Data from: Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana

Objectives: To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity. Design: Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths. Setting: Rural/periurban communities within the Kintampo Health Research Centre study area of the Brong-Ahafo Region of Ghana. Participants: 16 560 mothers who had a live singleton birth reported between 24 March 2008 and 11 July 2009, who were screened for probable postnatal depression (pPND) between 4 and 12 weeks post partum (some of whom had also had depression assessed at pregnancy), and whose infants survived to this point. Primary/secondary outcome measures: All-cause early infant mortality expressed per 1000 infant-months of follow-up from the time of postnatal assessment to 6 months of age. The secondary outcomes were (1) all-cause infant mortality from the time of postnatal assessment to 12 months of age and (2) reported infant morbidity from the time of the postnatal assessment to 12 months of age. Results: 130 infant deaths were recorded and singletons were followed for 67 457.4 infant-months from the time of their mothers’ postnatal depression assessment. pPND was associated with an almost threefold increased risk of mortality up to 6 months (adjusted rate ratio (RR), 2.86 (1.58 to 5.19); p=0.001). The RR up to 12 months was 1.88 (1.09 to 3.24; p=0.023). pPND was also associated with increased risk of infant morbidity. Conclusions: There is new evidence for the association between maternal pPND and infant mortality in low-income and middle-income countries. Implementation of the WHO's Mental Health Gap Action Programme (mhGAP) to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.

研究目的：评估产后即刻可能存在的抑郁对后续婴儿死亡率与发病率的影响。
研究设计：本研究为队列研究，嵌套于针对所有育龄女性的每周4次监测体系中，用于识别妊娠并收集分娩与死亡相关数据。
研究地点：加纳布朗阿哈福地区金坦波健康研究中心研究覆盖的农村及城郊社区。
研究对象：2008年3月24日至2009年7月11日期间报告的16560名活产单胎产妇，她们于产后4至12周接受了产后可能抑郁（probable postnatal depression, pPND）筛查（部分产妇在妊娠期亦接受过抑郁评估），且其婴儿在该筛查节点时仍存活。
主要与次要结局指标：主要结局指标为从产后评估至婴儿6月龄期间，按每1000婴儿-随访月计算的全因早期婴儿死亡率。次要结局指标包括：(1) 从产后评估至婴儿12月龄期间的全因婴儿死亡率；(2) 从产后评估至婴儿12月龄期间报告的婴儿发病率。
研究结果：本研究共记录130例婴儿死亡，单胎婴儿的总随访时长为67457.4婴儿-随访月。产后可能抑郁与婴儿6月龄前的死亡风险升高近3倍相关（校正后率比（rate ratio, RR）为2.86，95%置信区间1.58~5.19；p=0.001）。至婴儿12月龄时的校正率比为1.88（95%置信区间1.09~3.24；p=0.023）。产后可能抑郁还与婴儿发病风险升高存在关联。
研究结论：本研究为中低收入国家产妇产后可能抑郁与婴儿死亡率之间的关联提供了新的循证依据。建议落实世界卫生组织（World Health Organization, WHO）的《精神卫生差距行动规划（Mental Health Gap Action Programme, mhGAP）》，扩大与孕产妇健康整合的护理服务包覆盖范围，以此作为儿童生存保障工作的重要辅助手段。