1995-2020年英国产后第二年中度和重度精神疾病的患病率和发病率：一项使用初级保健数据的全国性回顾性队列研究

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-05-09 DOI:10.1016/j.lanepe.2025.101312

Ellie Jones , Laura Quinn , Jamie-Rae Tanner , Jelena Jankovic , Giles Berrisford , Christine MacArthur , Beck Taylor

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引用次数: 0

摘要

围产期精神疾病影响约20%的怀孕和产后第一年的妇女，几乎没有证据表明其在第二年的持续性和发病率。本研究旨在描述产后第二年中度和重度精神疾病的患病率和发病率，以估计可以从英国专科围产期心理健康服务延长至两年的妇女比例。方法采用英国初级保健临床实践研究数据链GOLD进行回顾性队列研究。所有1995-2020年期间在全科医生处登记的妊娠晚期、分娩代码或产后医疗记录的妇女均被纳入研究范围。次要目的是调查精神疾病类型及其相关因素。研究结果包括来自1361497名妇女的2132754名孕妇。产后第二年可能需要专业PMH服务的精神疾病患病率从1995年的3.1% （n = 2643/85,756）显著增加到2018年的7.4% （n = 2473/34,098）。事件病例从1995年的1.9% （n = 1630/85,756）增加到2018年的3.8% (n = 1285/34,098)，第二年占所有病例的56.6% （n = 69,926/123,510）。调整后的分析显示，第二年患精神疾病的几率更高：大多数年龄段的女性与30-34岁的女性相比；每增加一次妊娠（OR: 1.16, 95% CI: 1.13, 1.19 2比1）；早产（OR: 1.21, 95% CI: 1.15, 1.27），近期（OR: 1.21, 95% CI: 1.17, 1.25）或产后（OR: 1.07, 95% CI: 1.04, 1.09）与足月；有精神病史（OR: 2.46, 95% CI: 2.41, 2.52），吸烟（OR: 1.37, 95% CI: 1.35, 1.39），物质使用障碍（OR: 1.54, 95% CI: 1.48, 1.60），每年与1995年相比。使用一组数据进行的单独分析显示，所有五分之一的女性患精神疾病的几率都高于贫困程度最低的女性，白人女性患精神疾病的几率高于其他所有种族的女性。虽然严重程度无法准确衡量，但大多数记录在案的疾病都需要围产期心理健康专家的投入。解释专科围产期心理健康服务延伸至产后两年是合理的。西米德兰兹国家卫生与保健研究所应用研究合作（NIHR200165）。

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Prevalence and incidence of moderate and severe mental illness in the second postpartum year in England (1995–2020): a national retrospective cohort study using primary care data

Background

Perinatal mental illness affects around 20% of women in pregnancy and the first postpartum year with little evidence regarding persistence and incidence in the second year. This study aimed to describe prevalence and incidence of moderate and severe mental illness in the second postpartum year to estimate the proportion of women who could benefit from extension of England's specialist perinatal mental health services to two years.

Methods

A retrospective cohort study using United Kingdom primary care Clinical Practice Research Datalink GOLD. All women registered with a General Practitioner with third trimester, delivery code or postpartum medical record 1995–2020 were included. Secondary objectives were to investigate mental illness type and associated factors.

Findings

2,132,754 pregnancies from 1,361,497 women were included. Prevalence of mental illness likely to need specialist PMH services in second postpartum year increased significantly from 3.1% (n = 2643/85,756) in 1995 to 7.4% (n = 2473/34,098) in 2018. Incident cases increased from 1.9% (n = 1630/85,756) in 1995 to 3.8% (n = 1285/34,098) in 2018 representing 56.6% (n = 69,926/123,510) of all cases in the second year. Adjusted analysis showed odds of mental illness in second year were higher: for women in most ages vs 30–34 yrs; for each additional pregnancy (OR: 1.16, 95% CI: 1.13, 1.19 two vs one); for preterm births (OR: 1.21, 95% CI: 1.15, 1.27), near term (OR: 1.21, 95% CI: 1.17, 1.25) or post-term (OR: 1.07, 95% CI: 1.04, 1.09) vs term; with history of mental illness (OR: 2.46, 95% CI: 2.41, 2.52), smoking (OR: 1.37, 95% CI: 1.35, 1.39), substance use disorder (OR: 1.54, 95% CI: 1.48, 1.60), and for each year vs 1995. Separate analysis using a subset of data showed odds of mental illness were higher for women in all quintiles vs least deprived and for women of white ethnicity vs all other ethnicities. Although severity could not be accurately measured, most recorded illnesses would require specialist perinatal mental health input.

Interpretation

Extension of specialist perinatal mental health services to two years postpartum is justified.

Funding

National Institute for Health and Care Research Applied Research Collaboration West Midlands (NIHR200165).

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.