| 1. Study Objects and SignificancesDepression is a common mood disorder, prevalence of up to 10%. Worldwide epidemiological data show that the incidence rate of depression in the female population is 2 times the men, while women in the perinatal period is the peak incidence of depression, in addition to women who have a history of depression relapse easily, many women appeared for the first time in post-natal depressive episode. After pregnancy and childbirth, women experiencing great changes both physically and posycologically, emotional instability, are vulnerable to postpartum depression. Postpartum depression is the most common mental complication, not only affects the mother's own health and family, but also the nursing and mother-child relationship, and has long-term negative impact for infants'emotional behavior and development, or worse still will lead to acts of infanticide and suicide, is extremely hazardous. In addition, in the 80's social background of the family planning policy, the first child who is now married to the child-bearing age, and child psychological characteristics of the particular group to make them more vulnerable to postpartum depression.As a populous country and the special social environment, post-natal depression in our country constitutes a growing public health problem, adhering to the "on treatment of disease" in philosophy; it is self-evident to carry out the intervention and prevention for postpartum depression. Early assessment and diagnosis is the first step in the implementation of intervention of postpartum depression, but current screening techniques in screening content, form, timing of all defects, screening techniques have not formed through the organic integration of a scientific and effective intervention programs. Therefore, it is necessary to carry out community-based screening techniques and intervention for postpartum depression.This study aims to combine the characteristics of community health services, first of all, develop through the maternal "pre-pregnancy-prenatal-their production-post-natal" of the whole process, concerned about "bio-psycho-social" comprehensive community suitable screening technology for postpartum depression; Then, based on early research result of core group "postpartum depression collective intervention model in community ", form prevention and intervention programs for post-natal depression in community;Finally, through intervention program's pilot, we verify and perfect screening techniques and models, providing the critical information for the formation screening technology and models of a certain value, in line with our national conditions for postpartum depression in community. 2. Research methods and Data SourcesThrough structure-process-outcome model, we determine the concept of developing "pre-pregnancy-prenatal-Production Time-postpartum" of the whole process comprehensive prevention and intervention techniques;evidence-based medicine suggests the basic idea developing screening techniques; health technology assessment suggests that techniques need organization and policy support to achieve the expected value; project management and business process management suggest the ideas developing intervention programs; based on the project evaluation, we determined Evaluation of the intervention program ideas.The main sources of data and collection methods, including bibliometric analysis, field surveys, and literature analysis identify the source of item pool of screening and evaluation form; on-site investigation provide data information for the performance appraisal of screening techniques and evaluation of the effectiveness of intervention programs.Data is entered in Excel, Epidata, analysis is completed in SPSS15.0. In addition to a general description of all related data, but also correlation, exploratory factor analysis, reliability analysis, validity analysis, Kappa consistency check have been used for the performance evaluation of screening form and evaluation form.3. Main study results(1) The development of antenatal psychological related risk factors screening formStarting with risk factors,66 risk factors are collected from the literature and classical studies systematic, through experts'advice, the risk factors are combined and demonstrated to 62, then we get 49 pregnancy and 46 postpartum risk factors according to time, and finally they are demonstrated through the importance.Based the 49 pregnancy and 46 postpartum items as alternative entry pool, we build the screening form; through expert demenstration, we removed some inappropriate items,43 pregnancy and 44 postpartum items are left, the first draft of screening table has been formed; the first draft is pre-trialed with small samples of 50 pregnant women and 48 maternals; according to pre-test results, we optimize the entries and eventually determine 35 entries of the pregnancy and post-natal screening table and four score rating method.On this basis,612 pregnant women and 596 maternals have been surveyed. Exploratory factor analysis showed that pregnancy screening form can be extracted 12 common factors, and the cumulative variance contribution rate of 55.920%, post-natal screening form can be extracted 11 factors, and the cumulative variance contribution rate of 60.650%, and both can classified as physical, psychological, social function of three dimensions, In accordance with the theoretical concept of the screening form development;correlation analysis of the total score on the screening form and the classical scale SAS/SDS was done to evaluate the criterion validity,pregnancy screening table correlation coefficients were 0.518/0.500, and post-screening table correlation coefficients were 0.403,0.300, correlation was significant; Cronbach coefficient and split-half reliability are used to evaluate the reliability of screening table, Cronbach coefficients of pregnancy screening table and three dimensions are between 0.376-0.666, split-half reliability between 0.325-0.598, Cronbach coefficient of post-natal screening table and three dimensions are between 0.531-0.735, split-half reliability between 0.404-0.642; and finally we determine 50/51 and 44/45 as the cut-off value of the screening forms.