Intervention Review

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

  1. Marie-Paule Austin1,*,
  2. Susan R Priest2,
  3. Elizabeth A Sullivan3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 6 JUN 2008

DOI: 10.1002/14651858.CD005124.pub2

How to Cite

Austin MP, Priest SR, Sullivan EA. Antenatal psychosocial assessment for reducing perinatal mental health morbidity. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD005124. DOI: 10.1002/14651858.CD005124.pub2.

Author Information

  1. 1

    University of New South Wales, Black Dog Institute/School of Psychiatry, Sydney, New South Wales, Australia

  2. 2

    (b) Perinatal and Infant Psychiatry Program, University of Newcastle, (a) School of Public Health and Community Medicine, University of New South Wales, Sydney, Wallsend, Australia

  3. 3

    University of New South Wales, Faculty of Medicine, Randwick, NSW, Australia

*Marie-Paule Austin, Black Dog Institute/School of Psychiatry, University of New South Wales, Hospital Road, Sydney, New South Wales, 2052, Australia. m.austin@unsw.edu.au.

Publication History

  1. Publication Status: New
  2. Published Online: 8 OCT 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant.

Objectives

To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, the Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TR-Studies), HSRProj in the National Library of Medicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008).

Selection criteria

Randomised and quasi-randomised controlled trials.

Data collection and analysis

At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias.

Main results

Two trials met criteria for an RCT of antenatal psychosocial assessment. One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of 'high level' psychosocial risk where the ALPHA intervention had been used (relative risk (RR) 4.61 95% confidence interval (CI) 0.99 to 21.39). No differences between groups were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her healthcare providers plus a patient information booklet) and the standard care groups (RR 0.86 95% CI 0.61 to 1.21; 371 women).

Authors' conclusions

While the use of an antenatal psychosocial assessment may increase the clinician's awareness of psychosocial risk, neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes. Further studies with better sample size and statistical power are required to further explore this important public health issue. It will also be important to examine outcomes up to one year postpartum not only for mother, but also infant and family.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

Women can develop mental health problems during pregnancy or at childbirth and over the following year. These problems range from depression (both minor and major), anxiety disorders, post-traumatic stress disorder to bipolar disorder, schizophrenia and psychosis (puerperal psychosis). Life stresses such as bereavement, separation, unemployment, illness, moving house, migration, lack of social support networks, a past history of psychological or psychiatric disorders, history of physical, emotional or sexual abuse, drug or alcohol abuse, dysfunctional personality or coping styles and parenting behaviours can contribute to their onset. Obstetric factors such as timing and type of delivery and infant temperament can also play a role. Disorders may become chronic and carry over to future pregnancies. The mother’s mood during pregnancy and mental illness can impact on the development of the baby both during pregnancy and after birth. Assessing women for psychosocial risk factors and symptoms of distress during regular pregnancy checks gives the opportunity to link women with appropriate services.

The one study that met the criteria for this review randomised healthcare providers to either psychosocial assessment or routine care and involved a total of 273 women. The providers who assessed psychosocial factors were more likely than those giving routine care to identify psychosocial concerns and to rate the level of concern as high. They were also more likely to detect concerns about family violence. The trial did not look at the development of anxiety or depression in these women. Not all healthcare providers chose to take part in the trial and some dropped out, leaving only 48 of the original 185 approached. This could mean that providers who were less interested in this area of clinical practice did not participate and bias the findings toward better than average detection of psychosocial risk. Two studies are currently in progress looking at the impact of early postnatal psychosocial assessment on the prevalence of antenatal and postnatal anxiety and depression.  

