孕期抑郁和焦虑症筛查与治疗模式的差异:综合评述。

Rachel Eakley, Audrey Lyndon
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引用次数: 0

摘要

导言:孕期抑郁和焦虑症状如不及时治疗,会对孕妇、分娩结果和儿童发育造成严重不良影响。然而,与非孕妇相比,孕妇接受筛查和治疗的可能性较低。在本系统综述中,我们旨在探讨影响孕期抑郁和焦虑筛查、识别和治疗模式的个人、提供者和系统因素:2012年1月至2023年1月期间,在美国境内进行的、以英语发表的研究均符合纳入条件。每项研究都包含对筛查、识别或治疗参与率进行比较的分析,并明确讨论了边缘化群体的差异或健康公平问题。有 15 篇文章符合全部纳入标准:结果显示,不同患者群体在筛查、识别和治疗孕期抑郁和焦虑方面存在差异。筛查率从波多黎各的 51.3% 到阿拉斯加的 90.7% 不等。在特定的临床人群中,筛查率低至 2.0%。根据筛查或诊断结果转诊治疗的患者不到一半。年龄、种族、民族、社会经济和健康因素、精神健康史和肥胖等患者特征与筛查、诊断或治疗参与率的差异有关。语言因素是导致筛查率和治疗率较低的最常见因素:讨论:结果表明,许多孕妇被忽视,缺乏适当的转诊或治疗资源。结果与之前的研究结果一致,即角色混乱、缺乏时间、提供者培训和兴趣导致筛查和治疗率较低。未来的研究必须关注系统层面的因素,以系统、公平的方式解决筛查和治疗孕期抑郁和焦虑症的障碍。
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Disparities in Screening and Treatment Patterns for Depression and Anxiety During Pregnancy: An Integrative Review.

Introduction: Symptoms of untreated depression and anxiety during pregnancy are associated with serious adverse effects for the pregnant person, birth outcomes, and child development. However, pregnant persons are less likely to be screened and treated compared with nonpregnant people. In this systematic review, we aimed to explore individual, provider, and systems factors that impact screening, identification, and treatment patterns for depression and anxiety during pregnancy.

Methods: Studies were eligible for inclusion if they were conducted within the United States and published in English between January 2012 and January 2023. Each study included analysis that compared rates of screening, identification, or treatment engagement and explicitly discussed disparities or health equity in marginalized groups. Fifteen articles met full inclusion criteria.

Results: Results demonstrated variation in the screening, identification, and treatment of depression and anxiety during pregnancy among diverse groups of patients. Screening rates ranged from 51.3% in Puerto Rico to 90.7% in Alaska. Among specific clinical populations, rates were as low as 2.0%. Fewer than half of patients were referred to treatment when indicated by screening or diagnoses. Patient characteristics such as age, race, ethnicity, socioeconomic and health factors, mental health history, and obesity were associated with variation in the rates of screening, diagnoses, or treatment engagement. Language factors were the most common factor associated with lower rates of screening and treatment access.

Discussion: Results suggest that many pregnant people are being overlooked and lack appropriate referrals or resources to access treatment. Results are consistent with previous findings that role confusion and lack of time, provider training, and interest contribute to low rates of screening and treatment. Future research must focus on system level factors to address perceived barriers to screening and treating depression and anxiety during pregnancy in a systematic and equitable way.

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