症重点人群防治措施提供基础数据。方法系统检索PubMed、中国知网、万方数据库、维普数据库截至2021年9月5日公开发表的中国女性生育各阶段抑郁检出率的文献。利用Stata 15.1软件,根据异质性检验结果,采用随机效应模型合并中国女性生育各阶段的抑郁检出率;根据各分组因素对中国女性生育各阶段的抑郁检出率进行亚组分析并对合并检出率进行敏感性分析和发表偏倚检验。结果共纳入77篇文献,249310名研究对象。中国女性生育全程的抑郁合并检出率为17.84%(95%CI:16.06~19.61);孕期合并检出率为20.23%(95%CI:17.60~22.86),高于产后合并检出率14.50%(95%CI:12.53~16.48);其中,孕早期的合并检出率最高为24.48%(95%CI:17.89~31.06),之后随生育进程呈下降趋势,孕中期、孕晚期、产后42 d、产后100 d、产后6个月的抑郁合并检出率分别为20.63%(95%CI:15.30~25.95)、17.76%(95%CI:14.91~20.60)、16.95%(95%CI:13.88~20.02)、7.69%(95%CI:4.46~10.93)、2.37%(95%CI:1.62~3.12)。亚组分析结果显示,调查年份、研究设计、调查地区、抑郁量表、阳性界值、样本量和文献质量评价等级均不是原始研究间结果不一致的主要原因。结论中国女性生育各阶段的抑郁合并检出率自孕早期至产后6个月呈下降趋势,提示应及早提供抑郁症的评估和干预措施。现有研究中某些未测量或未报告的因素可能导致各原始研究结果间的异质性,后续应优化研究设计,改善研究质量。

Objective To synthesize the detection rates of perinatal depression previously reported among Chinese women for each stage of the process from the first trimester of pregnancy to six months after labor,and to provide evidence for the development and implementation of prevention and treatment measures for perinatal depression.Methods Studies on the detection rates of depression among Chinese women at all stages of childbearing process,which had been published before September 5th,2021,were searched through PubMed,CNKI,Wanfang,and VIP databases systematically.According to the heterogeneity test results,the detection rates of depression at different stages of childbearing process were pooled by a random effects model by using software Stata 15.1.The subgroup analyses were conducted to detect the differences in detection rates of perinatal depression.The sensitivity analyses and publication bias tests were performed.Results A total of 77 articles were included,with 249310 women.The pooled detection rate of depression during childbearing process was 17.84%(95%CI:16.06-19.61).The antepartum depression detection rate was 20.23%(95%CI:17.60-22.86),which was higher than the postpartum depression detection rate of 14.50%(95%CI:12.53-16.48).The highest detection rate was 24.48%(95%CI:17.89-31.06)in the first trimester of pregnancy,followed by those in the second trimester(20.63%,95%CI:15.30-25.95),the third trimester(17.76%,95%CI:14.91-20.60),forty-two days after labor(16.95%,95%CI:13.88-20.02),one hundred days after labor(7.69%,95%CI:4.46-10.93),and six months after labor(2.37%,95%CI:1.62-3.12).The results of subgroup analyses showed that the survey years,research designs,survey areas,depression detection tools,positive cutoff points,sample sizes and levels of study quality didn′t affect the heterogeneity of the original study results.Conclusions The pooled detection rates of perinatal depression among Chinese women show a decrease trend from the first trimester of pregnancy to six months after labor.The early screening and prompt intervention to identify and treat depression should be provided.Some unmeasured or unreported factors in the existing studies may lead to the heterogeneity of the original study results.The study design should be optimized and the study quality should be improved in the future.