前瞻性队列研究中与性取向有关的围产期心理健康差异

IF 4.1 Q1 PSYCHIATRY
Kodiak R.S. Soled , Sarah McKetta , Payal Chakraborty , Colleen A. Reynolds , S. Bryn Austin , Jorge E. Chavarro , A. Heather Eliassen , Siwen Wang , Sebastien Haneuse , Brittany M. Charlton
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引用次数: 0

摘要

性取向未成年女性(SMW)围产期心理健康不良的风险可能会增加,但之前的研究还很有限。我们研究了与性取向相关的围产期心理健康(即压力和抑郁)差异,以及临床上围产期抑郁症状严重程度不同的人群使用抗抑郁药的情况。护士健康研究 3(Nurses' Health Study 3)的参与者对妊娠进行了前瞻性评估(N = 6364),并接受了妊娠和产后问卷调查。利用加权对数二项式广义估计方程,我们研究了五个组别在压力(感知压力量表 4 [PSS-4])、抑郁(爱丁堡产后抑郁量表 [EDPS],四个截断分数[≥7、≥9、≥11、≥13])和抗抑郁药使用模式方面的差异:没有同性性伴侣的完全异性恋者(参照组;n = 5,178 人);有同性性伴侣的异性恋者(n = 245 人);大部分为异性恋者(n = 770 人);双性恋者(n = 106 人);以及女同性恋者(n = 47 人)。与完全异性恋参照组相比,SMW 在怀孕期间的压力更大(调整风险比 [ARR]:1.14,95% 置信区间 [1.02-1.28])。在 EDPS 的每个分值临界点,SMW 妊娠抑郁的风险都较高,随着分值的增加,差异的程度也在增加(调整风险比 [ARR]:1.09 [1.00-1.28],95% 置信区间 [1.02-1.28]):EDPS 评分≥7、≥9、≥11、≥13 时,差异率分别为 1.09 [1.00-1.20];1.20 [1.05-1.36];1.37 [1.16-1.63];1.49 [1.18-1.89])。主要是异性恋和双性恋亚群的差异程度最大。在参照组中,随着症状严重程度的增加,产后抗抑郁药的使用率也随之增加,但在 SMW 亚组中,只有在最高分(≥13 分)时才会出现相关情况。SMW 感染妊娠应激和抑郁症的风险更高,更有可能使用围产期抗抑郁药;主要为异性恋和双性恋者使用抗抑郁药的风险最高。在完全异性恋者中,产后症状的严重程度与抗抑郁药的使用密切相关,但在双性恋者中则不然--这表明在心理健康治疗方面存在差异。进一步研究的重点包括确定造成这些差异的原因,以及适当定制解决方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sexual orientation-related disparities in perinatal mental health among a prospective cohort study

Sexually minoritized women (SMW) may be at an increased risk of adverse perinatal mental health, though prior research is limited. We examined sexual orientation-related differences in perinatal mental health (i.e., stress and depression), and antidepressant utilization among those at different severities of clinically significant perinatal depressive symptoms.

Nurses’ Health Study 3 participants with prospectively assessed pregnancies (N = 6,364) received pregnancy and postpartum questionnaires. Using weighted log-binomial generalized estimating equations, we examined differences in stress (Perceived Stress Scale 4 [PSS-4]), depression (the Edinburgh Postnatal Depression Scale [EDPS] at four cut-off scores [≥7, ≥9, ≥11, ≥13]), and patterns of antidepressant utilization across five groups: completely heterosexual with no same-sex sexual partners (reference group; n = 5,178); heterosexual with same-sex sexual partners (n = 245); mostly heterosexual (n = 770); bisexual (n = 106); and lesbian (n = 47).

Compared to the completely heterosexual reference group, SMW reported increased stress during pregnancy (adjusted risk ratio [ARR]: 1.14, 95% confidence interval [1.02–1.28]). SMW reported an elevated risk of pregnancy depression at every EDPS score cutoff, with the magnitude of the disparity increasing as the score increased (ARRs: 1.09 [1.00–1.20]; 1.20 [1.05–1.36]; 1.37 [1.16–1.63]; 1.49 [1.18–1.89] for EDPS scores ≥7, ≥9, ≥11, ≥13, respectively). Disparities were highest in magnitude among the mostly heterosexual and bisexual subgroups. Utilization of postpartum antidepressants increased among the reference group with increasing symptom severity but was only associated at the highest score (≥13) among SMW subgroups.

SMW have increased risks of pregnancy stress and depression and are more likely to use perinatal antidepressants; mostly heterosexual and bisexual individuals had the highest risk of antidepressant use. Postpartum symptom severity closely corresponded to antidepressant use among completely heterosexual, but not SMW—suggesting disparities in mental health treatment. Further research priorities include determining the causes of these disparities and appropriately tailored solutions.

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来源期刊
SSM. Mental health
SSM. Mental health Social Psychology, Health
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2.30
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