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

進行產前心理社會評估,以減少周產期的精神健康病態

周產期發生精神健康病症,包括憂鬱症,不只會對於女性造成負面的影響,也會影響到她的伴侶、嬰兒和家人。例行性且普遍的產前心理社會評估,可以非常顯著地減少發病之可能性。

目標

本回顧的目的是評估產前心理社會的評估,對於周產期精神健康病態的影響。

搜尋策略

我們搜尋了Cochrane Pregnancy and Childbirth Group's Trials Register、Cochrane Depression, Anxiety and Neurosis Group's Trials Register (CCDAN TRStudies) 、HSRProj in the National Library of Medicine (美國)等資料庫,及Current Controlled Trials的網站http: //www.controlled trials.com/和英國UK National Research Register(最新的搜尋日期為2008年3月)。

選擇標準

隨機和半隨機對照試驗。

資料收集與分析

至少2位回顧作者獨立地評估試驗是否合乎資格;他們也從收納的試驗摘錄數據,並評估試驗是否有潛在的偏差。

主要結論

2項試驗符合了產前心理社會評估的RCT標準。1項試驗審查了一種產前評估工具(ALPHA) ,對於醫師發現產婦的心理社會風險之影響,以及對於產前ALPHA預測產後愛丁堡憂鬱症量表(Edinburgh Depression Scale, EDS)得分增加的女性的能力,該試驗發現,如果醫師使用ALPHA干預,將更容易發現「高度」心理社會風險的趨勢(相對風險(RR .61,95% 信賴區間(CI) 0.99到21.39)。有或無使用ALPHA工具的組別之間,女性產前EDS評分的分數並無顯著差異,當分數高於9分,就會被ALPHA視為具有憂鬱症的可能傾向(RR 0.69,95% I 0.35到1.38);139位醫療提供者。另一項試驗指出,干預組(與女性及其醫師溝通EDS得分,再加上患者資訊手冊)及標準照顧組相較之下,產後16週時的EDS得分超過12分, 兩組並無差異存在 (RR 0.86,95% I 0.61到1.21;371名女性)。

作者結論

使用產前心理社會評估,可能增加醫師發現患者之心理社會風險,但是這2項小型研究都無法提供充足的證據,證實只有例行性產前心理社會評估,就可以改善周產期的精神健康預後。還需要樣本大小更充足且統計效力更佳的試驗,進一步探索這個重要的公共衛生問題。同時,試驗也需調查到產後一年的預後結果,這不僅對於母親十分重要,對於嬰兒和家人也是很重要的。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

產前心理社會評估以減少周產期精神健康病態: 女性在懷孕期間、分娩時及之後的一年中,都可能發生心理健康問題。這些問題從憂鬱症(輕度和重度)、焦慮性疾病、創傷後壓力症候群到躁鬱症、精神分裂症和精神疾病(產後精神疾病)。生活上的壓力如居喪、分離、失業、疾病、搬家、遷移、缺乏社交支持網絡、過去曾有心理或精神疾病病史、身體疾病的病史、情感上的虐待或性虐待、藥物成癮或酒癮、不正常的人格或應付壓力的方式及父母行為異常,都可能造成這些情況的發生。產科的因素如分娩的時間和類型及嬰兒的性情,都可能造成影響。這些精神上的障礙可以會轉變為慢性的,並持續到下次懷孕。母親在懷孕期間的情緒及精神上的疾病,會在懷孕期間及生產後,對於嬰兒的發展造成影響。在例行的產檢期間,評估女性的心理社會風險因素及憂鬱的症狀,可以有機會將這些女性轉介至適當的服務機構。這一項符合本篇回顧標準的研究,將醫療提供者隨機分配至評估心理社會狀態或例行性照顧的兩組中,共有273名女性參與本項研究。評估社會心理因素的醫療提供者,比提供例行性照顧的醫療提供者,更能發現女性心理社會上的問題,並且將這些問題的重要性評比為較高的等級。他們也更可能發現家庭暴力的問題。這項試驗並未觀察這些女性發生的焦慮或憂鬱症。並非所有醫療提供者都選擇參與試驗,而且有些人中途退出試驗,因此原本接觸的185人中,只剩下48人完成試驗。這可能表示,對於這個領域的臨床實作較不感興趣的醫療提供者,並未參與本試驗,因此可能使得試驗的結果產生偏差,偏向於更好的心理社會風險偵測結果。目前正在進行的2項試驗,觀察早期的心理社會評估,對於預防產前焦慮及憂鬱症的盛行率之影響。