Journal of the American Medical Women's Association (1972)最新文献

This article summarizes the epidemiology, clinical features, and treatment of antepartum and postpartum major depression. This summary will enable primary care clinicians to recognize and screen for perinatal mood disorders and to initiate the risk-benefit decision-making process used in treatment selection. This review will also help identify patient factors that warrant psychiatric consultation. We selected and reviewed studies of antepartum and postpartum depression of greatest utility to primary care clinicians. We developed a graphical algorithm that summarizes the steps needed for the care of postpartum depressed women. The prevalence of postpartum depression ranges from 10% to 15%, with screening rates of depressive symptoms as high as 35% in African American women. The prevalence of antepartum depression is as high as 26% among women in poor, urban communities. Maternal depression is associated with adverse effects on fetal and infant development. The challenge of diagnosing perinatal major depression can be addressed by assessing for persistent cognitive and affective symptoms and functional impairment. Effective treatments include interpersonal psychotherapy and selective serotonin reuptake inhibitors. The treatment of perinatal depression requires a unique informed consent process that is guided by a discussion of maternal preferences, the severity of maternal illness and recommended treatment, the risks of psychotropic exposure, and the risks of untreated mental illness. Rapid and effective mental health intervention in depressed expectant or new mothers not only restores maternal function, but can also prevent adverse infant neurobehavioral outcomes.

This paper has two basic purposes. First, it will provide an understanding of the risks of depression in women, with a focus on the psychosocial factors. The lifetime prevalence of major depression in women ranges from 10% to 23%, twice the rate among men; until puberty, however, rates are similar among boys and girls. The emergence of sex differences at puberty has generated a great deal of research into the biological (in particular, reproductive hormones) and psychosocial factors that may account for this difference and contribute to depression in women across the life cycle. Depression is associated with significant impairment and physical conditions and, thus, clearly constitutes a significant public health problem. The second goal of this paper is to describe some tools for screening depression in the primary care setting. Ten percent to 25% of patients seen by primary care providers have some type of depressive disorder that affects not only their functioning and well-being, but also their physical health. Providers have limited time and expertise for assessing and treating depression. Information about the context of women's lives and an efficient and brief depression screen can help providers evaluate the presence, severity, and impact of depression in their patients.

Objective: The objectives of the current study are to delineate nonpsychiatric illness associated with posttraumatic stress disorder (PTSD) in order to inform services and interventions for traumatized patients in medical and public health settings. The current report examines sex differences in nonpsychiatric illnesses associated with PTSD in a nationally representative sample. Analyses account for the roles of poverty and major depression, 2 factors strongly linked to both health status and PTSD.

Method: Data on 2835 men and 3042 women from the National Comorbidity Survey were analyzed to obtain adjusted odds ratios for the risk of medical conditions and the types of medical conditions associated with PTSD for men and women.

Results: Women and men with PTSD were more than twice as likely to experience at least 1 current nonpsychiatric medical condition as were women and men without PTSD, even when age, socioeconomic status, and major depression were adjusted for. Depression and income below the poverty level were associated with additional risk of nonpsychiatric conditions among women, but not among men.

Conclusions: PTSD is associated with significant nonpsychiatric illness. The relationship between PTSD and current health conditions is similar for men and women, but depression and poverty, which frequently co-occur with PTSD, define a subset of disadvantaged women with significant health and mental health service needs. Interventions for this population must address the full range of both psychiatric and nonpsychiatric illness.

Objective: We conducted this study to identify residents' limitations in screening for, documenting, and managing domestic violence (DV) and to focus future educational interventions.

Methods: We administered a detailed survey to 103 internal medicine residents from 4 university-affiliated programs to ascertain their attitudes about and practices in screening for, documenting, and managing DV.

Results: Most residents agreed that DV is a significant health care problem (87%) and one in which physicians can intervene effectively (77%), yet 37% reported not screening for DV. Residents who said they do not screen reported a variety of mitigating factors, from uncertainty about how to screen for and manage DV, to fear of insulting or angering the patient. Eighty-two percent stated that they would document DV in the chart, but 51% had reasons for not documenting DV, ranging from fear that the patient's partner might harm the patient or the physician to concern that the patient may not be telling the truth. Fifty-seven percent of residents said they would ask about DV more often if state law mandated it. When asked to choose which management interventions were helpful or unhelpful, many residents made incorrect, potentially injurious choices.

Conclusion: Many residents reported beliefs and practices that could inhibit optimal care of DV victims. Educational interventions should be directed at remedying residents' gaps in knowledge and attitudes to improve screening for, documenting, and managing DV.

Forty percent of all menopausal women seek medical attention to alleviate symptoms of menopause, a natural physiologic process. Severe symptoms and an overall decrease in quality of life have prompted many women to demand additional information and treatment. Although menopausal hormone therapy has been the standard, increasing evidence suggests that women are looking to complementary and alternative therapies for management and treatment of menopausal symptoms. Modalities such as physical activity, diet supplements, body work, and mind-body techniques are often used without evaluation or treatment by conventional health care providers. Many of these treatments may present varying risks and contraindications. Consequently, there is a great need for ongoing education and research to ensure alternative therapy use is not only effective, but also safe. This paper provides a systematic review of current complementary and alternative modalities and of physical activity used in the management and treatment of menopausal symptoms.

Cardiovascular disease is the leading cause of death and morbidity among women. The prevalence of coronary heart disease (CHD) and its attendant risk clearly increase with advancing age. Though traditionally underrepresented in CHD trials, the proportion of women participating in these studies has risen in recent years. The American Heart Association has recently published statements on the optimal CHD care for both the elderly and female populations. Evidence-based life style and pharmacologic interventions for CHD appear to offer similar benefits in men and women as well as for older patients. However, older women with CHD differ from men in symptoms, the diagnostic performance of cardiac stress tests, the risk of complications from coronary revascularization procedures, and use of proven beneficial therapies. This article synthesizes the current state of the evidence on optimal diagnostic and therapeutic approaches to older women with established CHD.

Adolescent girls are at a higher risk of depression than boys are. Depression is of particular concern in pregnant and postpartum adolescents because of the potential impact on the infant. Primary care providers (PCPs) should routinely screen adolescent girls for depression and consider depression in their differential diagnoses of somatic complaints. Both medications and psychotherapy are effective treatments for depression in adolescents. Interpersonal psychotherapy and cognitive therapy are both effective. PCPs have additional obligations to understand the possible barriers to adolescent use of mental health services in the community and to use available resources to advocate for appropriate health care for adolescents.

This review evaluates the research published between 1966 and 2004 on several integrative treatments for depression, including omega-3 fatty acids, Hypericum perforatum (St. John's Wort), S-adenosyl-methionine, folate, 5-Hydroxytryptophan, acupuncture, exercise, and light therapy, with a particular emphasis on issues pertinent to women. Data from double-blind, placebo-controlled trials support each of these as treatment interventions for depression. We discuss both the strength of the evidence for each treatment and methodological issues related to interpretation of efficacy. Available data pertaining to considerations in women, including use during pregnancy and breastfeeding and interactions with hormonal therapies are discussed. The reviewed treatments deserve further research. Their appropriate place in the armamentarium of depression treatments for women must be defined. An evidence-based integrative medicine approach brings together treatment options with proven efficacy and the public's desire for complementary and alternative medicine treatments.