衛教新知
【陳姵蓉醫師選讀婦女身心相關文獻】
2018/08/13
摘要：
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial(RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation(n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
筆者註：
本文統整近年來78份關於孕產期憂鬱、焦慮、創傷相關疾患的治療。大部份研究選用的治療是認知行為治療（CBT, Cognitive Behavioral Therapy）和人際治療（IPT, Interpersonal Psychotherapy）。大致上來說，兩者都展現了顯著的效益，唯獨對於低收入或少數族群的女性，治療效果不一。部分研究也支持運動的效益。雖然研究數量少，但選擇性血清素再回收抑制劑（SSRI）相對於安慰劑而言有顯著的療效，儘管藥物的效果並未超越認知行為治療。然而，這些研究絕大多數聚焦在孕期的憂鬱之上，孕期的焦慮以及創傷相關的疾患之治療仍需要後續的研究拓展我們的認識。
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial(RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation(n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
筆者註：
本文統整近年來78份關於孕產期憂鬱、焦慮、創傷相關疾患的治療。大部份研究選用的治療是認知行為治療（CBT, Cognitive Behavioral Therapy）和人際治療（IPT, Interpersonal Psychotherapy）。大致上來說，兩者都展現了顯著的效益，唯獨對於低收入或少數族群的女性，治療效果不一。部分研究也支持運動的效益。雖然研究數量少，但選擇性血清素再回收抑制劑（SSRI）相對於安慰劑而言有顯著的療效，儘管藥物的效果並未超越認知行為治療。然而，這些研究絕大多數聚焦在孕期的憂鬱之上，孕期的焦慮以及創傷相關的疾患之治療仍需要後續的研究拓展我們的認識。
