低收入媽媽的產後憂鬱可能變成慢性憂鬱
作者：Brian Hoyle
出處：WebMD醫學新聞
May 7, 2010（英屬哥倫比亞溫哥華）－根據一項發表在小兒科學學會2010年會的研究結果，生育年齡「資源缺乏」女性的憂鬱症是非常常見的，且有近20%受訪女性在小孩12個月以後仍然持續有中重度憂鬱症狀。
主要研究者、康乃迪克州紐哈芬市耶魯大學醫學院小兒科副教授Carol C. Weitzman醫師於發表會後向Medscape小兒醫學表示，這些結果強化了其他研究發現，媽媽的憂鬱並不侷限於產後階段，隨著小孩成長，母親憂鬱的盛行率可能更高。
我想，這些發現是非常重要且令人興奮的，它們突顯了臨床醫師們應該知道產後階段之後，這些媽媽仍然憂鬱的負擔。紐約羅徹斯特大學醫學中心精神科、婦產科與小兒科副教授的Linda Chaudron醫師向Medscape小兒醫學表示，這項研究也將這些諮詢缺乏的媽媽體驗到憂鬱症狀嚴重度的資訊加入知識庫中。這也開始提供我們有關協助這些母親之可能成功介入的相關資訊。Chaudron醫師並未參與這項研究。
在設計這項研究時，Weitzman醫師與其同事們的論點是，小朋友的常規後續追蹤就診可以作為找出憂鬱母親的標的機會，因為這時候母親們比較願意尋求憂鬱症治療。
當訪查耶魯預防保健診所的低收入兒童時，845位說英語與西班牙語的母親提供居住地理區域且完成一份憂鬱症候自我報告快速清單（QIDS-SR）。這份共16個問題的問卷被用來量測憂鬱嚴重度。那些憂鬱症篩檢呈陽性的媽媽之後接受訪談，以確認症狀。
整體來說，44%母親（共372位) 有憂鬱症狀。QIDS-SR分數指出25%母親有輕度症狀，中度症狀的有13%，而嚴重症狀的有6%。
那些有中度症狀的母親，24%是沒有工作的，23%她們的孩子年齡超過5歲。種族、婚姻狀態、教育程度、以及懷孕時年齡，並未顯著影響中度憂鬱症狀的盛行率。
在372位母親中，71位被隨機分派接受一系列現場認知行為治療療程，或是轉介到個案管理社工。這些媽媽的憂鬱症狀都有改善，那些接受認知行為療程的媽媽改善較為明顯。
Weitzman醫師向Medscape小兒醫學表示，母親憂鬱是個很大的公共衛生議題，如果我們真的想要做些努力讓他們達到他的潛力，我們需要處理母親與父親的精神健康問題。
Chaudron醫師附帶表示，許多孩子還小的低收入母親有憂鬱的問題，我們了解他們的需求、以及曉得我們該如何最佳地幫助他們，讓他們熱衷於可接受且有效的治療是非常重要的。這項研究結果是此方向一個令人興奮的一步。
這項研究由Robert Wood Johnson、Finding Answers、Disparities Research for Change and the Children's Fund of Connecticut贊助。作者們表示沒有相關資金上的往來。
Postpartum Depression Could Become Chronic Depression in Low-Income Mothers
By Brian Hoyle
Medscape Medical News
May 7, 2010 (Vancouver, British Columbia) — Depression in "underserved" women of childbearing age is very common, with almost 20% of surveyed mothers of children 12 months or older continuing to experience moderate to severe symptoms of depression, according to the results of a study presented here at the Pediatric Academic Societies 2010 Annual Meeting.
"This finding reinforces the finding of other studies that depression in mothers is not restricted to the postpartum period, and that as children get older, the prevalence of maternal depression may be higher," said lead researcher Carol C. Weitzman, MD, associate professor of pediatrics at the Yale University School of Medicine in New Haven, Connecticut, in an interview with Medscape Pediatrics after her presentation.
"I think these findings are very important and exciting. They underscore the need for clinicians to be aware of the burden of depression among mothers beyond the postpartum period. This study also adds to the knowledge base about the severity of depressive symptoms experienced by mothers in underserved communities. It also begins to provide us information about possible successful interventions to help mothers," said Linda Chaudron, MD, MS, associate professor psychiatry, obstetrics, gynecology, and pediatrics at the University of Rochester Medical Center, in New York, told Medscape Pediatrics. Dr. Chaudron was not involved with the study.
In designing the study, Dr. Weitzman and colleagues reasoned that children's routine check-up visits could serve as a targeting opportunity to identify depressed mothers, since women can be less inclined to seek out treatment for depression.
While visiting a Yale well-child clinic for disadvantaged children, 845 English- and Spanish-speaking mothers supplied demographic information and completed the Quick Inventory of Depressive Symptomology-Self Report (QIDS-SR). The 16-item questionnaire is an established measure of depression severity. Those who screened positive for depression were interviewed to confirm the symptoms.
Overall, 44% of mothers (n?= 372) had depressive symptoms. The QIDS-SR scores were indicative of mild symptoms in 25% of the mothers, moderate symptoms in 13%, and severe symptoms in 6%.
Of those with moderate symptoms, 24% were unemployed and 23% had a child 5 years of age or older. Ethnicity, marital status, education, and maternal age had no significant bearing on the prevalence of moderate symptoms of depression.
Of the 372 mothers, 71 were selected at random for a series of on-site cognitive behavior therapy sessions or referral to a case management social worker. All showed improvements in their depression symptoms, and improvements were especially pronounced in those who received cognitive behavioral therapy.
"Maternal depression is an enormous public health issue and, if we truly want to stack the deck in favor of children reaching their potential, we need to address maternal and paternal mental health issues," Dr. Weitzman told Medscape Pediatrics.
"With the knowledge that many low-income mothers of young children experience depression, it is important that we understand their needs and understand how we can best help them to engage in treatment that is acceptable and that works for them. The study results are an exciting step in this direction," Dr. Chaudron added.
The study was funded by the Robert Wood Johnson, Finding Answers, Disparities Research for Change and the Children's Fund of Connecticut. The authors have disclosed no relevant financial relationships.
Pediatric Academic Societies (PAS) 2010 Annual Meeting: Platform session?1480.290. Presented May?1, 2010.