(2) The development of self-rating pregnancy psychology formThis section to apply a broad, mature scale, high reliability and validity, the principle is simple extensive collection of classic depression rating scale, and summarizes the characteristics of each scale, be evaluated by maximizing the entry table 52 entry pool options, according to the frequency of entry, screening out the frequency of 2 times or more entries, the formation of the 20 screening assessment table entries, and comments by the experts to do some repairs.An expert group set up demonstration by experts on the Expression entry accuracy, and relevance of postpartum depression rate, respectively, proposed additions and deletions should be combined and adjustment entries, and to give reasons for changes and suggestions. Experts on the 20 primary items are out of the Expression of the score, the score on the relevance of all of 0.8 points (total score of 1 point) or more, and did not raise other objections, it entry without making amendments. Followed by random selection of 50 pregnant women, pre-trial assessment of the table, all respondents are able to understand all the 20 entries in the statements, and that there is no duplication between the various entries, thus the final evaluation form to determine the 20 entries and four score means.On this basis,612 pregnant women have been surveyed. correlation analysis show that 20 entries were all related to total score; Exploratory factor analysis showed that five common factors were extracted,and the cumulative variance contribution rate of 52.151%; correlation analysis of the total score on the self-rating form and the classical scale SAS/SDS was done to evaluate the criterion validity, the correlation coefficients were 0.787 and 0.771, was strongly associated; the reliability analysis show that, with the exception of factor 5, other 4 common factors and the entire table of Cronbach coefficient are between 0.522-0.792,the split-half reliability between 0.493-0.790; and finally we determine 37/38 as the cut-off value.(3)The formation of prevention and intervention program for postpartum depression in communityWe form a set of practical intervention program under the local conditions, using previous theoretical research "collective intervention model" as a platform, integrating the screening forms and evaluation forms. Intervention program for the implementation of appropriate technology, is a guide of the implementation, identifying a clear intervention targets (why), intervention targets (who), intervention content and tools (what), intervention implementation and process (how), intervention time (when), and intervention programs appear in the form of manual finally.(4) The implementation of the prevention and intervention program for postpartum depression in communityThe implementation of the intervention program show that, the Shanghai Jiading has enrolled 87 people,313 people carried out the pregnant women school,62 people carried out the husband school, the enrolled number of Changzhou, Jiangsu reached 117,100 people carried out the pregnant women school,49 people carried out the husband school.The intervention work is being carried out as planned. Active screening rate has increased from 73.7% in early pregnancy to 100% in third trimester of pregnancy;proportion of people who think the screening form useful increased from 31.7% in early pregnancy to 41.7% in late pregnancy; people who think that the arrangements, content, description, form of collective intervention curriculum in pregnant women school good form a proportion of 75% or more basicly; through interviews, pregnant women receive the majority of pregnant women and their husbands schools welcome, pregnant women, improve the knowledge, needs are met; In addition, the supplier also believe that their own expertise and competence have been greatly enhanced through the intervention.4. Study conclusionsThe two screening techniques of this study-screening table and evaluation table solve the current technical bottlenecks of post-natal depression screening in the community, the development process is rigorous and specifications, evaluation results are more satisfactory; community-based postpartum depression prevention intervention program is based pre-theoretical study results, and adjusted according to field research, both to ensure the scientific, and cater operational; The intervention programs have been recognized since the implementation in the pilot areas, and is paying off, but at this stage, the value of the core screening technology and intervention program can't be evaluated systematic,we need to do a comprehensive assesment in the end of the intervention. |
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