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Abstract：
BACKGROUND: Perinatal depression (PND) is underdiagnosed in the clinical setting. This study explores the role of obstetricians, and other primary care providers of maternal and child healthcare in detecting, screening, and referring women during the perinatal period identified as depressed, anxious, or exhibiting other symptoms of mental health disorders.
METHODS: Information was gathered from obstetricians (n = 16), and other primary care providers (pediatricians, nurse practitioners, physician assistants) (n = 85), on identifying and supporting childbearing women with symptoms of perinatal depression using an online survey.
RESULTS: Statistical comparisons across participant groups were adjusted for years of practice in the profession. Statistically significant differences were noted. Obstetricians inquired more about the mother\'s social support network (p = .011) and addressed mothers that appeared sad, upset, or unhappy (p = .044) compared to other primary care providers. Other primary care providers were more likely to refer patients to mental health support services (p = .005), provide PND-related information in their waiting rooms (p = .008), and use the Edinburgh Postnatal Depression Scale (EPDS) (p = .027). There was also a significant difference in positively identifying eight symptoms of PND between provider groups. Obstetricians had higher rates of identifying the following symptoms: excessive crying (p < .001), feeling little or no attachment to the infant (p < .001), little feeling of enjoyment (p = .021), feelings of failure (p < .001), hopelessness (p < .001), agitation with self and infant (p < .001), fear of being alone with the infant (p = .011), and fear that these symptoms would last (p < .001).
CONCLUSIONS: Although certain screening practices were performed well, especially by the obstetrician group, screening deficits were noted within each group, and screening practices differed between groups. Training offered to maternal child health primary care providers on addressing perinatal mental health disorders may help improve provider screening practices and detection of PND symptoms in perinatal women. PND screening that combines face-to-face open-ended interviews with standardized screening tools can enhance patient-provider communication, potentially improving PND detection rates and follow-up care in perinatal women.
METHODS: Information was gathered from obstetricians (n = 16), and other primary care providers (pediatricians, nurse practitioners, physician assistants) (n = 85), on identifying and supporting childbearing women with symptoms of perinatal depression using an online survey.
RESULTS: Statistical comparisons across participant groups were adjusted for years of practice in the profession. Statistically significant differences were noted. Obstetricians inquired more about the mother\'s social support network (p = .011) and addressed mothers that appeared sad, upset, or unhappy (p = .044) compared to other primary care providers. Other primary care providers were more likely to refer patients to mental health support services (p = .005), provide PND-related information in their waiting rooms (p = .008), and use the Edinburgh Postnatal Depression Scale (EPDS) (p = .027). There was also a significant difference in positively identifying eight symptoms of PND between provider groups. Obstetricians had higher rates of identifying the following symptoms: excessive crying (p < .001), feeling little or no attachment to the infant (p < .001), little feeling of enjoyment (p = .021), feelings of failure (p < .001), hopelessness (p < .001), agitation with self and infant (p < .001), fear of being alone with the infant (p = .011), and fear that these symptoms would last (p < .001).
CONCLUSIONS: Although certain screening practices were performed well, especially by the obstetrician group, screening deficits were noted within each group, and screening practices differed between groups. Training offered to maternal child health primary care providers on addressing perinatal mental health disorders may help improve provider screening practices and detection of PND symptoms in perinatal women. PND screening that combines face-to-face open-ended interviews with standardized screening tools can enhance patient-provider communication, potentially improving PND detection rates and follow-up care in perinatal women.
摘要：
背景：围产期抑郁症（PND）在临床上被低估。这项研究探讨了产科医生的作用，和其他初级保健提供者的妇幼保健在检测，筛选,提到围产期被确定为抑郁的女性，焦虑,或表现出精神健康障碍的其他症状。
方法：信息来自产科医生（n=16），和其他初级保健提供者(儿科医生，执业护士,医师助理)(n=85)，关于使用在线调查识别和支持有围产期抑郁症症状的育龄妇女。
结果：对参与者组的统计比较进行了调整，以适应该行业多年的实践。注意到统计学上的显著差异。妇产科医生询问了更多关于母亲的社会支持网络（p=.011），并解决了出现悲伤的母亲，心烦意乱,与其他初级保健提供者相比，或不满意(p=.044)。其他初级保健提供者更有可能将患者转介给心理健康支持服务(p=0.005)，在他们的候诊室提供PND相关信息(p=.008)，并使用爱丁堡产后抑郁量表（EPDS）（p=.027）。在提供者组之间积极识别PND的8种症状方面也存在显著差异。产科医生识别以下症状的比率更高：过度哭泣（p<.001），对婴儿感觉很少或没有依恋（p<.001），有点享受的感觉（p=.021），失败的感觉（p<.001），绝望（p<.001），自我和婴儿的激动（p<.001），害怕与婴儿独处（p=.011），并担心这些症状会持续（p<.001）。
结论：尽管某些筛查方法表现良好，尤其是产科医生组，每组都注意到筛查缺陷，和筛选实践不同的群体。向妇幼保健初级保健提供者提供有关解决围产期精神健康障碍的培训可能有助于改善提供者的筛查做法和对围产期妇女PND症状的检测。PND筛查将面对面开放式访谈与标准化筛查工具相结合，可以增强患者与提供者的沟通，可能改善围产期妇女的PND检出率和随访护理。
方法：信息来自产科医生（n=16），和其他初级保健提供者(儿科医生，执业护士,医师助理)(n=85)，关于使用在线调查识别和支持有围产期抑郁症症状的育龄妇女。
结果：对参与者组的统计比较进行了调整，以适应该行业多年的实践。注意到统计学上的显著差异。妇产科医生询问了更多关于母亲的社会支持网络（p=.011），并解决了出现悲伤的母亲，心烦意乱,与其他初级保健提供者相比，或不满意(p=.044)。其他初级保健提供者更有可能将患者转介给心理健康支持服务(p=0.005)，在他们的候诊室提供PND相关信息(p=.008)，并使用爱丁堡产后抑郁量表（EPDS）（p=.027）。在提供者组之间积极识别PND的8种症状方面也存在显著差异。产科医生识别以下症状的比率更高：过度哭泣（p<.001），对婴儿感觉很少或没有依恋（p<.001），有点享受的感觉（p=.021），失败的感觉（p<.001），绝望（p<.001），自我和婴儿的激动（p<.001），害怕与婴儿独处（p=.011），并担心这些症状会持续（p<.001）。
结论：尽管某些筛查方法表现良好，尤其是产科医生组，每组都注意到筛查缺陷，和筛选实践不同的群体。向妇幼保健初级保健提供者提供有关解决围产期精神健康障碍的培训可能有助于改善提供者的筛查做法和对围产期妇女PND症状的检测。PND筛查将面对面开放式访谈与标准化筛查工具相结合，可以增强患者与提供者的沟通，可能改善围产期妇女的PND检出率和随访护理。
