背景:产后抑郁症(PPD)是全球范围内的重要公共卫生问题。中国正计划在社区环境中开展PPD筛查,但是对于PPD的社区患病率和经过验证的筛查工具存在疑问。
方法:我们争取在长沙两个区的产后家访中招募所有符合条件的新妈妈,中国,在知情同意后,使用三个自我管理问卷-爱丁堡产后抑郁量表(EPDS)对他们进行PPD筛查,患者健康问卷(PHQ-9),和抑郁症筛查的Wooley问题。根据《精神障碍诊断和统计手册-IV》(DSM-IV),由不知道筛查结果的合格专家在线进行视频结构化诊断访谈。最佳筛查是根据量表和诊断准确性指标的可接受性确定的,包括灵敏度,特异性,阳性预测值(PPV),和阴性预测值(NPV)。
结果:在3004名符合条件的女性中,2730人(90.9%)完成了筛查问卷。在那些被筛选的人中,对1,862例(68.2%)和62例(3.3%)被诊断患有当前抑郁状况进行了视频结构化诊断性访谈.最佳筛选方法包括将Wooley问题(至少一个“是”)与EPDS(截止值>10)串联起来,灵敏度为0.76(95%CI0.63至0.85),特异性为0.93(0.92至0.94),PPV为0.28(0.21至0.36),净现值为0.99(0.98至1.00)。
结论:由于区域样本,排除了电话联系而不是家庭访问的母亲,我们的研究结果可能无法完全推广到整个人群.
结论:该样本中女性PPD的患病率大大低于中国以前的研究报告,其中大多数使用屏幕阳性来测量患病率。将WhooleyQuestions与EPDS系列相结合是该人群中最佳的筛查方法,尽管在目前的患病率下,这仍然会导致大量的假阳性。
Postpartum depression (PPD) is an important public health problem worldwide.
China is planning to launch PPD screening in community settings, but there are questions on the community prevalence of PPD and validated screening tools.
We sought to recruit all eligible new mothers during postnatal home visits in two districts of Changsha,
China, and after informed consent, screened them for PPD using three self-administered questionnaires-the Edinburgh Postpartum Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9), and Whooley Questions for Depression Screening. Video structured diagnostic interviews were performed online according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) by qualified specialists who were blinded to screening results. Optimal screening was determined based on the acceptability of scales and diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Out of 3004 eligible women, 2730 (90.9 %) completed the screening questionnaires. Among those screened, the video structured diagnostic interview was administered to 1862 (68.2 %) and 62 (3.3 %) were diagnosed with a current depressive condition. The optimal screening approach involved combining Whooley Questions (at least one \"yes\") with EPDS (cutoff >10) in series, with sensitivity of 0.76 (95 % CI 0.63 to 0.85), specificity of 0.93 (0.92 to 0.94), PPV of 0.28 (0.21 to 0.36) and NPV of 0.99 (0.98 to 1.00).
Due to the regional sample and exclusion of mothers with telephone contact rather than home visits, our findings may not be fully generalizable to the entire population.
The prevalence of PPD among women in this sample was substantially lower than those reported in previous studies in
China, the majority of which used screen positivity in measuring prevalence. Combining Whooley Questions with EPDS in series is the most optimal screening approach in this population, though this would still result in a high number of false positives at current prevalence.